CONTACT: W. Ryan Neuhofel, DO, MPH of the Midwest DPC Alliance
PHONE: 785-727-4131


Oct 26, 2018 -- Lawrence, KS -- As a family physician who operates a Direct Primary Care (DPC) practice in Lawrence, I am encouraged to see the attention that DPC is generating in the Kansas gubernatorial race, including how this innovative model of care might be included in Medicaid reforms. However, some of the recent discussion about the DPC model, and how a Medicaid DPC program may affect the state’s Medicaid budget, needs clarification.

Although our numbers are still relatively small, the growth of independent DPC medical practices in Kansas, and across the nation, has been steady and remarkable. This grassroots movement now is comprised of nearly 1000 DPC practices nationwide.  I helped found a regional organization that helps support the DPC movement called the Midwest DPC Alliance; the majority of our members are from Kansas.

First, DPC is a model of primary care that promotes health through patient engagement, as I believe our patients would tell you. But it is just one of many fixes that the overall health system desperately needs. The question for policymakers should not be “either/or” -- expand innovative care models like DPC OR Medicaid – but how to provide better access to care, for everyone.

For doctors and clinics, DPC also saves money because there is no bureaucratic middle man and red tape. By removing the usual burdens of billing insurance, a DPC practice can reduce their overhead costs of by approximately 40%.

More importantly, providers can treat their patients as a partner, not as a billing code. In DPC, patients pay their primary care practice of choice directly-- typically a fixed monthly or membership fee outside of traditional insurance billing system-- for a set of agreed-upon primary care services which includes prevention planning, chronic disease management, and acute illness. Also, being member supported, DPC practices also are able to offer patients access to deeply discounted ancillary services such as generic medications, labs, and radiology.

DPC saves money for patients because it restores value to primary care which provides better access to a personal physician or provider– which keeps patients healthier, and generally speaking, happier. Patients can avoid unnecessary visits to the emergency room and specialists-- the expensive parts of our system-- because they have 24-7 access to a doctor that knows them, understands their physical and behavioral health needs, and is available to them, whether in-person, via text, email, or telephone.

Neither DPC practices, nor any other primary care practice, provides specialty care, hospitalization, or major surgery. So, patients are encouraged to have a high deductible health plan or wrap around insurance for services not offered through the DPC practice. The sum total often is cheaper when compared to low-deductible, or “cadillac” health insurance plans. And unlike “concierge” medicine, which takes insurance AND charges a monthly fee, DPC has been found to cost less than half the cost of concierge practices.

The questions remains: how could DPC practices (working outside of an insurance-managed system) be incorporated into a Medicaid (KanCare) system?

Medicaid patients are, by definition, low income, and often medically complex with a heavier burden of psychosocial issues. Better access to high quality, relationship-based primary care is even more important in this group of people. An investment in this innovative primary care can both improve an individual’s health and lower overall costs of the Medicaid program. Research on how much this kind of health care might save a state Medicaid program is developing, and fairly limited. Regardless of the exact impact, reducing overall spending per beneficiary would ease budgets and make coverage expansion more fiscally palatable.

DPC doesn’t pretend to be the cure for all that ails the system -- but it can be an innovative answer to our health system’s over reliance on expensive sick care. I challenge the next Governor of Kansas to invest in primary care AND to strengthen our Medicaid program. By doing so, Kansas can show the rest of the nation what truly patient-centered innovation really looks like.

Doing such will require creative thinking and involvement from many stakeholders across the health system, and we stand ready to help.


W. Ryan Neuhofel, DO, MPH
Lawrence, KS

and members of the Midwest DPC Alliance

Damon Heybrock MD
Westwood, KS

Jennifer Smith, DO,
Lawrence, KS

Josh Umbehr, MD
Wichita, KS

Harish Ponnuru, MD
Overland Park, KS

Brandon Alleman, MD, PhD
Wichita, KS

Holly Cobb, APRN
Topeka, KS

Charles Willnauer, MD
Overland Park, KS

Kylie Vannaman,
Overland Park, KS

Nicholas Tomsen
Wichita, KS

Allison Edwards, MD
Kansas City, KS

Mikki Minocha, MD
Manhattan, KS

Vance Lassey, MD
Holton, KS

Jennifer Harader, MD
Topeka, KS

John Dunlap, MD
Overland Park, KS

Andrew Pope MD
Manhattan, KS

Haseeb Ahmed DO, MHA
Overland Park, KS