Direct Primary Care
"Oh my God, I'm so much happier!," says physician Jane Klaes.
by Jan Schlain
From the February, 2021 issue
A Plymouth native, Klaes graduated from MSU's College of Osteopathic Medicine in 2004. After four years with a physicians' group providing primary care for low-income patients in rural West Virginia, she came to Ann Arbor in 2011 to join Integrated Health Associates (IHA), the giant physician network affiliated with St. Joe's. But after eight years, she says, she tired of seeing twenty patients a day while "checking boxes in the electronic health records." She left IHA in 2019, and last August opened a one-'woman office in her home west of town.
Until recently, solo practices seemed doomed, in part because only groups like IHA have the systems and specialists needed to navigate the insanely complex medical billing rules required for insurance reimbursement. But Klaes bypassed that entirely. She's practicing a new concept called "direct primary care" (DPC), which doesn't require her to send bills or accept insurance. Instead, her seventy patients pay flat fees of $30 to $90 a month, depending on their age.
For that, she says, "they have access to me when they need me" via text, email, phone, video, or in-person visits--"whatever works." For testing, she connects them to companies that provide "lab and imaging for a huge discount--up to 90 percent" for direct payment.
Amy Blondin, a patient of Klaes from IHA, was one of the first to sign up. "I didn't have insurance for several years," she says, "and was paying for everything out of pocket ... I didn't go as often because I couldn't afford all the fees and costs."
DPC physicians typically recommend that patients buy "major medical" insurance that will kick in if they need expensive specialized care or hospitalization. Through her employer, Blondin now has that. And when she sees Klaes, she says, "I can relax [knowing] I'm not going to have to pay $150 out of pocket if I come to see her about my sore knee."
Klaes says some of her patients have no insurance at
all. Just having regular access to a physician, she says, is "a big step up for them."
Jeff O'Boyle, who opened a DPC practice on Packard in 2018, knows all about that. "During my medical school I was completely uninsured," he says. "Working in the wards of the biggest hospital systems in Chicago, I could not access the care I was providing ... my wife worked as a paralegal, and we made too much money to qualify for Medicaid but not enough money to afford any health insurance."
After a residency at Beaumont Hospital, O'Boyle says, "I worked briefly in a hospital-based clinic for about a year, and let me tell you, I was absolutely miserable ... It's all about the turnover, because in the insurance fee-for-service system, the more people you see, the more money, obviously, you'll make.
"You've got to see between twenty and twenty-five people a day, you get on average about eight minutes with each patient, and you know, there's just mountains of paperwork to satisfy the insurance companies. You end up working for the insurance companies! You don't work for the patients! I kid you not. I'm in my thirties and I told myself I was going to quit medicine altogether and do a different career if this was my life."
But then he heard about direct primary care from a colleague and "thought that was absolutely fascinating ... I put about four or five months of research into it, opened my clinic, and have been going strong ever since."
He currently has 300 patients paying $30-$80 a month. For them, he says, DPC is "sort of like Netflix, but for medicine." Like Klaes, he's negotiated direct-payment discounts at independent labs for testing and imaging. He also buys medication wholesale--"the same place Walmart, Kroger, CVS buy them"--then "sell[s] those medications wholesale back to my patients."
O'Boyle has a medical assistant and plans to hire a second doctor as the practice grows--his goal is 600 patients. But he wants that second doctor "to buy into the fact that we're not just going to turn people out every ten-fifteen minutes," he says. "We want to sit down and listen to our patients and get to know them."
Patient Lisa Profera appreciates that O'Boyle goes "above and beyond" to be accommodating, like meeting her on a Saturday to give her a Covid test. A former IHA pediatrician who now helps people "look better and feel better" at her aesthetics and lifestyle practice ProjuvuMD, she also appreciates the money she's saving. Her husband is also self-employed, and they had been paying $25,000 a year for health insurance. Now, she says, they're paying about $5,000 a year for primary care plus a major medical plan for themselves and their two grown daughters.
"Yes, we're doing this because we want to make a living doing this," says O'Boyle. "But we're also doing this because we're good at what we do. ... In any business, the way you get more business is to connect with your customers. And DPC is on the forefront of that for health care in the foreseeable future."
Klaes says she's still "filling out" her practice, and is making only a fraction of what she did at IHA--but "luckily, that doesn't have to be my goal." And to her surprise, she says, she loves having her work "more seamlessly integrated with my life."
She thought that working at home might mean "blurring lines in a way that I wouldn't like. But it really feels very natural. I enjoy it much more than I thought.
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