DPC doctors are blinded without clinical data
By Ben Newton | Published: 2025-10-29 14:39:00 | Source: MedCity News
Direct primary care (DPC) physicians are most effective when they direct and coordinate their patients’ medical journeys, acting as “middle players” in health care. Unfortunately, unlike the quarterback who directs 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 on the ten-yard line with thirty seconds left in the fourth quarter. The center lofts the ball to the quarterback, who looks to his left and right for a wide open receiver. Except – wait for it… the quarterback is wearing a blindfold, and can’t hear anything over the crowd noise. He backs down. He throws. He’s gone a mile and that’s the game.
No one wants to see football played by a blindfolded quarterback. That would be as exciting as watching curling at the Winter Olympics. Yet this is exactly how the men and women in direct primary care (DPC) work every day. They guide their patients through their healthcare journey with very little information about what happens to their patients outside the clinic walls. Access to real-time clinical data will ensure that DPC clinics can provide the best, most cost-effective care.
The DPC physician is the midfielder in 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 do often encounter overworked physicians with little time for personal care.
With effective operating and subscription models, DPC physicians can achieve the true ideal family physician. The American Academy of Family Physicians (AAFP) defines a primary care provider as a medical professional “who provides definitive care to the undifferentiated patient at the point of first contact and has ongoing responsibility for providing comprehensive care to the patient.” The DPC provides a framework where primary care providers can spend significant time understanding their patients’ needs and acting as a “quadrant of care.”
To be an effective midfielder, a DPC doctor needs to see across the entire field of play and communicate effectively with specialists when handing off the ball. Unfortunately, most primary care providers struggle to obtain details about patient interactions outside of their clinic, and the health care system often places the burden on the patient to serve as the intermediary. DPC is a highly effective model of care. Real-time access to clinical data would reduce wasted time and effort tracking referral records and enable a more proactive, rather than reactive, approach to patient treatment plans.
Playing rules for midfielders in DPC
There are three important elements to a successful quarterback’s game: situational awareness, successful hand-offs, and post-game reviews.
1. Situational awareness
The most effective midfielders in football know how to read the field quickly and make the best decisions – all while evading the defence. DPC providers need to understand their patients’ health journey and current condition in detail to make the best decisions. Preventive 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 right tests and procedures to avoid more costly long-term problems.
Unfortunately, most primary care physicians (PCPs) struggle to obtain the necessary background on 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. Not only does this lead to unnecessary delays in care, but it also results in increased costs and frustration for both patients and providers.
2. Perfect delivery
Situational awareness is of little use if you mess up your delivery. Champion soccer teams must work in perfect synchronization. When the quarterback carries the ball to his side, he needs to know that the running back is ready there to accept the handoff. When a PCP recommends a critical procedure, he or she needs to receive the results quickly and directly from the specialist.
Unfortunately, this handover process is one of the most problematic areas for primary care providers. DPC offices often rely on fax to request records and receive results. While large, sophisticated hospitals may send digital records automatically, smaller, less sophisticated specialists rarely do so and may respond late, if at all. The PCP must then rely on the patient to convey complex information or even retrieve records themselves. This broken delivery process wastes time and increases frustration all around.
3. Post-match report
You can’t improve what you can’t measure, and qualitative reports are never as compelling as hard numbers. Most clinical analyzes rely on claims data derived from the insurance payment process. Most DPCs do not submit claims for insurance except in special circumstances such as vaccinations or laboratory 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 in the clinical analysis. Unfortunately, very few clinical analytics solutions can analyze health records out of the box and may require expensive consulting hours to prepare the data. Few DPCs have the resources or time for this, so few can effectively report on the great work they do. On the other hand, patient records are a much better guide to the impact of care than claims.
In a world transformed by artificial intelligence and other advanced technologies, it is unacceptable for our clinical workforce to work with one hand tied behind their back. Direct primary care represents an opportunity to change the narrative and show a better way forward. It only remains to be seen whether the healthcare IT industry is ready for progress.
Photo: Mascot, Getty Images
Ben Newton He is the CEO of the company Milliman Health Multiple And a director at 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 unlocking clinical data and enhancing healthcare services. Under his leadership, Pluritem Health developed a robust clinical platform and was acquired by Milliman in August 2024. Ben now heads the Milliman Pluritem Health practice, which offers the Milliman CareFlowIQ clinical data platform.
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