A Wichita family physician is trying to make primary care more affordable and accessible through a subscription-based model called direct primary care.
Trying to get in touch with a primary care doctor can be difficult. You call, meander through the automated prompts, and oftentimes don't speak to your doctor directly.
This is for good reason: there's a nationwide shortage of primary care physicians. Family doctors generally have to take on a lot of patients and have limited time to field questions.
A facility in Wichita is taking a different approach from top to bottom. Instead of relying on insurance, the group offers a subscription service. For a monthly fee you get care and what patients say is easier access to physicians, like directly texting a doctor.
"It's personal. You don't have to wait. You can text them if you have questions," Wichita resident Randi Krier said. "It's so easy to contact your doctor."
Krier goes to Antioch Med in Wichita. It's what's known as a direct primary care practice - they don't accept insurance. Instead, members pay a monthly fee that tops out at $250 per family.
According to a 2021 study published in the American Journal of Lifestyle Medicine, this model is growing. People who champion direct primary care argue it allows more autonomy for doctors and gives them more time with their patients, allowing for a better experience on both ends.
Dr. Brandon Alleman, co-founder of Antioch Med in Wichita, is working to make direct primary care more accessible and affordable for Kansans.
How direct primary care works
Instead of billing on a traditional fee-for-service model, where doctors are paid for each service they perform, like appointments or lab tests, direct primary care offices bill monthly. Membership typically grants people direct access to their doctor, by appointment, phone, text, email or video call and some preventive care.
At Antioch Med, membership costs $39 a month per child (ages 0-17) and $79 per adult, with a family cap at $250. Members can see their doctor on demand at no extra cost and have access to steeply discounted prescriptions, wholesale lab tests, imaging and basic procedures.
Krier has three children with a fourth on the way. She sees Alleman for prenatal care and takes her kids for pediatric care.
The transparent pricing and affordability are just a few of the things Krier likes about Antioch Med. She said if one of her kids gets sick, she's able to call or text and bring them in for treatment the same day.
"Really, for the most part, they can do everything here," she said. "I know exactly what it's going to cost and I just trust the people here to do it."
Krier went to Antioch Med recently for a pregnancy checkup. She walked in and was shown right to the exam room, which she said is normal there. She said she's never had to wait in the waiting room and the environment is calm and relaxed.
"With other doctors that I've gone to previously, I've always felt super rushed and felt like I couldn't ask questions because they were ready to move on to the next thing," Krier said.
But the clinic can't do everything.
Krier said on top of membership costs, her family also has to pay for insurance to cover anything Antioch Med can't do or emergencies.
"That's probably the only thing that I wish I didn't have to do ... mostly because I never use it (insurance)," she said. "If I really need anything, I come here."
Antioch Med's story
Doctors Alleman and Nick Tomsen founded Antioch Med in 2016. Alleman said even in medical school, he knew he wanted to work at a direct primary care practice.
Alleman said during his PhD program he studied medical tourism, where people from the U.S. travel internationally to get medical procedures at a lower cost.
"When you added up all the cost of things, it was much less than the price if you went to a hospital," Alleman said. "But it was in the range of what a hospital would take from certain payers for these procedures."
That made made him feel like the U.S. has it wrong in how it operates its health care system, with complex billing systems and negotiated prices between insurance companies and care providers.
"There is no transparency in what things cost," Alleman said. "There is no transparency and access. Everything is kind of defined by what billing code we can put in."
When Antioch Med opened, the direct primary care model was still kind of rare. He said there were only about 200 other direct primary care practices in the nation. Now, there are nearly 2,500, dozens of which are in Kansas, according to DPC Frontier, a group that maps direct primary care offices.
Survey data from the American Academy of Family Physicians shows that not only are more doctors practicing direct primary care, but they're happier. About 94% of direct primary care survey takers said they are happy in their jobs, while only 57% of doctors who don't work in the direct primary care model are.
"Physicians are realizing this is a more fulfilling way to practice medicine, and then consumers are realizing this is a better way to access primary care as well," Alleman said.
One of Antioch Med's major goals, according to Alleman, is to be a patient's "medical home." Alleman said he and the physicians at his practice maintain close working relationships with their patients. He said they want to know about a patient's daily life and family so they are better able to understand their health issues.
Part of that relationship, Alleman said, is answering questions and helping explain diagnosis even when patients leave Antioch to go to specialists for things like cancer care.
