Direct Primary Care: Wyoming’s Opportunity for Affordable Healthcare

by Charles Katebi

In a promising moment of bipartisan agreement, members of Wyoming's Joint Labor, Health and Social Services Committee began drafting legislation that will allow patients and physicians to contract directly with each other and escape our disastrously overregulated insurance system.

This legislation will strengthen every Wyoming resident's Constitutional right to health freedom. As stated:

"Any person may pay, and a health care provider may accept, direct payment for health care without imposition of penalties or fines for doing so." – Article 1, Section 38(b) of the Wyoming Constitution

Wyoming's Labor Committee members recognized Direct Primary Care's tremendous potential and wanted to make sure doctors can practice it uninhibited by onerous regulations. The initial draft bill only allowed doctors to provide "routine healthcare services" through direct care. Representative Eric Barlow worried these words will confine direct payment doctors to only providing basic primary care:

"We shouldn't be restricting Direct Primary Care to routine services. These providers will be offering all types of services in the future and this bill shouldn't tie their hands," he said.

He's right. Regulations with broad powers hold back innovations that weren't even considered possible when they were written. In fact, seven percent of specialist physicians are already interested in transitioning to direct pay in the next few years, according to the Physician Foundation. As direct care's benefits become more apparent, these numbers will continue to grow. We shouldn't hobble physicians looking to provide an affordable alternative to our broken healthcare system.

For decades, private insurance has paid for our healthcare on a fee-for-service basis. The more services we use, the more doctors are paid. Doctors have every incentive to provide as many services as possible, regardless of whether they improve our health.

Our insurance system is also a nightmare for physicians. Private practices spend a quarter of their budgets on simply doing business with insurers. Submitting claims, negotiating reimbursements, and complying with state and federal insurance regulations require an administrative bureaucracy fewer and fewer independent practices can afford to pay for. Since 2000, the share of physicians working independently fell from 57 percent to just 39 percent as administrative costs continue to increase.

Some doctors have finally had enough and now contract directly with their patients. Under Direct Primary Care, patients pay their physicians a flat monthly fee in return for medical services clearly laid out in a contract. Doctors love it because they can treat patients without paying huge sums to deal with insurers. And patients can pay just $100 a month for direct care, less than a quarter of what the average Wyomingite pays in insurance premiums.

When providers charge a fixed fee, the onus is on them to control costs and not pass them onto patients. They must keep their patients as healthy as possible, as cost-effectively as possible. If your doctor provide too much care, the cost of those unnecessary procedures will come out of his pocket. On the flip side, if your doctor provides too little care and your health worsens, he will have to pay for more expensive care in the future.

Direct care offers additional benefits for doctors. Physicians within the direct care network, Qliance, collect $700 to $800 per patient every year in membership fees. That's roughly three times more than if they were being paid through traditional insurance. It's no wonder eight percent of primary care physicians already offer this service across the country. And another 15 percent are planning to transition to direct care over the next few years.

Direct Primary Care has proven it can deliver both savings for patients and greater earnings for doctors. This is an opportunity Wyoming can't afford to pass on.