Direct Primary Care (DPC) physicians are most effective when they direct and coordinate their patients’ medical journeys, acting as “quarterbacks” of healthcare. Unfortunately, unlike a quarterback directing a football team’s offense, DPC physicians do not have the support or infrastructure they need to successfully execute winning plays for their patients.
Picture this: It’s the third down on the ten-yard line with thirty seconds to go in the fourth quarter. The center hikes the ball to the quarterback, who looks to his left and his right for an open wide receiver. Except – wait… The quarterback is wearing a blindfold, and he can’t hear a thing over the crowd noise. He pulls back. He throws. He’s off by a mile and that’s the game.
No one wants to see football played by a blindfolded quarterback. That would be about as exciting as watching curling in the Winter Olympics. Except that is exactly how the men and women in Direct Primary Care (DPC) work every single day. They guide their patients along their healthcare journey with very little information about what is happening to their patients outside the clinic walls. Access to real-time clinical data would ensure DPC clinics could deliver the best, and most cost effective, care.
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The DPC doctor is the quarterback of care
The severe shortage of primary care doctors in the United States means that most Americans don’t have a regular Primary Care Physician (PCP) and the few that do are often confronted with overworked doctors with too little time for personalized care.
DPC physicians, by virtue of their efficient operating and subscription models, can realize the true family doctor ideal. The American Academy of Family Physicians (AAFP) defines the PCP as the medical professional “who provides definitive care to the undifferentiated patient at the point of first contact and takes continuing responsibility for providing the patient’s comprehensive care.” DPC provides a framework where PCPs can spend significant time understanding their patients’ needs and act as a “Quarterback of Care”.
To be an effective quarterback, the DPC physician needs visibility over the entire field of play and effective communication with the specialists when they hand off the ball. Unfortunately, most PCPs struggle to get the details on patient interactions outside of their clinic and the healthcare system too often places the onus on the patient to act as the intermediary. DPC is an extremely effective model of care. Real-time access to clinical data would reduce the wasted time and effort tracking down referral records and enable a more proactive, rather than reactive, approach to patient treatment plans.
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The DPC quarterback’s playbook
There are three important elements to the successful quarterback’s game: situational awareness, successful handoffs and post-game reviews.
1. Situational awareness
The most effective quarterbacks in football know how to quickly read the field and make the best decisions – all while evading the defense. DPC providers need to understand their patients’ health journey and current state in detail to make the best decisions. Preventative Care is one the most effective ways to drive the best health outcomes and primary care is the most effective vehicle for getting patients the right screenings and procedures to avoid much more costly long-term issues.
Regrettably, most primary care physicians (PCPs) struggle to obtain the necessary background on their patients. This lack of access to comprehensive clinical data often forces doctors to spend valuable time repeatedly asking patients for the same information during each visit. As a result, care can become fragmented and inefficient, with physicians sometimes having to repeat lab tests or other diagnostic procedures simply because they do not have access to prior results. This not only leads to unnecessary delays in care but also increases costs and frustration for both patients and providers.
2. The perfect handoff
Situational awareness is of little use if you fumble the handoff. Champion football teams must work in perfect synchronization. When the quarterback holds the ball to his side, he needs to know that the running back is right there ready to accept the handoff. When the PCP recommends a crucial procedure, they need to receive results quickly and directly from the specialist.
Unfortunately, this handoff is one of the most problematic areas for PCPs. DPC offices often rely on faxes both to request records and receive results. While large, sophisticated hospitals may send digital records automatically, smaller, less sophisticated specialists rarely do and may respond late, if at all. The PCP must then rely on the patient to convey complicated information or even retrieve records themselves. This broken handoff wastes time and increases frustration all around.
3. The postgame report
You can’t improve what you can’t measure, and qualitative reports are never as convincing as hard numbers. Most clinical analytics rely on claims data derived from the insurance payment process. Most DPCs don’t file claims to insurance except in special circumstances like vaccines or lab tests. This means that DPC clinics are a black hole in the world of claims analysis. The solution is to include patient records in the Electronic Health Record (EHR) system in clinical analysis. Unfortunately, very few clinical analytics solutions can analyze health records out of the box and may require expensive consulting hours to prep the data. Few DPCs have the resources or time for this, so few of them can effectively report on the amazing work that they do. On the other hand, patient records are a much better guide to the impact of care than claims.
In a world being transformed by AI and other advanced technologies, it is unacceptable that our clinical workforce is working with one hand tied behind their backs. Direct Primary Care presents an opportunity to change the narrative and show a better way forward. It only remains to see whether the healthcare IT industry is ready to step up.
Photo: Maskot, Getty Images
Ben Newton is the CEO of Milliman Pluritem Health and a Principal at Milliman. With over 25 years of experience in the enterprise software market, Ben has led product and sales teams through three successful IPOs. In 2021, he co-founded Pluritem Health with John Clark, a company focused on unlocking clinical data and enhancing healthcare services. Under his leadership, Pluritem Health developed a robust clinical platform and was acquired by Milliman in August 2024. Ben now heads the Milliman Pluritem Health practice, which offers the Milliman CareFlowIQ clinical data platform.
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