Report on Direct Primary Care Models and Sustainable Development Goals

Introduction: Financial Pressures and the Search for Sustainable Healthcare Models

Amid growing financial pressures from uncompensated care and the prevalence of high-deductible health plans (HDHPs), healthcare Chief Financial Officers (CFOs) are exploring alternative financial frameworks. The Direct Primary Care (DPC) model, which involves a recurring flat fee paid directly by patients to providers, is emerging as a potential solution. This report analyzes the DPC model’s viability, risks, and ethical considerations, with a significant emphasis on its alignment with the United Nations’ Sustainable Development Goals (SDGs).

The DPC Model: A Pathway to Financial Stability and SDG Alignment

The DPC model offers a predictable revenue stream by bypassing traditional insurance billing complexities. This stability is crucial for healthcare institutions to continue providing essential services, directly supporting several SDGs.

• SDG 3 (Good Health and Well-being): By providing a more stable, patient-focused alternative for primary care, DPC models can contribute to universal health coverage (Target 3.8). The predictable fee structure aims to prevent surprise medical bills, reducing financial barriers to essential care.
• SDG 8 (Decent Work and Economic Growth): A predictable revenue path for healthcare providers ensures financial sustainability for organizations, securing employment and promoting a stable economic environment within the health sector.

Risks, Regulations, and Patient Expectations in the Context of SDGs

The implementation of DPC models is not without challenges. These risks must be managed to ensure the model promotes, rather than hinders, progress toward key development goals, particularly those focused on equity and access.

Key Challenges and Mitigation Strategies

• Regulatory Ambiguity: State-level regulations concerning direct patient-provider contracts can be unclear. Early engagement with compliance teams is essential to build a framework that supports SDG 16 (Peace, Justice and Strong Institutions) by ensuring accountability and transparency.
• Patient Understanding: There is a risk of patient misunderstanding regarding the scope of services covered. Clear contracts, detailed fee schedules, and robust patient education materials are necessary to set expectations and build trust.
• Affordability and Equity: The model’s affordability is a primary concern, potentially creating barriers for lower-income patients. This directly challenges SDG 1 (No Poverty) and SDG 10 (Reduced Inequalities). To address this, providers can explore hybrid or sliding-scale fee models to expand access and ensure healthcare does not become a driver of financial hardship.

Balancing Financial Innovation with Ethics and Trust

The successful implementation of any new payment model, including DPC, hinges on balancing financial objectives with ethical responsibilities. The industry has seen backlash against pre-payment policies that were perceived as inequitable, highlighting the sensitivity around healthcare access for vulnerable populations.

An Ethical Framework for Financial Decisions

Rick Gundling of the Healthcare Financial Management Association (HFMA) emphasizes that as out-of-pocket costs rise, trust and compassion are paramount. The HFMA proposes a framework for ethically-sound financial decision-making to guide leaders. A positive financial experience for patients is critical for several reasons:

1. It reduces administrative costs and improves financial results for the organization.
2. It enhances patient satisfaction and loyalty.
3. It helps patients make better decisions about their healthcare, advancing the goals of SDG 3.

Ultimately, for DPC to succeed as a sustainable model, it must integrate financial innovation with an unwavering commitment to transparency and equity. This approach ensures that while addressing financial instability, healthcare systems continue to advance the fundamental objective of providing accessible, quality care for all, in line with the Sustainable Development Goals.

SDGs Addressed or Connected to the Issues in the Article

• SDG 3: Good Health and Well-being: The article’s core subject is healthcare financing and delivery models (Direct Primary Care) aimed at ensuring patient access to primary care.
• SDG 1: No Poverty: The article discusses the financial burden of healthcare on patients, particularly “lower-income patients,” and how models like DPC could impact their access to basic services.
• SDG 10: Reduced Inequalities: The text highlights concerns about affordability and equitable access to healthcare, emphasizing that new payment models must not deepen the divide for lower-income populations.
• SDG 8: Decent Work and Economic Growth: The article frames the adoption of DPC as a “financial innovation” to “reshape outdated processes,” which relates to improving economic productivity within the healthcare sector.
• SDG 16: Peace, Justice and Strong Institutions: The need for “clear contracts,” “transparency,” and navigating “regulatory ambiguity” points to the importance of developing accountable and transparent healthcare institutions.

Specific Targets Identified from the Article’s Content

1. SDG 3: Good Health and Well-being

   • Target 3.8: Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all.
     
     The article directly addresses this target by examining Direct Primary Care (DPC) as a method to provide “defined primary care services.” It discusses financial risk protection through DPC’s “recurring flat fee,” which helps patients avoid “surprise bills.” The rise of “High-deductible health plans (HDHPs)” and “uncompensated care” are presented as challenges to achieving universal and affordable coverage.

2. SDG 1: No Poverty

   • Target 1.4: By 2030, ensure that all men and women, in particular the poor and the vulnerable, have equal rights to economic resources, as well as access to basic services…
     
     The article connects to this target by highlighting how healthcare costs affect the vulnerable. It notes that “affordability is another concern, particularly for lower-income patients” and mentions the instability of Medicaid. The suggestion to “offer sliding scale or hybrid models to expand access” is a direct strategy to ensure the poor have access to the basic service of healthcare.

3. SDG 10: Reduced Inequalities

   • Target 10.3: Ensure equal opportunity and reduce inequalities of outcome…
     
     This target is relevant as the article discusses how different financial models can create unequal access to healthcare. The backlash against the Cleveland Clinic’s “pay-now policy” is cited as an example of a model that could negatively affect “healthcare access to lower income patients.” The call for “equity” in DPC implementation is a call to reduce inequalities of outcome in health.

4. SDG 8: Decent Work and Economic Growth

   • Target 8.2: Achieve higher levels of economic productivity through diversification, technological upgrading and innovation…
     
     The article presents DPC as a “financial innovation” designed to “reshape outdated processes” like complex “claims-based billing.” This innovation aims to create a “clearer, more predictable revenue path” for providers, thereby improving the financial efficiency and productivity of the healthcare sector.

5. SDG 16: Peace, Justice and Strong Institutions

   • Target 16.6: Develop effective, accountable and transparent institutions at all levels.
     
     The article stresses the need for transparency and accountability in implementing DPC models. It states that “clear contracts and a detailed fee schedule of services included are essential to set expectations” and that success requires a “commitment to transparency and equity.” This reflects the goal of building more trustworthy and accountable healthcare institutions.

Indicators Mentioned or Implied in the Article

1. Under SDG 3, Target 3.8

   • Indicator 3.8.1: Coverage of essential health services.
     
     This indicator is implied through the discussion of DPC models that “allow patients to pay a recurring flat fee directly to providers for defined primary care services.” Progress could be measured by tracking the number of patients covered by such plans, ensuring they receive essential primary care.
   • Indicator 3.8.2: Proportion of population with large household expenditures on health as a share of total household expenditure or income.
     
     This indicator is directly implied by the article’s focus on rising “out-of-pocket costs for consumers” and the prevalence of “High-deductible health plans (HDHPs).” The DPC model’s “recurring flat fee” is a direct attempt to manage and reduce this financial burden, and its success could be measured by analyzing the health expenditure of enrolled populations.

Table of SDGs, Targets, and Indicators

Source: healthleadersmedia.com