Some doctors are looking at a whole new way of doing medicine that might truly help people who are under or uninsured, or have high deductible insurance plans. Patients may also receive better quality care.
This new and innovative model is known as direct primary care. Instead of accepting insurance, it allows patients to pay a monthly membership fee which gives them office visits, lower prescription drug and lab costs, and even urgent care type visits. In addition, it comes with access to the doctor almost all the time even through Skype while on vacation.
Dr. Josh Umbehr, MD, explains the direct primary care model to a group at an Association of American Physicians and Surgeons conference:
Dr. Bryan Hill opened up a direct primary care pediatric practice about a year ago in South Carolina. He said he realized after doing a home visit for an ill child, he really wanted to practice medicine without all the insurance requirements.
Hill’s practice charges a one time low enrollment fee and then $45 monthly for children ages 2-12, and he gives discounts for families with multiple children. This includes same day or next day office visits with up to 36 per year, after-hours care, drugs at wholesale prices, and several other perks. Non-members can pay for one time visits but do not receive all the other member perks.
High deductible health insurance plans are on the rise. The Kaiser Family Foundation conducted a survey in 2016 that found that 51 percent of workers had a deductible of $1,000 or more. Drew Altman, CEO of Kaiser, said:
“We’re seeing premiums rising at historically slow rates, which helps workers and employers alike, but it’s made possible in part by the more rapid rise in the deductibles workers must pay.”
This makes the direct primary care model look attractive to some patients who might choose to just reserve their high deductible plans for hospital emergencies. With direct primary care, they can receive quality and lower cost office visits, and save on prescription drug costs. Lydia Ramsey says:
“To describe how coverage functions under direct primary care, doctors use the example of car insurance: You don’t use your car insurance for small transactions like oil changes, but it’s there for you if you get in a car accident. Likewise, health-insurance plans — especially those with high deductibles — can be there if you require healthcare beyond primary care.”
Here is a chart that breaks down the differences between the traditional insurance model and the direct primary care model:
At a time when the healthcare situation in the U.S. is uncertain, this could be a viable option for many people. There are pros and cons to direct primary care, but if more physicians decide to adopt this model it could change how doctors do business and ultimately the face of the healthcare industry.
Maybe it would eventually drive down the cost of drugs or cause insurance companies to make big changes (or God forbid – put them out of business!). In some ways, it might even push us toward a single-payer system. For the time being, it’s a real option that could offer much-needed relief for some.
Featured image from YouTube video.