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Direct Primary Care & Health Reform

How Will Direct Primary Care Work with Health Reform?

The Patient Protection and Affordable Care Act that was signed into law in March of 2010 includes a provision giving Americans an affordable new choice.

Section 1301(a)(3) allows direct primary care medical homes to operate in the state-based insurance exchanges beginning in 2014.

This means more Americans will be able to elect direct primary care, a more affordable health care option to traditional insurance plans, for the primary portion of their health care.

Under the new law, flat-fee direct primary care medical home membership can be an option in the insurance exchanges when bundled with a lower-cost "wrap-around" insurance plan that covers unpredictable and expensive services outside the scope of primary care, such as specialist care, hospital stays or emergency room visits. Insurance carriers are already in discussions with direct primary care providers about how to design these "wrap-around" insurance plans.

State-Based Insurance Exchanges

The Affordable Care Act will require most people in the United States to buy health insurance. It sets up state-based "exchanges" where individuals and small businesses can shop for health care. The exchanges will provide consumers with a choice of health plans, and create healthy competition among health plan providers.

Direct primary care medical homes are the only non-insurance based entities currently allowed to compete in these exchanges. Their inclusion will enable every American to purchase excellent, affordable primary care directly from the provider instead of through an insurance company.

Health Policy and Regulations Affecting Direct Primary Care

The Secretary of The U.S. Department of Health and Human Services (HHS) is in the process of drafting the regulations implementing the Affordable Care Act, including the provisions regulating direct primary care medical homes.  Getting these rules written correctly is critical. Direct primary care providers, patients, and state lawmakers have written the Secretary, stressing the importance of direct primary care medical homes to the future of health care and real cost savings. Several have urged HHS to use the Washington State primary care law as a model and to make sure that the federal regulations allow direct practices to remain independent of insurance companies.  Without this independence, it will be extremely difficult for any practice to continue to offer high quality, affordable primary care.  Here are some examples of comments submitted to HHS:

  • Letter to Secretary Sebelius from Washington State Delegation of U.S. Senators Cantwell and Murray and U.S. Representative Inslee
  • Letter to Secretary Sebelius from U.S. Representative Baird
  • Letter to Secretary Sebelius from Governor Christine Gregoire of Washington

We strongly urge you to submit comments of your own.  The more of us who emphasize the importance of direct practice primary care, the better the chance this model will be allowed to grow and flourish.

What's Happening in My State?

Direct primary care medical homes currently exist in at least 21 states, and are estimated to be serving as many as 100,000 patients today. For a list of known direct primary care providers in your state, visit our DPC PRACTICES page. If you are a direct primary care provider and would like to be listed and receive regular updates from the Direct Primary Care Coalition, please join us.

What Can I Do To Support This Type of Care?

If you are a provider you can:

If you are a patient, you can:

 

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Primary Care:

Essential to Good Health

Primary care includes disease prevention, health maintenance, patient education and counseling, diagnosis and treatment of acute and chronic illnesses. It spans preventive care (such as immunizations and check-ups), routine treatment of common injuries and complaints, and maintenance for ongoing health issues.

Primary care is the foundation of good health. It's the key to preventing debilitating and expensive problems. A health care solution that doesn't address primary care is no solution at all.