Direct Primary CareState Policy Updates

Philip Eskew, DO, JD, MBA

2017 AAFP State Legislative Conference

Dallas, TX – Nov 3, 2017

Why Pass a State DPC Law?

• “Not Insurance” Protection

– Lower Legal Costs (Both State Ins Commish & Drs)

– Consistent with other state law & ACA

• Promotes Wise Practice Design

– Differentiate between FFNCS (Concierge)

– Less confusion about refunds & up front payment

• Protects Patients

– Clarity about entering and exiting the practice

Good DPC Laws

• Include:

– “Not Insurance” protections

– “Not Insurance” mandatory disclosures

– “Double Dipping” prohibitions

• Avoid

– Insurance Commissioner Policing Authority

– Marketing Restrictions

– Separate Licensure

Wyoming’s DPC Law

• This (insurance) code does not apply to:• (vi) A direct primary care agreement. A direct primary care agreement means a

written agreement that:• (A) Is between a patient or their legal representative and a health care provider;• (B) Allows either party to terminate the agreement in writing, without penalty or

payment of a termination fee, at any time or after notice as specified in the agreement which notice shall not exceed sixty (60) days;

• (C) Describes the health care services to be provided in exchange for payment of a periodic fee;

• (D) Specifies the periodic fee required and any additional fees that may be charged;

• (E) May allow the periodic fee and any additional fees to be paid by a third party;• (F) Prohibits the provider from charging or receiving additional compensation for

health care services included in the periodic fee; and• (G) Conspicuously and prominently states that the agreement is not health

insurance and does not meet any individual health insurance mandate that may be required by federal law.

June 2014 – 125 Locations

July 2015 – 290 Locations

Sept 2016 – 445 Locations

Aug 2017 – 655 Locations

2017 “Wins” Summary

KY #18 03/17/17

WV 03/24/17 – Replaced bad law with good

AR 04/07/17 – Revised bad law with good

IN #19 04/21/17

CO #20 04/24/17

VA #21 04/26/17

AL #22 05/26/17

ME #23 06/01/17

2017 “Losses” Summary

MT – Better language, same bad governor

FL – Extensive efforts, broad support

GA – died early, insurance company obstruction

SC – died early, insurance company obstruction

2017 State Political Climate

• DPC is Bipartisan!– NE & WY without a single nay vote!

– Reps like free market approach (5 govs)

– Dems like emphasis on access to care (3 govs)

• Insurance companies manipulate both parties

• No “Bad” laws enacted

• Increasing DPC Interest– Michigan Medicaid Pilot

– State Employees (NC, NJ, CO)

When Approaching Republicans

• Price Transparency

• Free Market Pricing

• Less Red Tape

• Lower Government Spending

• Favored by HHS / President Trump

When Approaching Democrats

• DPC is already legal and growing in 47 states

– This avoids legal waste for government & Drs

– Establishes consistency & predictability

• DPC does not discourage insurance coverage

– Mandatory disclaimers

– Promoted in the Affordable Care Act

• Ongoing primary care, not UC/ED avoidance

• DPC is NOT Concierge (no double dipping)

Continued Efforts

• Pennsylvania – DPC “not insurance” legislation talks are ongoing

• CA, NY, MA, AK, HI, NH, VT – All have had discussions about DPC at varying levels

• State Employee Plans (NJ, CO, NC)

• Michigan Medicaid Pilot Discussions

• Dispensing Hurdles– Partial Repeal of prohibition in Utah

– Ongoing Efforts in Texas