7-26-16 – Hawaii Direct Care

by John McClaughry

Here’s some heartening news on health care from Hawaii. A husband-and-wife team of doctors is now offering patients membership in the state’s first direct primary care practice.

Dr. Michelle Suber is a naturopathic physician. She also founded a middle school that “cultivates the relationship between students and the land through growing and sharing nourishing food in our outdoor living classroom,” with the aim of “connecting land stewardship, culture, health and pleasure with lifelong learning,”.

Now Dr. Suber and her husband, medical doctor Buzz Hollander, have converted their traditional fee-for-service practice into Iris Integrative Health.  Iris offer patients preventive care services in exchange for a monthly membership fee, which at Iris starts at $125 for one adult and $50 for one child, with discounts for additional children. The fee covers “virtually all the costs of primary care,” including tests, electrocardiograms, minor surgeries, and other procedures, plus office visits and phone calls. The practice doesn’t take health insurance. Patients can buy high deductible coverage and use their tax free Health Savings Accounts to pay for Iris.

A study conducted by Qliance, a group headquartered in Seattle, demonstrated a 20 percent reduction in the health care costs of 15,000 Medicaid patients who were given DPC memberships in 2013 and 2014.

Could an integrated primary care practice like Iris appear in Vermont? Under the coming All Payer regime, my guess is probably not. It doesn’t fit the convoluted Accountable Care Organization model, where the Green Mountain Care Board tells the One Big ACO how much money it gets to cover its assigned patient load, and the One Big ACO rations it out, sharing the “savings” if not all is spent.

– John McClaughry is the vice president of the Ethan Allen Institute.