Dr. Michel Accad has a direct cardiology practice and a direct primary care practice; he has authored a book (Moving Mountains: a Socratic Challenge to the Theory and Practice of Population Medicine) and he blogs (www.alertandoriented.com) and podcasts (www.accadandkoka.com).
Dr. Accad explains why he left traditional insurance-based practice and started his direct cardiology practice where patients pay directly for services and insurance is not involved. He later added a direct primary care (DPC) practice that primarily serves older people and operates on a membership basis like many other DPC practices. We discussed the increasing interest in direct specialty care.
We imagined a “healthy branch” of healthcare delivery where DPC is the foundation, patients have coverage for catastrophic expenses but insurance is not used for routine expenses, leading to dramatic savings on insurance premiums, and patients are empowered to save for their own healthcare expenses in an HSA or similar account. Dr. Accad does not see navigating this healthier patient-centered delivery system as a significant barrier to care, as it is the responsibility of DPC doctors to help patients through the process of finding and receiving downstream care. The bigger challenges would be patient understanding and engagement leading to their interest in this approach, and the difficulty of contractually defining what specific care is catastrophic and thus covered by insurance. We also need more primary care and specialty care physicians using direct approaches for the “healthy branch” to grow.
We discussed population health and Dr. Accad’s book Moving Mountains. He characterizes population health as an idea promoted by academics focused on health policy. They think about populations in terms of averages. While increasing population metrics like the number of people screened for cancer or the number of diabetics with hemoglobin A1c in the desired range may be a worthy goal, such metrics don’t always translate well to care of individual patients. It’s not difficult to imagine a diabetic patient whose A1c is not the top concern, particularly if the patient has other chronic conditions. Population metrics should not dictate the care of individual patients.
Finally, we touched on Dr. Accad’s view of the biggest problems in healthcare. His response touched on personal responsibility, moral hazard, and how our focus on technical solutions to natural health problems increases the public’s anxiety about their health.
Dr. Michel Accad has a direct cardiology practice and a direct primary care practice; he has authored a book (Moving Mountains: a Socratic Challenge to the Theory and Practice of Population Medicine) and he blogs (www.alertandoriented.com) and podcasts (www.accadandkoka.com).
Dr. Accad explains why he left traditional insurance-based practice and started his direct cardiology practice where patients pay directly for services and insurance is not involved. He later added a direct primary care (DPC) practice that primarily serves older people and operates on a membership basis like many other DPC practices. We discussed the increasing interest in direct specialty care.
We imagined a “healthy branch” of healthcare delivery where DPC is the foundation, patients have coverage for catastrophic expenses but insurance is not used for routine expenses, leading to dramatic savings on insurance premiums, and patients are empowered to save for their own healthcare expenses in an HSA or similar account. Dr. Accad does not see navigating this healthier patient-centered delivery system as a significant barrier to care, as it is the responsibility of DPC doctors to help patients through the process of finding and receiving downstream care. The bigger challenges would be patient understanding and engagement leading to their interest in this approach, and the difficulty of contractually defining what specific care is catastrophic and thus covered by insurance. We also need more primary care and specialty care physicians using direct approaches for the “healthy branch” to grow.
We discussed population health and Dr. Accad’s book Moving Mountains. He characterizes population health as an idea promoted by academics focused on health policy. They think about populations in terms of averages. While increasing population metrics like the number of people screened for cancer or the number of diabetics with hemoglobin A1c in the desired range may be a worthy goal, such metrics don’t always translate well to care of individual patients. It’s not difficult to imagine a diabetic patient whose A1c is not the top concern, particularly if the patient has other chronic conditions. Population metrics should not dictate the care of individual patients.
Finally, we touched on Dr. Accad’s view of the biggest problems in healthcare. His response touched on personal responsibility, moral hazard, and how our focus on technical solutions to natural health problems increases the public’s anxiety about their health.