Hawaii Says ‘Aloha’ to Direct Primary Care

by Michael T. Hamilton, Heartland.org, Consumer Power Report #512, July 15, 2016

A husband-and-wife team of doctors is turning its slice of Hawaii’s health care system into a luau.

The strategy: Pool their knowledge of two schools of patient care and offer patients membership in the state’s first direct primary care (DPC) practice.

Dr. Michelle Suber is a naturopathic physician, professional dance instructor, and mother of daughters aged 7 and 3, West Hawaii Today reported in June. Suber also founded a middle school that “cultivates the relationship between students and the land through growing and sharing nourishing food in our outdoor living classroom,” with the aim of “connecting land stewardship, culture, health and pleasure with lifelong learning,” according to the school’s website.

Now Suber is combining stewardship and health in a way Hawaii patients have never seen. As of July 1, Suber and her husband, medical doctor Buzz Hollander, converted their traditional fee-for-service practice into Iris Integrative Health, Hawaii’s first DPC practice.

DPC providers offer patients a buffet of preventive care services in exchange for a monthly membership fee, which at Iris starts at $125 for one adult and $50 for one child, with discounts for every family member added. Iris’ fee covers “virtually all the costs of your primary care,” including blood sugar tests, rapid strep tests, flu testing, electrocardiograms, minor surgeries, and other procedures, the practice’s dues schedule states.

Patients who have experienced sitting an hour in a waiting room to be rewarded with six minutes of face time with their doctor will appreciate another benefit: Office visits and phone calls are included in the monthly fee. This perk boosts the likelihood patients will seek preventive care in order to stay healthy and get healthier. Better yet, it reduces patients’ unnecessary and time-consuming trips to the doctor.

In fact, saving time for their patients and themselves was a prime motivator for Suber and Hollander to adopt the DPC model.

“A conventional doctor has to have on average about 2,500 patients in order to survive,” Hollander told West Hawaii Today. “That’s 20–25 patients or more per day, and under 60 minutes per patient, per year. So it’s no surprise that over half of physicians report being burnt out.”

In contrast to conventional doctors, most DPC providers maintain a practice of just 1,000 patients per year, sometimes giving patients 45 minutes--per visit--of face-to-face care.

In addition to offering patients the health care equivalent of an open-buffet pig roast, DPC could help the state of Hawaii “feed the pig”--i.e., the piggy bank. A study conducted by Qliance, a DPC group headquartered in Seattle, Washington, demonstrated a 20 percent reduction in the health care costs of 15,000 Medicaid patients who were given DPC memberships in 2013 and 2014.

Hawaii’s lawmakers are well aware of the increasing financial burden government-funded health care will place on the state budget. Some are hoping DPC will reduce this burden, if House Concurrent Resolution 157, approved on April 27, is any indicator.

More than “338,000 individuals were enrolled in the State’s Medicaid program and Children’s Health Insurance Program,” as of December 2015, and the share of the population aged 60 or older will grow from 18.7 percent to 27.4 percent by 2030, the resolution notes.

Unfortunately, in crafting HCR 157, lawmakers struggled to define DPC accurately. The initial version of the legislation confused DPC--priced to serve low- and middle-income earners--with concierge medicine, which costs far more.

Concierge doctors typically charge between $1,500 and $5,000 annually to provide patients 24/7 access, charge patients additionally for services rendered, and bill through insurance.

DPC, by contrast, typically costs between $600 and $1,500 per year, bypasses middle-men insurers, and includes the services Suber and Hollander offer through Iris’ eight plans. The patient-empowering couple distinguishes DPC from concierge in question 2 of 17 on the “Frequently Asked Questions” on its website.

“… ‘Concierge medicine’ generally describes a very small patient panel and a very high price: upwards of several thousand dollars a year,” the page states. “Our goal is not to fly to Europe with you to meet with your German orthopedic surgeon. We want to provide in-depth, timely, individualized care for a moderate number of patients--small enough to know everyone well, but large enough to care for a sizable hunk of our community.”

Lawmakers ultimately improved upon the House version of HCR 157, but the resolution still instructs the Department of Commerce and Consumer Affairs (DCCA) to study DPC and concierge side by side. DCCA’s insurance division will conduct the study. This is ironic and unsettling, considering skipping insurance altogether enables DPC providers to save everyone money and thus improve quality of care.

Suber and Hollander have taken the DPC plunge. Will others follow? The answer may hinge on lawmakers’ willingness to recognize DPC as the feast amid the government-funded health care famine--a feast to which patients of all income brackets are invited.

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HCR157: Text, Status