"David Clause" in Obamacare

Discussion in 'Healthcare/Insurance/Govt Healthcare' started by Greenbeard, Jul 26, 2012.

  1. Greenbeard
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    Greenbeard Gold Member

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    Writing in Forbes today, Microsoft veteran and now health care-themed tech startup founder Dave Chase waxes poetic about Direct Primary Care (DPC), something he calls “concierge medicine for the masses.” More like a gym membership than an insurance plan, its boosters describe it as the antidote to what they consider to be a system that currently overinsures people:

    Chase obviously is a firm believer in the notion that most health insurance plans pay for too much, like car insurance covering your gas (in the past he's compared it to a hypothetical homeowner's insurance policy that covers the routine servicing of household appliances). Given his faith in this DPC approach, he apparently sees a light at the end of the tunnel: "What looks like a very minor part of Obamacare may prove to be the most important clause to slaying the healthcare cost giant that has crushed family, business and government budgets."

    His piece is: "David Clause" in Obamacare Ready to Slay the Healthcare Cost Beast:
    I'm not convinced his argument is particularly strong, but it's an interesting perspective. I suppose we'll see if those arrangements take off.
     
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  2. Vidi
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    Vidi CDZ prohibited

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    For a family of four at the lowest rate of 49 bucks ( most likely per person ) thats 200 bucks a month. Thats cheaper than what Im paying now but with my high deductable, Im paying for all visits out of pocket.

    Because my family doesnt need to go every month, it would be more cost effective for us to pay out of pocket as we do currently than to join a "health care club"

    However, the concept may have some merit.

    Thanks for the article. Its interesting.
     
  3. Greenbeard
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    Greenbeard Gold Member

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    I have to say, I'm not very familiar with the details of how the Direct Primary Care model works. I gather it's a way to fill in the gaps, so to speak, of a world that's more reliant on high-deductible plans. Insomuch as high-deductible plans are only going to get more popular, these DPC medical homes could be a good thing.

    They seem to be hybrids of the notions that (1) insurance shouldn't pay for "routine" (however that's defined) care, and (2) folks are better off having a regular source of care and a real connection to their primary care provider. So why not make the primary care experience more health clubby?

    That second point there is presumably why they're called "medical homes," since there are existing models of primary care called patient-centered medical homes (PCMHs) that really do seek to build a coordinated, patient-centered system around the patient.

    However, there are accrediting bodies for PCMHs that make sure providers who want to be PCMHs (or market themselves as PCMHs or collect bonus payments for being PCMHs, etc) are walking the walk: enhancing access and continuity of care for patients, managing their patient populations and their care, helping to connect them to community resources and coordinate their care with other doctors, and measuring and improving their own performance. So, for instance, the National Committee for Quality Assurance has a program in place that accredits primary care practices that seek this designation.

    I was curious whether these Direct Primary Care medical homes would be held to any such standards so, as I'm wont to do, I looked at the regulations on the ACA's health insurance exchanges that came out from the feds earlier this year. And the answer is no:

    There's the need for innovation and experimentation (clearly their preference on this one), and there's the need for accountability and quality assurance--it's a balancing act not to stray too far from either one. I guess we'll be able to assess in a few years whether they've done that with regard to Direct Primary Care.
     

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