Direct primary care physicians (DPCs) are most effective when they direct and coordinate their patients’ medical journeys, acting as health care “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 passes the ball to the quarterback, who looks to his left and right for an open wide receiver. Except – wait… The quarterback is wearing a blindfold and he can’t hear anything over the noise of the crowd. He steps back. He throws. He’s a mile away 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 care journey with very little information about what happens to their patients outside of the clinic walls. Access to real-time clinical data would ensure that DPC clinics can provide the best and most cost-effective care.
The DPC doctor 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 doctors who are overworked and with too little time for personalized care.
DPC doctors, through their efficient operating and subscription models, can realize the true ideal of the family doctor. The American Academy of Family Physicians (AAFP) defines the PCP as the healthcare professional “who provides definitive care to the undifferentiated patient from the first contact and assumes ongoing responsibility for providing comprehensive care to the patient.” DPC provides a framework in which practicing physicians can devote significant time to understanding the needs of their patients and act as a “quarterback of care.”
To be an effective quarterback, the DPC doctor needs visibility across the entire playing field and effective communication with specialists when handing off the ball. Unfortunately, most healthcare physicians struggle to obtain details about patient interactions outside of their clinic, and the healthcare system too often places the burden on the patient to act as the middleman. DPC is a highly effective model of care. Real-time access to clinical data would reduce time and effort wasted searching for reference records and enable 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 read the field quickly and make the best decisions, while avoiding the defense. CPD providers need to understand their patients’ health journey and current status in detail to make the best decisions. Preventative care is one of the most effective ways to achieve the best health outcomes, and primary care is the most effective way to provide patients with the appropriate screenings and procedures to avoid much more costly long-term problems.
Unfortunately, most primary care physicians (PCPs) struggle to obtain the necessary information about their patients. This lack of access to comprehensive clinical data often forces doctors to spend valuable time repeatedly asking patients for the same information during each visit. As a result, care can become fragmented and inefficient, with doctors sometimes having to repeat laboratory tests or other diagnostic procedures simply because they do not have access to previous results. This not only causes unnecessary delays in care, but also increases costs and frustration for patients and providers.
2. The perfect transfer
Situational awareness is of little use if you fail to transfer. Champion football teams must work in perfect synchronization. When the quarterback holds the ball at his side, he should know that the running back is there, ready to accept the handoff. When the PCP recommends a crucial procedure, he or she must receive the results quickly and directly from the specialist.
Unfortunately, this transfer is one of the most problematic areas for PCPs. DPC offices often rely on faxes to request records and receive results. While large, sophisticated hospitals can automatically send digital records, smaller, less sophisticated specialists rarely do so and may respond late, if at all. The PCP must then rely on the patient to transmit complex information or even retrieve the records themselves. This interrupted transfer wastes time and increases everyone’s frustration.
3. The post-match report
You can’t improve what you can’t measure, and qualitative reports are never as compelling as hard numbers. Most clinical analytics rely on claims data derived from the insurance payment process. Most DPCs do not file insurance claims except in special circumstances like vaccinations or lab 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 during clinical analysis. Unfortunately, very few clinical analytics solutions are capable of analyzing health records directly and can require costly consultation hours to prepare the data. Few CPDs have the resources or time to do this, so few can effectively report on the incredible work they do. On the other hand, patient records are a much better indicator of care impact than claims.
In a world transformed by AI 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 show a better way forward. All that remains to be seen is whether the healthcare IT industry is ready to step up its efforts.
Photo: Maskot, Getty Images
Ben Newton is CEO 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 leveraging 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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