The direct care subscription delivery model is growing rapidly. Hint Health, a national leader in direct care, found a 241% increase in patients receiving direct primary care and a 159% increase in direct primary care clinicians over the past 4 years.
Direct Care (DC) rebuilds the primary relationship between physician and patient without insurance participation. Care is provided through a subscription model that pays directly to physicians, reducing overhead, reducing the number of patients, and significantly improving patient accessibility. By restoring physician autonomy, physicians focus on patients rather than excessive bureaucratic insurance rules. DC practices have been around for over a decade, and there are currently estimated to be over 1,800 practices.
The DC model has repeatedly proven successful for adults. A study published in 2020 by the Society of Actuaries found that patients attending DC experienced significant reductions in utilization of overall health care services (-12.6%) and emergency department services (-40.5%). Additionally, they found that DCs achieved better health, better quality, lower costs, and happier doctors.
Several adult-centred direct primary care networks exist. Amazon is buying subscription network One Medical for $3.9 billion. There is speculation that CVS will acquire one of these networks in 2022. But what about the kids?
We have previously outlined how the current pediatric system is failing our children. Direct paediatric care (DPC) is a possible solution to this national systemic failure. Approximately 22% of the total U.S. population is children, providing an opportunity to establish a network of direct pediatric care. However, it has to be very different from an adult-centric web. The reasons are outlined below.
Children are not just little adults
Physical, psychological, social and developmental aspects that make them different from adults. The office environment must be child-friendly to ensure a trusting, warm and non-threatening experience. In addition, children’s physiology, bones, mental abilities, and thought processes undergo dramatic changes throughout childhood. Children learn differently. The impact of environmental impacts (pollution, electronics, social media, bullying, etc.) on current and future health varies over time. Social support structures and related support service needs are different. Applying the principles of adult primary care to children and their families simply fails to understand children’s many unique needs—which is why pediatrics developed into its own specialty more than a century ago.
What happens in childhood doesn’t stay in childhood
Countless studies have been Long-term effects of early socialization are demonstrated – healthy emotional development in adults. Safe, stable, and nurturing early childhood relationships are key to a person’s adult health trajectory. The current paediatric birthing framework does not allow for time nor for a meaningful doctor-patient relationship to affect long-term health. DPC does provide these opportunities. The care provided now is always important.
Children need family-centred care
A If not considering the whole The needs of the family and the social structure of the family cannot meet the health needs of children. The situation of siblings, parents and grandparents must be valued and addressed to optimize the health of the child. Parenting, school holidays, sibling rivalry, family discipline and rules of the game, meal times and more must all be taken into account. This home or home approach requires time and skills not supported by traditional care delivery models.
Lower cost of pediatric care requires a unique approach
with Compared to adults, the overall cost of care for children is lower, meaning any real savings from the direct care model will be less. This requires a lower overhead structure than the adult model. This can be done, but not without effort and implementation of best practice technology, leveraging supplier contracts, and unique patient access and operational workflows.
Economies of scale and shared network resources are important
The supplier network has been Proof has many advantages. They provide camaraderie for fellow physicians and professional learning and supportive environments. Networks provide pricing leverage for technology and supplier contracts. They support sharing lessons learned and best practices. In fact, a 2022 Hint Health survey shows that DC network practices are growing nearly twice as fast as standalone practices.
The network can also help lower barriers for pediatricians to enter DPC. Doctors want to see patients; many don’t want to run their own businesses and have little or no business training in medical school or residency. The barriers to starting a practice from scratch are high. However, the network can provide physicians with turnkey solutions and financial assistance that removes barriers to entry into the DPC.
REDUCING MORAL HARM
Some call it physician burnout. Others call it moral harm. Physicians know how to help patients; however, they do not have the time, resources or energy to do so in traditional practice models. The DPC model puts physicians back in power, potentially reducing rates of moral harm for pediatricians and increasing satisfaction and longevity.
Pediatric care needs to become more innovative, flexible and collaborative
Children interact with many community sectors unique to them, from schools and community behavioral health services to child care, camps, sports teams and child-focused community service organizations. Developing relationships in these areas is critical to adequately advocating for pediatric patients. Adult-focused networks have their own unique relationships to nurture and don’t necessarily have the same kid-friendly resources. Collaboration across community sectors requires an innovative and flexible approach. It requires rapid adaptation and adjustment to modern technologies and opportunities, without bureaucratic barriers or competition with the financial or labor resources of adult medicine.
DPC can reduce child health inequalities
There are concerns that the DC model may Increase health disparities. However, if widely adopted and easy to use, they are more likely to reduce differences. As mentioned earlier, the DC model improves patient accessibility and doctor-patient trust—two drivers of health equity. If employers offer DPC subscriptions as a benefit, their employees’ children will benefit regardless of socioeconomic status. Additionally, if Medicaid managed care plans adopt a subscription payment model, physicians will be able to move to a value-based rather than volume-based model of care. The poorest children will receive DPC model benefits.
Changes needed
Bad kids. Pediatricians are not normal and cannot provide the care needed. Children are our future. We must experiment with innovative care delivery models that may address the problems of the current system.
With the above reasons in mind, it becomes clear that we need a direct network of pediatric nursing physicians.
Andrew Hertz, MD, has been a general pediatrician for 30 years. He oversees a network of over a hundred pediatric providers and is now a pediatric health care consultant. Keili Mistovich, MD, MPH, co-founder of a pediatric direct primary care clinic in Beachwood, Ohio, has been a pediatrician for 7 years.
