Many experts see primary care as the key to improving the health of the nation. However, many primary care providers say insurance companies get between patients and their doctor. One such physician, Zubin Damania, MD, spoke at the 2013 TEDMED conference where he said insurance paperwork and phone calls take up time that could be better used treating patients. His solution is to cut out the insurance companies and use a payment structure where patients, or their employers, pay a flat fee for primary care. Health insurance would only be used for emergencies, inpatient care, or specialty care. Damania has partnered with Iora Health to create a clinic in Las Vegas that is paid under that structure, and has already contracted with a large employer in the area. The clinic is scheduled to open in the fall of 2013 and is Iora’s fourth clinic. The company also manages locations in Hannover, NH, Brooklyn, NY, and Burlington, MA. For a monthly fee, patients at Iora Health clinics have access to a multidisciplinary team that is made up of health coaches, nurses, and physicians. Patients can receive care via office visits, email, video chat, or phone calls. The concept is not entirely unique. Across the country, primary care providers are cutting their ties with insurance companies. For example, this spring, Michael Ciampi, MD of Portland, ME made headlines when he stopped accepting private and governmental insurance, and posted prices for his services on his website. Other primary care providers have switched to a concierge model where patients pay an out-of-pocket annual fee. Critics of the concierge model say that only the wealthy can afford the high out-of-pocket cost, which means the model essentially creates a two-tiered healthcare system. Another concern is that while primary care physicians who use the model can spend more time with each patient, they will treat fewer patients on the whole, thus exacerbating the primary care shortage. That’s what makes the Iora model unique. Patients do not pay the monthly fee out of their own pocket, their employers do. As far as the patient is concerned, he or she is receiving more attentive care at a comparable price. Also, the use of a multidisciplinary team makes it possible to see a high volume of patients. It will be interesting to see if the Iora clinics will produce improved outcomes for patients. Could such a model be the future of primary care?