Direct Primary Care (DPC): In My Area Now…Possibly Yours Soon?

I had found out recently about this insurance-free approach to healthcare from periodic excitement about it on Twitter.  Yet, I hadn’t seen it in action yet, so it was harder for me to grasp the concept & find out exactly how it worked.

Very recently, of my friends alerted me to the fact that it is indeed in our area now by pointing out this article in one of our local news publications.  It’s a great practical explanation of how it works (from a practice who has moved to using it).

With deductibles on plans increasing & premiums on the rise, I can see how this could actually work for people in limited instances.  However, there’s no direct hospital care, so right now it’s not a full replacement for insurance.   Just an alternative to possibly offset some costs, or for those without insurance to get some very basic services.

I know health insurance policies can be confusing. People seem to also want to cut corners to save money which is risky. I also know that some employers & insurers are offering what is called Minimum Essential Coverage (MEC) plans as an alternative to traditional policies too.

The problem with those MEC plans is there are major services like ER room visits, ambulance, & hospitalizations that are absolutely NOT covered at all by those plans. They are completely eliminated & excluded (why the premiums are so low) which most people don’t realize until they are in a hard situation.   You pay less, but if you fall & break a hip out in a mall parking lot on a winter day, you’re in serious trouble because a MEC policy may not cover you at all (just using this as a very general example).

So while DPC is a step in the right direction, it’s not a stand-alone insurance alternative.   However, maybe if this model proves successful, other entities might start adopting a similar model as an alternative.  I know this will lead to huge segmentation, but most people are desperate to offset their deductibles & insurance premiums by any means they can.  Especially since they continue to raise & sometimes double year to year.

I’m sure people & the providers of such services wouldn’t miss dealing with claims, negotiating discounts on services, authorizations, & all the other bureaucratic tangles & paperwork that come with dealing with insurance companies.

Still, it’s a nice start to see people thinking outside the usual box.  Especially because like it or not there’s still a huge coverage gap in states without Affordable Care Act exchanges in which the premiums are still too high on the marketplace offerings & people make too much to qualify for Medicaid & may also not qualify yet for Medicare.

A healthcare consumer shouldn’t have to cook up complex math to find something workable, but yet that’s exactly what many people are forced to do to find a plan they can possibly afford.

It will be interesting to see how fast this model gets adopted & others spring up.

I also don’t blame primary care providers for moving to such a model to begin with from a business standpoint. They are paid the least of most doctor specialties yet have the most patients & work the longest hours.  They also receive lower reimbursements back from insurance on their services than their counterparts.  They are also a dwindling specialty. Because of these factors & more, there are less doctors in this area of medicine than others.

Maybe a model like this will entice others back to the specialty if this is a back channel way to even the playing field & alleviate some of these other issues.  That’s a farther stretch, but I can’t help but think about it.

This model doesn’t work for me right now because my primary care copays per visit are still lower than the monthly fee.

Yet, if that changes too, it’s nice to have an alternative to offset some of these costs.  I have to say I would be highly tempted if I had a $5,000 deductible with a Health Savings Account or just a straight high deductible plan though, because it might actually save money in the end run at least in this one area, especially if the initial charge & applied in-network discount amounted to more per visit than the monthly fee.  I’d be able to keep this plan at a lower premium but offset those costs paying out of pocket this way. There are years I might come out ahead.

I’d be curious also to see if any specialists are going to toy with moving to a similar model in the future.

(For further reading here’s a nice NPR article that outlines the positives & negatives of this model & how it originated.)

 

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4 thoughts on “Direct Primary Care (DPC): In My Area Now…Possibly Yours Soon?

  1. I love this idea! Obviously it wouldn’t work for everyone but it would work great for people like me! Thanks for the interesting info!

    Liked by 1 person

  2. yeah as a model I do like it, as long as people are aware of what they are getting & what’s they aren’t 🙂 but choices that work and worthy of consideration are always good 🙂 Especially if they circumvent the hassles of the usual means 🙂

    Like

  3. Someone whom I am no longer friends with kept trying to push me into buying into a concierge program; he was convinced it was the answer to all of my needs. He didn’t seem to understand that if I only had my thyroid problem and had a sinus infection once or twice a year, that it would probably be okay. However, I have had major hospital, lab and scan bills for the entire span of my life so far. Also, what he was trying to push me into would have cost me $12k-15k/year. He didn’t see that paying that plus my insurance premiums/deductible/co-pays through the work plan as being a problem – because, you know, we all have $15k laying around as disposable income. (Sheesh.) Anyway, when he got angry at me for not agreeing with him and jumping right on and signing up, I cut him off. And if you’re wondering if he got some kind of kickback for bringing me on, he didn’t. He was just a jerk.

    Liked by 1 person

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