"We want to be the place where if they have questions ... if we need to have a phone call, if we need to go over their diagnosis, we're that medical home for them," he said.
Patient rosters
Direct primary care offices intentionally have smaller rosters of patients than traditional fee-for-service practices. Alleman said a family doctor's roster includes patients they've seen in the last three years.
At other primary care offices, Alleman said a physician has about 2,000 - 3,000 patients on their roster. At Antioch, physicians see about 600-800 patients.
"But our goal is, we want to do 90% of the care for those 700 patients, those 600 patients, not just do 20% of the care for the 2000 patients," Alleman said.
Alleman said the direct primary care model is criticized for the smaller patient load. But he said with the lighter load, doctors are less likely to experience burnout and patients are less likely to utilize urgent or emergency care.
Dr. Tina-Ann Thompson is the senior vice president for the primary care service line at Emory Healthcare, an academic health care system based in Atlanta, and the division chief of family medicine at Emory University School of Medicine.
Thompson said every physician has a threshold or preference for how many patients they see and it doesn't make one physician better than the other.
She said direct primary care is one solution to physician burnout.
"They may be seeing less patients, but at least they're seeing patients. Some of these people would have left medicine," Thompson said.
Another criticism of direct primary care is that it may not be accessible to everyone. Thompson said people below the poverty line may not be able to afford direct primary care membership fees.
"But it can be cheaper than one trip to the emergency room for those folks who may not have access to insurance," Thompson said. "So I think that it still serves a purpose to me and definitely fills a need in our community."
A solution to make direct primary care less cost-prohibitive would be if it was subsidized by governmental programs, if individual direct primary care offices set membership fees on a sliding scale or for employers to cover membership costs.
Although she works for a traditional health system, Thompson said she supports the growth of direct primary care.
"We are all necessary. None of us are competing -- the minute clinics and the urgent cares and the direct primary cares," Thompson said. "We're all in this together to try to take care of the population of patients."
Getting direct primary care to more Kansans
Back in Wichita, Alleman recently started a health insurance advisory firm, called Candid Health Advisors. He said when he started at Antioch Med, he expected for health insurance costs to go down. But they didn't.
Alleman said for people to get the most out of their direct primary care investment, insurance needs to be structured differently. Getting the direct primary care option into employer health plans could be part of that.
Candid Health Advisors came from this idea. Molly Breitenbach is COO and the other half of the company's two-person team.
She said her background is in accounting, and since starting at Candid about a year and a half ago, she's learned how complicated and sometimes problematic our health care system is.
"I always say the health care system isn't broken. It's operating exactly as it was designed and the design is a problem," Breitenbach said.
At Candid, Breitenbach said they help employers self-insure, so that they can choose to cover direct primary care membership fees for their employees.
She said Candid "unbundles" health insurance benefits, choosing vendors that are focused on transparent pricing models to make the other stuff - like emergency or specialty care - more affordable.
Breitenbach said traditionally, health insurance consultants are compensated by insurance companies when they advise clients to use their product. But at Candid, they only receive payment from their client.
"We only want to put solutions in place for our clients that are going to work for them," she said.
Breitenbach said they're currently working with four mid-sized Wichita employers, with goals to expand in the coming year.
One of their clients is Village Travel, a tour bus company based in Wichita, with locations in Oklahoma, Arkansas and Missouri.
Katy Bingham is the human resource director for Village Travel. She said before the company switched to a self-insurance model with Candid, premiums were skyrocketing.
With the change, out-of-pocket health costs for employees have decreased by 80%. Bingham said they offer their employees two health plans - an open access plan that works a lot like traditional insurance, with a deductible and monthly premiums, and a direct primary care plan.
The majority of their employees are on the direct primary care plan, and though it took some explaining in the beginning, the employees love it.
"You get people that come in and say, 'Thank you so much for our insurance. Our insurance is amazing. I've never had anything like it,'" she said.
This fall, Village Travel and Candid Health received an award from Health Rosetta for their high-quality, low-cost health plan. Health Rosetta is a non-profit organization that helps employers and unions create more transparent and cost-effective health plans.
"It was exciting to see that there's this movement of people that recognize that something is wrong in the health care industry, and something has to change," Bingham said.
Bek Shackelford-Nwanganga reports on health care disparities and access for the Kansas News Service. You can email her at [email protected].
The Kansas News Service is a collaboration of KCUR, Kansas Public Radio, KMUW and High Plains Public Radio focused on health, the social determinants of health and their connection to public policy.