Last week, Hint Summit 2022 was held in Denver, Colorado, bringing together the health tech and direct primary care (DPC) communities. As the direct primary care movement has grown nationally, many new players have entered the space seeking to bring innovative solutions to continue propelling the practice model forward. Here’s a high level review of the ideas and people from the summit. 

Let’s start with an introduction to Hint Health. Hint was founded in 2013 as a billing platform for DPC practices which don’t rely on traditional claims billing from insurance carriers, but instead on monthly memberships directly from patients. Since its inception, the company has grown to produce HintOS, a platform for large DPC networks to help manage employer contracts, and Hint Connect, an effort to facilitate large employer contracts across the entire DPC landscape. They very recently closed their series B funding at $45 million backed by Banneker Partners and Frist Cressey Ventures. Hint’s history as a health tech solution in the DPC community, which has made some serious moves into the employer space, made it the perfect conduit to bring together the worlds of DPC, health tech, and employer benefits. 

Direct Primary Care

The DPC model started in 1997, began gaining serious momentum around 2013 and has been growing and evolving rapidly in the last 4-5 years. Most DPC practices are small, independent businesses owned and run by the practicing physician with 1-2 other employed doctors, focusing primarily on retail, or individual patients. There are, however, a category of practices which have scaled and grown to a larger size by successfully navigating the employer-sponsored healthcare market. These practices include physician-owned and run, VC backed, and now even a public company. Some of the DPC pioneers who got into the employer game early developed the idea of DPC networks where they contracted with surrounding independent practices to help manage large groups of employees. Notable examples include Dr. Clint Flanagan’s practice Nextera Healthcare in Colorado and Dr. Kyle Rickner’s practice Primary Health Partners in Oklahoma. Everside, formerly Palladina, was an early DPC based company to have VC backing. PeakMed is a DPC network founded and run by Dr. Mark Tomasulo, and has made history in the DPC space as the first to be acquired by publicly traded company, One Medical. One Medical previously acquired Iora Health which initially attempted large scale DPC before pivoting to Medicare Advantage. 

Two other companies in the DPC category which are challenging what traditional care looks like are Firefly and Rezilient. Both engage with employers with a per member per month model, but both offer a virtual first model which some argue is more DPC-ish than true DPC. Firefly offers virtual-only primary care, a practice type now more commonly known as VPC or Virtual Primary Care. Rezilient has an innovative approach to traditional care through the use of “cloud clinics.” Doctors remain virtual and can see their patients from anywhere while patients have their physical exam and vitals done by care staff, the results of which are sent in real time to the doctor via the Rezilient platform. 

Health Tech

By removing billing and coding, the DPC tech stack has always been much smaller than the fee for service one. Early on, practices had to use existing technology including legacy EMRs and even gym membership software for billing. As more primary care practices become DPC practices, the infrastructure has grown alongside them. 

Many doctors know the EMR to be more of a piece of billing software than a true patient care tool, which in the DPC space does not apply and allows for creation of a sleek doctor-friendly, patient-focused EMR. Elation has been a big player for several years now and their CEO Kyna Fong has been a supporter of the model, having written and spoken publicly about the benefits of DPC. Akute came on the scene a few years ago and for a time was bootstrapped by founder Sharud Agarwal himself. He received $125K in funding just under a year ago and has a team now helping him further build out the platform. Fold made its debut at this Summit as an EMR enhancer. They have an all-star founding team and will be a company to watch as it develops. Several notable DPC-based EMRs were notably absent as speakers or vendors. 

Monthly billing, as simple as it sounds, does require its own technology; perhaps not so much simply as a transaction mediator, but more so as a membership manager. Hint Health definitely leads the pack, integrating with most of the EMRs. Interestingly enough, their competitors in the space are the EMRs. Several of the EMRs have billing capabilities, which makes Hint’s development of HintOS and Hint Connect make more sense as they leverage their billing platform to develop more robust membership management on a large scale. 

DPC practices have used telemedicine for years because they have no incentive to force patients into the office. Spruce has been the leading company for patient messaging, integrating with Hint and a couple of EMRs. They do patient messaging in addition to phone lines and fax, allowing for private member lines for doctors as well as public office numbers. Similar to Hint, their main competitors currently are the newer EMRs which build in patient communication, or unlike with Hint, super scrappy doctors who prefer to use free Google services or their own personal cell numbers. 

A developing paradigm shift in DPC has been consults with specialists. RubiconMD, recently acquired by Oak Street and not present at the summit, started this innovation in 2013. Rapidly developing in the space now are specialists who prefer consults which will lead to, in my personal opinion, a marketplace where primary care doctors consult specialists for a fee, and technology mediates the conversations and transactions like Fiverr. Thea is working out this developing field right now. If done right, they have the opportunity to be a first mover and help facilitate this massive change from a predominantly in-person referral to an e-consult first type of practice. 

Primary care deals with preventive medicine and the world of vitamins and supplements is one where patients have a great interest but where doctors generally lack training. Fullscript seeks to solve this issue by providing vetted products and education on a virtual storefront which integrates into most DPC workflows and EMRs. 

Health Insurance

The whole DPC movement started because doctors were fed up with insurance companies, which makes the entrance of insurance companies into the space both counterintuitive and very interesting. 

As mentioned above, DPC has grown increasingly popular amongst employers. The main issue has been that unless a company has a fantastic benefits advisor to build a comprehensive plan, most employers and DPCs are left to figure out how to piece together everything outside the DPC. Enter DPC-based health plans. Poppins and Decent are both fairly new and figuring out this issue for small to medium employers. Decent was founded in 2018, operating primarily in Texas. They recently brought on Dr. Ben Aiken to help navigate the DPC piece. Poppins, rebranded from Unifi Health, started in 2019 and operates in Ohio. 

Flume takes the idea even further, encouraging practices themselves to build health plans and partake in the upside benefits brought on by the higher level of care seen in DPC practices. They help piece together the different pieces of a health plan to build custom, local population-specific plans. Depending on how simple they make the process, they could democratize health insurance, moving it from the hands of a few to the offices of most local primary care physicians. 

Overall Trends

DPC: As early as 5 years ago, working with employers was an unorthodox, fringe idea in the DPC community. Today, most start up DPCs begin thinking about working with employers from day 1 of their practice. The growth of DPC and employers was on full display at the Summit and will likely drive the next 5 years of growth in the DPC space.

Health Tech: Now seems to be the start of the new age of EMRs. 10 years ago, an ideal DPC EMR was simply one that was affordable, whether it was technically advanced or not. Tomorrow’s EMR will not only be affordable, but encompass the whole DPC tech stack and have automation/AI as the cherry on top. 

Insurance: Unclear outlook on this one. Movement in this space will rely on decisions made by those putting together DPC based plans, and more importantly by how the DPC community accepts or rejects the ideas put forth by these companies.