Direct primary care (DPC) physicians are most effective when they guide and coordinate a patient's medical journey, serving as the “quarterback” of health care. Unfortunately, unlike a quarterback who directs a football team's offense, DPC doctors don't have the support or infrastructure they need to successfully execute winning plays for their patients.
Picture this: Thirty seconds left in the fourth quarter and it's third down from the ten-yard line. The center passes the ball to the quarterback, who looks to the left and right for open receivers. Except – wait for it… the quarterback was wearing a blindfold and he couldn't hear anything over the roar of the crowd. He took a step back. He throws. He was a mile behind and that was the race.
No one wants to see a blindfolded quarterback play football. It’s as exciting as watching curling at the Winter Olympics. But that's exactly how the men and women in direct primary care (DPC) work every day. They guide patients on their health care journey, but there is little information about what happens to patients outside the clinic. Access to real-time clinical data will ensure DPC clinics can provide the best, most cost-effective care.
DPC Doctors are the Quarterbacks of Nursing
There is a critical shortage of primary care physicians in the United States, which means that most Americans do not have a regular primary care physician (PCP), and the few who do are often faced with overworked doctors who do not have time for personalized care.
With its efficient operation and subscription model, DPC doctors can realize the true ideal of a family doctor. The American Academy of Family Physicians (AAFP) defines a PCP as a medical professional who “provides clear-cut care to undifferentiated patients at the first point of contact and remains accountable for providing comprehensive care to the patient on an ongoing basis.” The DPC provides a framework in which the PCP can spend significant time understanding the patient’s needs and serve as the “quarterback of care.”
In order to be an effective quarterback, the DPC physician needs to understand the entire playing field and communicate effectively with the specialists as they pass the ball. Unfortunately, details of patient interactions outside the clinic are difficult to obtain for most PCPs, and health care systems often shift the responsibility of serving as intermediaries to patients. DPC is an extremely effective model of care. Real-time access to clinical data will reduce wasted time and effort tracking referral records and enable patient treatment plans to be developed in a more proactive rather than reactive manner.
DPC Quarterback Playbook
There are three important elements to a successful quarterback play: situational awareness, successful handoffs and post-game reviews.
1. Situational awareness
The most efficient quarterbacks in football know how to quickly read the field and make the best decision—all while evading defenses. DPC providers need a detailed understanding of a patient's health journey and current status to make the best decisions. Preventive care is one of the most effective ways to drive optimal health outcomes, and primary care is the most effective tool for providing patients with the right screenings and procedures to avoid costly long-term problems.
Unfortunately, most primary care physicians (PCPs) have difficulty obtaining the necessary background on their patients. The lack of comprehensive clinical data often forces physicians to spend valuable time repeatedly asking patients for the same information at each visit. As a result, care can become fragmented and inefficient, with doctors sometimes having to repeat lab tests or other diagnostic procedures simply because they cannot obtain previous results. Not only does this lead to unnecessary delays in care, it also increases costs and frustration for patients and providers.
2. Perfect switching
If the handoff goes wrong, situational awareness is of little use. Championship football teams must work in perfect sync. When the quarterback has the ball in his hands, he needs to know the running back is there ready to receive the handoff. When PCPs recommend a critical procedure, they need to receive results quickly and directly from experts.
Unfortunately, this handoff is one of the areas where PCPs have the most problems. DPC offices often rely on faxes to request records and receive results. While large, advanced hospitals may automatically send digital records, smaller, less advanced specialists rarely do so, and responses, if any, may come late. PCPs must then rely on patients to communicate complex information or even retrieve records themselves. This interrupted handoff wastes time and increases surrounding frustration.
3. Post-match report
What you can’t measure can’t be improved, and qualitative reports will never be as convincing as hard data. Most clinical analyzes rely on claims data obtained from the insurance payment process. Most DPCs will not file insurance claims except in special circumstances such as vaccines or lab testing. This means that DPC clinics are a black hole in the world of claims analysis. The solution is to incorporate patient records into electronic health record (EHR) systems for clinical analysis. Unfortunately, few clinical analytics solutions can analyze health records immediately, and expensive consulting time can be required to prepare the data. Few DPCs have the resources or time to do this, so few of them are able to effectively report on the good work they do. Patient records, on the other hand, are a better guide to the impact of care than claims.
In a world that is being transformed by artificial intelligence and other advanced technologies, it is unacceptable for our clinical staff to work with one hand tied behind their back. Direct primary care offers the opportunity to change the narrative and demonstrate a better way forward. Whether the healthcare IT industry is ready to step up remains to be seen.
Photo: Maskot, Getty Images
Ben Newton is CEO of Milliman Pluritem Health and a principal at Milliman. Ben has over 25 years of experience in the enterprise software market, leading 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 delivery. Under his leadership, Pluritem Health developed a strong clinical platform and was acquired by Milliman in August 2024. Ben now leads the Milliman Pluritem Health practice, which provides the Milliman CareFlowIQ clinical data platform.
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