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Shaping Policy: The Evolution and Impact of Direct Primary Care

Updated: 20 hours ago

Exploring Innovations, Legal Battles, and Legislative Efforts in Direct Primary Care

Direct Primary Care (DPC) represents a paradigm shift in healthcare, allowing patients to develop lasting relationships with their physicians through a low monthly membership fee. The episode of "My DPC Story Podcast" brings together pioneers and advocates, including Dr. Garrison Bliss, Dr. Phil Eskew, and Jay Keese, to discuss the evolution, impact, and current challenges facing the DPC movement. This episode delves deep into the intricacies of direct primary care and its potential to transform the healthcare landscape.

Origins and Evolution of Direct Primary Care

Dr. Garrison Bliss, a retired DPC doctor and co-founder of Qliance, recounts the genesis of direct primary care. Dissatisfied with the traditional insurance-driven model, he transitioned to a monthly fee structure to foster better patient relationships and provide quality care. With initial investments and support from visionaries like Nick Hanauer, Qliance sought to offer affordable care, coupled with superior service and rapid access to physicians. Bliss emphasizes the voluntary nature of DPC and the need to preserve the culture of care as the model scales.

Legal and Legislative Landscape

Jay Keese, Executive Director of the Direct Primary Care Coalition, provides insights into the legislative milestones and ongoing efforts to codify DPC within federal and state laws. Established in 2009, the Coalition has been instrumental in passing provisions and state laws to enhance access to primary care. Keese highlights the successful passage of two critical bills related to DPC and the Senate Finance Committee's interest in implementing a flat monthly fee payment for primary care services.

He also mentions upcoming events crucial for the DPC movement, including a steering committee meeting and a Capitol Hill fly-in event on September 10th and 11th. These events aim to lobby legislators to pass the Primary Care Enhancement Act and the Medicaid Primary Care Improvement Act, both pivotal for expanding DPC’s reach and impact.

The Role of Employers and Autonomy in DPC Practices

Dr. Maryal Concepcion underscores the growing employer support for DPC, which offers an appealing alternative to traditional health insurance plans. She discusses the importance of maintaining autonomy in DPC practices, allowing physicians to provide personalized and evidence-based care.


Dr. Garrison Bliss reflects on the early challenges faced by Qliance in negotiating payment structures with employers and government entities. He emphasizes the need for fair compensation and autonomy to sustain the voluntary nature of DPC.

Addressing Misconceptions and Legal Protections

Dr. Phil Eskew, a family physician and attorney, defends the DPC model against misconceptions, particularly the idea that DPC cherry-picks patients. He argues that DPC is about delivering real, comprehensive care to diverse populations. Eskew also touches on legal protections for DPC and similarities with HealthShares, recounting instances of aggression from state insurance commissioners. He stresses the need to make primary care appealing to physicians by allowing them to handle a broad scope of cases, ultimately reducing the need for specialists and improving overall healthcare.

Legislative Advocacy and the Future of DPC

The episode concludes with a discussion on the momentum and bipartisan support for DPC in Congress. Two hot bills on Capitol Hill—HR 3029, the Primary Care Enhancement Act, and another bill facilitating CMS to create a rubric for primary care DPC in Medicaid—are highlighted as pivotal for the future of DPC. These legislative efforts aim to make DPC more accessible and affordable, allowing tax-preferred dollars into Health Savings Accounts for DPC practices charging less than $150 a month. NOTE: This does not put a restriction on what practices can charge per month. For more on this listen to Dr. Eskew's previous interview.


Call to Action: Shaping Healthcare Policy

The guests collectively emphasize the importance of stakeholder engagement in shaping healthcare policy. They advocate for participation in the Direct Primary Care Coalition’s efforts and upcoming events, urging listeners to contribute to the transformation of primary care. As Dr. Phil Eskew notes, embracing a broad scope of primary care can lead to significant cost savings and better healthcare outcomes, drawing inspiration from successful models in other countries.

Key Takeaways and Resources

Direct Primary Care is positioned to revolutionize the healthcare system by fostering meaningful patient-physician relationships and providing affordable, quality care. However, its growth and sustainability depend on overcoming legal hurdles, securing fair compensation, and maintaining physician autonomy. This episode serves as a call to action for stakeholders to engage in legislative advocacy and support the ongoing efforts of the Direct Primary Care Coalition.

For further exploration, listeners are encouraged to access additional resources, articles, and recordings related to DPC, and share their questions or comments via the MyDBC stories speak pipe podcast voice mail line.

By bringing together experts and advocates, the "My DPC Story Podcast" shines a spotlight on the promise and challenges of direct primary care, urging collective action to ensure its success and accessibility for all.





DPC Frontier: Created by Dr. Phil Eskew HERE

DPC Coalition Steering Committee Meeting HERE

Current ACTIVE Bills on Capitol Hill:

Milliman Study from the Society of Actuaries: HERE



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