🔒Membership-based primary care practice aims to challenge traditional business model

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Long wait times to get a primary care appointment.

Hassles dealing with health insurance.

Quick visits that lack a true connection with a physician, if a patient is lucky enough to even see an actual medical doctor.

Those issues define many of the problems with modern medicine.

They are also what Dr. Vasanth Kainkaryam is trying to eschew with his three-year-old physician practice that has adopted a relatively new and innovative business model: direct primary care.

Kainkaryam, 40, is the founder of 4 Elements Direct Primary Care & Wellness Space, which has offices in South Windsor and Rocky Hill. The practice is unique because it doesn’t accept health insurance.

Instead, patients pay a monthly fee, which guarantees them shorter wait times and longer face-to-face visits with the doctor, as well as access to phone, text or telehealth services.

It also promises no surprise billing for primary care; often lower-cost medications, labs and imaging; e-consults with access to more than 120 specialists; and same-day or next-day sick-care appointments, Kainkaryam said.

Doctors, like Kainkaryam, who offer direct primary care — which differs from the better-known concierge medicine model — are few and far between.

Kainkaryam is one of only about five direct primary care providers in Connecticut; only 2,500 exist nationwide, according to the American Academy of Family Physicians.

Kainkaryam said he believes the model is the wave of the future because it offers patients quicker and increased access to their doctor. It also gives physicians more freedom and control over how they deliver care.

So far, it has had appeal. Since its 2019 launch, 4 Elements Direct has built a 200-patient practice, with the goal of adding 100 more in the next few years. He’s also planning to hire more doctors and expand to new locations.

“Direct primary care takes away all the complexities of billing and coding and what does and does not your insurance cover,” he said. “Many doctors are not happy with their jobs and have no control over their practice. This (model) gives me full freedom on how to take care of patients.”

Growing the practice

Prior to forming 4 Elements Direct, Kainkaryam climbed the corporate healthcare ladder.

He was previously regional medical director of Hartford HealthCare Medical Group’s primary care division. He also worked for Iora Health, which partnered with Hartford HealthCare on primary care services, and spent time as the chief medical officer for First Choice Health Centers, a community health center system.

It was that past experience that led Kainkaryam to want to open up his own direct primary practice, he said.

Kainkaryam said he took multiple part-time jobs to help fund his business. He didn’t take on a bank loan. His wife is also a working physician, helping make ends meet while he pursed his entrepreneurial venture.

He said his 200 patients cover the economic spectrum and most do have health insurance (ranging from regular commercial insurance to medical cost-sharing plans or Medicare and Medicaid) to cover medical needs like specialist care, surgery or hospital visits. But they are willing to pay a membership fee to see a doctor on short notice with face-to-face time they often can’t get with traditional health care.

“It brings back the feeling of having a community doctor,” said Kainkaryam, whose patients include a large swath of small business owners and their employees.

Kainkaryam, a board-certified internist, charges $35 to $100 a month depending on a patient’s age. His gross annual revenue is at least $250,000 to $300,000, he said.

The membership covers a wide variety of services including primary and obesity care, pediatric medicine and telehealth.

Kainkaryam said that while many primary care doctors have upwards of 4,000 patients, he’d like to build out his roster to only about 300. He said adding more than that would mean he’d lose some of the personal touch he can offer members.

For example, he spends about 90 minutes with patients for their annual physical.

Some doctors who belong to large practice groups complain about pressures to see significant numbers of patients to meet organizational benchmarks.

Conversely, smaller physician practices have struggled to survive over the past decade due to the increasing costs of doing business and administrative headaches, including dealing with health insurers.

The direct primary care model aims to avoid some of those issues, Kainkaryam said.

In addition to adding patients — via word of mouth and through a marketing strategy that includes a podcast and social media — he also plans to add a second doctor to his practice within the next three to six months, with the possibility of adding a third in the next few years.

And, he said, he’d like to expand in two areas of the state by the first quarter of 2023 — the Enfield/Somers region near the Massachusetts border and Greater New Haven.

Patient relationship

Experts said direct primary care — albeit adopted by a small number of doctors overall — could have broader appeal because of what it can offer: accessible care at a low cost.

“Physicians can have increased time and more access with their patients with real-time texting and no layers of bureaucracy with call centers, and patients are given priority with same-day scheduling,” said Dr. David Hass, a gastroenterologist and the recently-named president of the Connecticut State Medical Society.

The medical society, he said, supports any model, like direct primary care, that allows patients to “receive comprehensive, effective care in a manner in which they are well cared for.”

Dr. Teresa Lovins, a physician for 30 years, started her own direct primary care practice in Indiana two years ago.

She’s also a board member of American Academy of Family Physicians, which advocates for family physician practices across the country.

Lovins, who has about 150 patients, said the model affords her the ability to develop a “very close relationship” with members.

“The main benefits are the length of time you spend with patients,” she said. “In my previous practices, administrators were trying to push more patients into the day and were cutting patients’ visits down to 10 or 15 minutes. I didn’t really feel like I was getting to know the patients well enough to be able to care for them the way I wanted to care for them.”

With direct primary care, Lovins said, “I have anywhere from 30 to 90 minutes with the patient — as opposed to a few minutes — depending on what that patient needs. So, we get to know each other very well.”

Hass said a potential downside with direct primary care is that it can create inequitable care access.

“You need to have resources to be able to apply for the subscription model,” Hass said. “So, while we certainly support the model, we are also cognizant of the fact that it may impair certain populations and might not allow everyone to take advantage of this model.”