This is How Business People Are Talking About Direct Primary Care

It’s the same old game. Doctors treat patients. No middleman. Patients are happy. Third parties see a way to get involved. They create chaos. Preach how they can fix the chaos. They jump in and the system breaks down.

This happened decades ago and it is going to happen with Direct Primary Care as well.

It is inevitable.

A recent post about DPC on LinkedIn is a perfect example. The author is discussing another article written by a wannabe DPC expert. I say wannabe because she is not a doctor, got interested in DPC only a year ago, and now is producing articles almost weekly that are being printed by mainstream media everywhere. She obviously has connections.

Her latest piece is about the same old complaint that Direct Primary Care cherry picks healthier patients. There are no valid studies that prove this, but who needs validity when you are trying to become an expert? You can read the thread in the link above, but I just want to point out some of the terms and phrases being thrown about:

• Healthcare Disruptors
• “Providers”
• Insurance risk pool
• Textbook adverse selection
• Financing architecture
• “Catastrophic pairing” tier
• DPC layer as primary care infrastructure
• “Innovation that scales at the expense of equity is not reform. It is fragmentation by another name.”
• Good intentions don’t override actuarial math
• A model that pulls healthy lives without accounting for the pools they leave behind is not innovation – it’s incomplete design.
• When adoption isn’t intentionally structured within the broader risk pool, selection dynamics can still occur regardless of individual clinic performance.
• The next phase is building systems where both can function together – with transparency, risk adjustment, and employer-anchored contracting doing the structural work.

I have to be honest. Maybe I am not that smart, but this crap is all gobbleygook to me. It is the same nonsense I used to hear in meetings from administrators when I worked for a hospital. It is meant to confuse us and make them feel that they are smarter than us. It is a way for them to see a crack in the DPC model and try to worm their way in.

Who are they? Let me list a few of the descriptions they list about themselves in their own profile:

• Clinical Health Plan Value Architect
• The Money Coach
• Architect of Market-Aligned Healthcare Models
• CEO of Cochran Health Ventures
• Forbes Featured Cashpatient Maker
• Operational leader, compliance, strategy, and structured intentional transformation from small business to complex organization.
• Helping employers save money while improving their employee’s benefit plans
• On a Mission to Hype Healthcare’s Brightest Voices @TopHealth Done-For-You Media
• Risk Manager

I believe there was only one doctor in the whole conversation (other than me).

What is interesting to me is that these people are using all this nonsense to claim DPC docs are cherry-picking, even if non-intentionally. The truth is that if you remove the Medicaid population, then they would realize that our demographics are basically the same as any fee-for-service practice that doesn’t take Medicaid. It’s not that we reject Medicaid as they do; it’s just that there are far fewer Medicaid patients willing to pay cash for something they get absolutely 100% free in the system. Even with that, many of us have some Medicaid patients.

I thought I would share this because it has been bugging the hell out of me. I’ll end this post as I started it.

It’s the same old game. Doctors treat patients. No middleman. Patients are happy. Third parties see a way to get involved. They create chaos. Preach how they can fix the chaos. They jump in and the system breaks down.