{"id":4497,"date":"2018-02-20T09:51:36","date_gmt":"2018-02-20T14:51:36","guid":{"rendered":"http:\/\/chirblog.org\/?p=4497"},"modified":"2018-02-20T09:51:36","modified_gmt":"2018-02-20T14:51:36","slug":"direct-primary-care-arrangements","status":"publish","type":"post","link":"https:\/\/chirblog.org\/direct-primary-care-arrangements\/","title":{"rendered":"If It Talks Like Insurance and Walks Like Insurance: The Curious Case of Direct Primary Care Arrangements"},"content":{"rendered":"
For decades, elite \u201cconcierge\u201d practices<\/a> have been providing easy access to primary care in return for several thousand dollars in retainer fees. Recently we\u2019ve seen the emergence<\/a> of more affordable versions of this arrangement, with monthly fees that cost far less than the average ACA marketplace plan premium. At first blush, these arrangements, frequently called \u201cdirect primary care arrangements\u201d (DPCAs), might seem like an innovative solution to the problem of ensuring access to health care services in the face of rising health insurance premiums, but depending on how they are designed and marketed, they could pose risks for consumers \u2013 and the insurance market as a whole.<\/p>\n What is a Direct Primary Care Arrangement?<\/em><\/p>\n Simply put, a direct primary care agreement is a contract between a primary care provider (PCP) and a consumer under which the consumer pays a periodic membership fee directly to the PCP and the PCP agrees to provide, at no extra cost, services within the scope of primary care practice, which in some cases includes management of chronic diseases. DPCAs do not typically cover prescription drugs, specialty care services, hospitalization, or other benefits provided by a major medical insurance policy. While many advocates of DPCAs recommend<\/a> that these arrangements supplement, not supplant, major medical insurance, there is evidence<\/a> that many patients who choose DPCAs use it as their only source of coverage. Further, some companies<\/a> have begun marketing DCPAs as \u201calternatives\u201d to traditional health insurance, sometimes in combination with membership in a health care sharing ministry<\/a>.<\/p>\n When is a DPCA considered insurance?<\/em><\/p>\n An entity that takes on insurance risk is one that bears the risk<\/a> for an individual\u2019s health care costs and spreads that risk across a larger pool of people. In such a case, state insurance regulators have an interest in protecting consumers from potential fraud and insolvency, and the broader insurance market from an uneven regulatory playing field. Can a primary care practice be considered a risk-bearing entity that should be regulated as insurance? At least one state department of insurance<\/a> thinks so, arguing that direct primary care arrangements, by providing unlimited visits and charging fees that do not represent the fair market value of the promised services, are pooling risk and conducting the unauthorized business of insurance.<\/p>\n