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The Data Disconnect Holding Back direct Primary Care - and How to Fix It
Direct Primary Care (DPC) is gaining momentum as a compelling alternative to traditional healthcare, offering patients a more personalized and accessible experience. But a significant hurdle is preventing DPC practices from truly flourishing and demonstrating their value: a frustrating disconnect with healthcare IT infrastructure. As someone who’s spent over 25 years in enterprise software and now leads Milliman Pluritem Health,I’ve seen this firsthand. Let’s explore the challenges and how we can unlock the potential of DPC through better data utilization.
Why DPC is Different – and Why That matters
DPC flips the traditional model. Rather of billing insurance for each visit, patients pay a membership fee for direct access to their physician. This fosters stronger doctor-patient relationships and allows for proactive, preventative care. Though, this shift creates unique challenges when it comes to data and analytics.
The Three Major Pain Points
here’s where the system breaks down for DPC practices:
1. specialist Communication Breakdown:
Getting details to and from specialists is frequently enough clunky and slow. Specialists, particularly those less tech-savvy, frequently don’t utilize patient portals effectively. This forces Primary Care Physicians (PCPs) to act as intermediaries, relaying information or even requesting records themselves. This wasted time and frustration impacts both providers and patients.
2. The Handoff Headache:
Seamless transitions of care are crucial, but often absent.When patients see specialists, the PCP often doesn’t receive timely or thorough updates. Less sophisticated specialists rarely respond promptly,if at all. You, as the PCP, end up relying on your patient to bridge the communication gap – a process that’s inefficient and prone to errors.
3. The missing “Postgame Report” – Data & Analytics
You can’t improve what you don’t measure. Traditional clinical analytics rely heavily on insurance claims data. But most DPC practices don’t file claims, except for services like vaccines or lab tests. this makes DPC clinics essentially invisible to standard claims-based analysis.
This is a critical issue. Patient records within an Electronic Health Record (EHR) offer a far richer and more accurate picture of care impact. Unfortunately, most analytics solutions aren’t designed to easily analyze these records. Preparing the data often requires expensive consulting work – a barrier for many DPC practices.
The Solution: Unleashing the Power of Clinical Data
The answer isn’t to force DPC into the traditional claims-based system. It’s to adapt the technology to their model. We need solutions that can:
* Integrate seamlessly with existing EHR systems.
* Analyze patient records directly, without costly data preparation.
* Provide actionable insights into patient outcomes and practice performance.
* Facilitate secure and efficient data sharing with specialists.
Imagine being able to quickly identify trends in your patient population, track the effectiveness of preventative interventions, and demonstrate the value of your DPC model with concrete data. This isn’t just about better reporting; it’s about better care.
The Future of Healthcare Requires Adaptability
We’re in an era of rapid technological advancement, particularly with the rise of AI. It’s unacceptable that our clinical workforce is hampered by outdated systems. DPC represents a powerful prospect to redefine healthcare delivery.
The question now is: is the healthcare IT industry ready to step up and provide the tools DPC practices need to thrive? It’s time to move beyond a one-size-fits-all approach and embrace innovation that supports the evolving landscape of healthcare.
About the Author:
[Image of Ben Newton]
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 triumphant 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
