For those that haven’t stumbled upon it, direct primary care is an emerging model for changing the relationship between primary care docs and their patients. Under this model, patients pay primary care practices a flat fee per month which covers all services they use during that month. From what I’ve seen, fees are typically between $50 and $100 per month, depending on the patient’s age.
The key to this model — which borrows from but is emphatically not a concierge set-up — is taking insurance companies out of the relationship. And investors seem to be excited about this approach, with VC money flowing into DPC companies and startups like Turntable Health, which is backed by Zappos.com CEO Tony Hsieh.
I bring this up because I wanted to lay out a theory and see what you folks think. The theory doesn’t come from me; it was tossed out in a blog item by Twine Health, which makes a collaborative care platform. In the item, Twine blogger Chris Storer argues that the DPC movement is enabling doctors to junk their EMRs, which he suggests have been put in place to handle insurance documentation.
While the notion is self-serving, given that Twine seemingly wants to replace EMRs in the healthcare continuum, I thought it gave rise to an interesting thought experiment. Are EMRs mostly a tool to placate insurance companies? It’s worth considering. While Twine may or may not offer a solution, it’s hard to argue that existing EMRs “have empowered both physicians and patients in developing relationships that result in better healthcare outcomes.”
In the blog item, Storer argues that primary care practices largely use EMRs as a means of capturing data, and by doing so meeting insurance claims requirements. Though he offers no evidence to this effect, Storer suggests that DPC practices are dumping EMRs to focus better on patient care. There’s actually at least one direct-primary-care oriented EMR on the market (atlas.md, which is backed by a DPC practice in Wichita, KS), but that doesn’t prove the blogger wrong.
For Twine and its ilk, the question seems to be whether switching from EMRs to another care management model would actually improve the patient experience in and of itself. I’m sure that Twine (and others who consider themselves competitors) believe that it will.
As I see it, though, they’re talking around some key issues. no matter how user-friendly a platform is, No how laudable its goals are, I doubt that even a direct primary care practice unfettered by insurance requirements could seamlessly shift their practice to a platform such this. And no matter how good next-gen collaborative tools are — and I’m optimistic about them, as a category — the workflow issues which have alienated patients in the EMR age won’t go away entirely.
So while I’ll believe that DPC practices want to pitch their EMR, my guess is that the odds of their replacing it with an alternative platform are slim. Now, if collaborative care players catch practices when they’re being formed, that may be a different story. But for now my guess is that any practice that has an EMR in place is unlikely to dump it for the time being. The alternatives (including going back to paper charts) are unlikely to make sense.