Direct primary care (DPC) physicians are most effective when they direct and coordinate the medical journey of their patients, acting as healthcare “quarterbacks.” Unfortunately, unlike a quarterback running a football team’s offense, DPC doctors do not have the support or infrastructure they need to successfully execute winning plays for their patients.
Picture this: It’s third down at the ten-yard line with thirty seconds left in the fourth quarter. The center brings the ball to the quarterback, who looks to his left and right for an open receiver. Except… wait… The quarterback is blindfolded and can’t hear anything over the noise of the crowd. He backs away. He throws. It’s off by a mile and that’s the game.
No one wants to watch football played by a blindfolded quarterback. It would be as exciting as watching curling at the Winter Olympics. Except that’s exactly how the men and women of Direct Primary Care (DPC) work every day. They guide their patients through their healthcare journey with very little information about what is happening to them outside the walls of the clinic. Access to real-time clinical data would ensure that DPC clinics could provide the best and most cost-effective care.
The DPC physician is the quarterback of care.
The severe shortage of primary care physicians in the United States means that most Americans do not have a regular primary care physician (PCP) and the few who do often face overworked doctors with too little time for personalized care.
DPC physicians, by virtue of their efficient operating and underwriting models, can make the true family doctor ideal a reality. The American Academy of Family Physicians (AAFP) defines the PCP as the medical professional “who provides definitive care to the undifferentiated patient at the point of first contact and assumes ongoing responsibility for providing comprehensive care to the patient.” DPC provides a framework in which PCPs can spend significant time understanding their patients’ needs and serving as “quarterbacks of care.”
To be an effective quarterback, the DPC doctor needs visibility throughout the field of play and effective communication with specialists when handing off the ball. Unfortunately, most PCPs struggle to obtain details about interactions with patients outside of their clinic, and the healthcare system too often places the onus on the patient to act as an intermediary. DPC is an extremely effective model of care. Real-time access to clinical data would reduce time and effort wasted searching for referral records and allow for a more proactive, rather than reactive, approach to patient treatment plans.
The DPC Quarterback Playbook
There are three important elements to successful quarterback play: situational awareness, successful handoffs, and post-game reviews.
1. Situational awareness
The most effective quarterbacks in football know how to quickly read the field and make the best decisions, all while evading the defense. DPC providers must thoroughly understand their patients’ health journey and current status to make the best decisions. Preventive care is one of the most effective ways to achieve the best health outcomes, and primary care is the most effective vehicle for patients to receive the appropriate tests and procedures to avoid much more costly long-term problems.
Unfortunately, most primary care physicians (PCPs) struggle to obtain the necessary background information on their patients. This lack of access to complete clinical data often forces physicians to spend valuable time repeatedly asking patients for the same information during each visit. As a result, care can become fragmented and inefficient, and doctors sometimes have to repeat laboratory tests or other diagnostic procedures simply because they do not have access to previous results. This not only creates unnecessary delays in care, but also increases costs and frustration for both patients and providers.
2. The perfect transfer
Situational awareness is of little use if you fail the handoff. Champion soccer teams must work in perfect synchronization. When the quarterback holds the ball at his side, he needs to know that the running back is there, ready to accept the handoff. When the PCP recommends a crucial procedure, you should receive the results quickly and directly from the specialist.
Unfortunately, this handover is one of the most problematic areas for PCPs. DPC offices often rely on fax to both request records and receive results. While large, sophisticated hospitals can send digital records automatically, smaller, less sophisticated specialists rarely do so and may respond late, if at all. The PCP must then trust the patient to convey complicated information or even retrieve his or her own records. This interrupted handover is a waste of time and increases everyone’s frustration.
3. The post-game report
You can’t improve what you can’t measure, and qualitative reports are never as compelling as hard numbers. Most clinical analyzes are based on claims data derived from the insurance payment process. Most DPCs do not file insurance claims except in special circumstances, such as vaccinations or laboratory tests. This means that DPC clinics are a black hole in the world of claims analysis. The solution is to include patient records in the Electronic Health Record (EHR) system in clinical analyses. Unfortunately, very few clinical analytics solutions can analyze medical records out of the box and can require expensive consulting hours to prepare the data. Few DPCs have the resources or time for this, so few of them can effectively report on the incredible work they do. On the other hand, patient records are a much better guide than claims to the impact of care.
In a world that is being transformed by AI and other advanced technologies, it is unacceptable for our clinical workforce to work with one hand tied behind their back. Direct Primary Care presents an opportunity to change the narrative and show a better way forward. It just remains to be seen if the healthcare IT industry is ready to step up.
Photo: Maskot, Getty Images
ben newton is the executive director of Milliman Pluritem Health and director of Milliman. With over 25 years of experience in the enterprise software market, Ben has led 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 improving healthcare services. Under his leadership, Pluritem Health developed a robust clinical platform and was acquired by Milliman in August 2024. Ben now leads the Milliman Pluritem Health practice, which offers the Milliman CareFlowIQ clinical data platform.
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