FORBES: ‘The state of Washington was also the first state to explicitly enable DPC where it’s used in Medicaid and the public insurance exchanges resulting in explosive growth for the pioneer of DPC, Qliance. In addition, the first Medicare Advantage program to be managed by a DPC provider (Iora Health) opened in Seattle as its first location (along with Phoenix).’

Dave,

As always, packed full of great points, solid data and valuable insights. I call all the engagement and communication piece “life style friendly patient care”, because it goes on anytime, anywhere.

I have not doubt that patient engagement of the kind you speak of, and that is the norm with the enlightened and dedicated folks at Qliance and others, will yield better outcomes for any population/payer mix that avails themselves to it. I can already see what appears to be better than average outcomes with my small panel compared to what would likely have occurred in a mainstream practice situation.

I can’t help but be concerned about trying to wed DPC with existing government programs such as Medicaid/Medicare. Why would I think that my participation, even in a voluntary DPC pilot or on-going program, will not be followed with even deeper hooks of control that could very well jeopardize long-term viability, flexibility and professional autonomy. I can’t imagine that CMS would not demand and put in place a large number of “hoops” resulting in a large regulatory burden, very similar to what they do now.

One of the main reasons why DPC and other upfront pricing/transparent direct fee practices work well is their ability to deliver real value; furthermore, they allow value to be discerned because real prices are known upfront and can be adjusted to market conditions.

Until Medicaid recipients can participate in a real market, with real dollars (think defined contribution model for outpatient, non-critical care) then I am skeptical that DPC and CMS can co-exist without CMS eventually running the show.

As always, your leadership in the transformation of healthcare, and championing enlightened approaches to it, is truly appreciated and valued.

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