‘Like Amazon or Netflix’: Virginia doctor offers primary health care by subscription

Health care is expensive — especially for people who don’t have insurance.

A Spotsylvania County, Virginia, doctor is rethinking the business model for primary care  physicians: “Patients have the ability to subscribe to my services with a monthly fixed payment, without worrying about how many times they can visit, and how long they can visit,” said Dr. Abhijeet Nakave, who recently opened Smart Prime Care.

For a monthly subscription of $125, patients between the ages of 18 and 54 can be seen up to three times a month for their primary care needs.

“Even after hours, we are available via text. We do televisits. And the biggest gain for the patient is that I promise to see them within 48 hours,” Nakave said.

A primary care physician typically treats long-term conditions, including acid reflux, acne, high blood pressure, sinus and urinary tract infections. Smart Prime Care doesn’t provide emergency services.

Since COVID-19, telemedicine technology has improved. Nakave says in most cases, care — including diagnosis — can begin remotely.

“We use a video call, where they have the ability to show their skin, their mouths, sometimes their eyes, to me directly, where I can see them,” Nakave said. Clinic visits can also be scheduled.

Nakave intends to limit his practice to approximately 400 patients, but could bring on other direct primary care practitioners.

According to the Direct Primary Care Coalition website, about 1,600 DPC practitioners in 48 states treat approximately 300,000 patients.

The practice does not file insurance claims.

“I spoke with one woman who says she’s not been to doctor for 15 years, and was hesitant, and said ‘Will you accept me, because I don’t have insurance,'” Nakave recounted.

“She’s the perfect candidate because I can see her right away — she’s coming tomorrow morning, at 8 o’clock.”

Nakave said some patients who do have insurance paid for by an employer choose to use that policy as a backup for emergencies and hospitalizations.

The Smart Prime Care plans include the $125 monthly option or a yearly subscription of $1,200. In addition, small businesses that can’t offer their staff insurance can pay $199 per employee per year — an employee can do a televisit for $49 or an in-clinic visit for $99.

“In direct primary care, it’s a commitment from both sides,” Nakave said. “I’m committed to provide service whenever a patient needs it, and the patient is committed to pay me monthly, without interruption, whether they’re sick or not.”

If the business model seems familiar? “It’s like you’re subscribing to Amazon. You may not purchase all the time. And you may not always watch Netflix movies, but you’re still paying the monthly charges to Netflix,” Nakave said.

Neal Augenstein

Neal Augenstein has been a general assignment reporter with WTOP since 1997. He says he looks forward to coming to work every day, even though that means waking up at 3:30 a.m.

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