The direct primary care model: Health policy analysts propose state solutions

Health policy analysts at the Heartland Institute have an idea for a way states could free the market for primary medical care: Pass a law that lets physicians form direct primary care practices, or subscription-based primary care practices, and defines the practices as something other than insurance arrangements.

The analysts contend that a physician with a direct primary care practice can do well with a panel of just 450 patients paying a fee of $80 to $150 per month, rather than scrambling to serve a panel of about 2,500 patients through managed care networks.

The strategy has been popular with consultants and motivational speakers in recent years.

Heartland Institute analysts have included the direct primary care proposal and eight others in “The 2024 American Health Care Plan: State Solutions,” a look at ideas state lawmakers could use to try to make health finance work better in their states.

The commentary also includes ideas such as increasing health care transparency, verifying Medicaid enrollees’ eligibility for Medicaid, expanding access to telemedicine and supporting “reference-based pricing,” or the strategy of naming a low price for a medical device or service and seeing if providers will match that price.

Related: How self-funding and primary care can save even more

The Heartland Institute is a group with strong ties to the Cato Institute and the conservative and libertarian communities.

It’s competing with other conservative groups, including the Cato Institute, the Paragon Institute and the Heritage Foundation, to shape how Republicans in Congress and state legislatures will approach health policy after the fall elections.

“While we continue to advocate for passage of the national reform plan, the current landscape in Washington, D.C., makes it difficult to foresee sweeping federal reforms happening anytime in the near future,” the group says in a summary of the paper. “Meanwhile, there are many things that states can do to make health care more accessible and affordable on the way to a hoped-for federal plan to replace the outdated, overly expensive, access-denying, government-warped health care system.”