Fritz Busch describes being smitten with DPC the first time he heard a DPC physician talking about the model. He found the model very appealing because it seemed like it would work, it would provide better care.  Fritz had always been bothered that so many physicians are burned out.  He was very pleased to learn how much physicians loved practicing in a DPC model, as there was finally something that’s going directly at our physician burnout problem.  Fritz wanted to study DPC, to see if he could prove that results are better in DPC.  He ultimately was involved in the Society of Actuaries’ study of Direct Primary Care (available here: https://www.soa.org/resources/research-reports/2020/direct-primary-care-eval-model/) and other DPC papers and consulting projects. 

Next we discussed the changes he’s seen in the last several years, in terms of the DPC model and the consulting work associated with it.  We discussed that self-insured employers have the flexibility to adopt DPC and that much of the growth of DPC is taking place in this market.  Fritz also noted that lines are blurring between corporate DPC and onsite clinics.

While DPC isn’t particularly actuarial (primary care is not insurable in a technical sense as costs are almost entirely knowable), DPC clinics seek consulting for a variety of reasons.  Some are looking to add services that, similar to primary care, have high frequency, knowable costs (such as physical therapy).  Others are looking at increasing the value they provide to their patients in terms of revenue per square foot of clinic space.  Modeling risk and risk sharing are other areas where DPCs may seek consulting services.  Fritz described a current project that involves both qualitative and quantitative analysis of the value of DPC.  The inclusion of qualitative methods recognizes that the better experience for employees is not fully captured in a financial analysis involving DPC fees, savings due to lower spending on primary and downstream care, and savings in patient cost sharing.

Finally we got into the biggest problem in the healthcare system.  Fritz gave a detailed and insightful answer involving distortions caused by 3rd party payment and too much money being thrown into the healthcare system by Medicare and Medicaid paying automatically (without competition). Given how our system is set up, we really can’t expect anything other than the very expensive system that we have.  Thanks for a great conversation, Fritz!