August 27, 2019

How Cost Sharing and Direct Primary Care are Changing the Landscape of Modern Medicine

The average cost of healthcare in the United States breaks down to about $10,739 per person per year. US healthcare prices have been steadily rising in the US for decades. Even with health insurance coverage provided by large employers, health spending for the average family has risen 67% in the last 10 years. Health insurance premiums and out of pocket costs just keep rising. That affects the ability for Americans to budget for and actually access the care they need.

For doctors, there has been a growing pressure to see as many patients as possible every day. That can make a trip to the doctor feel a little bit like riding on a conveyor belt. Patients often spend more time in the waiting room than face-to-face with their doctor. In fact, one study found that the waiting room slog was the most stressful part of going in for a checkup!

It’s a frustrating system for both doctors and patients. The prognosis for conventional modern medicine is not good.

Fortunately, a *new* trend has emerged. Direct primary care (or “DPC” for short) is a return to traditional medicine. You know, the kind where your doctor actually knows who you are, takes time to talk with you and understand your medical needs, and spends more than 15 minutes with you during a visit. It may feel like a brand new concept for those of us who have gotten used to the assembly line style of medicine that's invaded American healthcare, but it's actually how medicine was always supposed to be!

What is Direct Primary Care?

DPC is a membership-based direct pay doctor’s office. What does that mean? Well, first off, you don’t need insurance. You can pay out of pocket. If you do have insurance most DPC’s will bill them.

DPCs charge a monthly membership fee. Membership fees typically cover basic visits and services. That's right: one flat membership fee gets you all the care you need.

DPCs can take care of most of your medical needs, such as wellness exams and physicals, treatment for colds and flu, immunizations, minor in-office surgical procedures, sprains, some imaging, etc. Some DPCs even offer services like dental care and counseling.

Occasionally you may need something like a lab test or imaging that goes beyond the basics. Not a problem! DPC’s often have an established network of specialists and service providers available for referrals when you need something outside of their scope. When you get referred by a DPC you’ll typically get a pre-negotiated rate for the care you need and a doctor following up on your behalf.

Unlike the pricing structures at traditional doctor’s offices and hospitals, DPCs have set fees for services that are a fraction of the standard cost. You know what you’ll pay upfront and there are no surprise deductibles.

Also, some DPCs have in-house pharmacies for common medications at essentially wholesale prices. That’s right! Instead of paying inflated pharmacy prices you can get many medications at cost through a DPC. If they don't have what you need, they’ll usually help you find the best price for medications they don’t carry. You can save up to 90% on medications with a DPC[5]. The savings from that feature alone could more than cover the membership fee for many patients!

What is Virtual Primary Care?

You may have heard the term “telemedicine” in the zeitgeist recently. This term refers to the ability to have a visit with your doctor either by phone or video chat. This is a great solution for basic issues or those that may not require a face-to-face visit like counseling or going over lab results.

All you have to do is dial into the call or video chat from a phone or computer with a data connection and, voila, you’ve arrived at your doctor’s appointment! This saves the time, money and hassle of trekking to an office for a visit. It’s a real lifesaver for busy families and professionals with lots of schedules to juggle.

When you need medical attention, it can be easy to make excuses and avoid getting the care you need. With Virtual Primary Care you can work around your schedule and connect with a doctor wherever you are.

Virtual Primary Care is sometimes provided as a standalone service and sometimes as an extension of your regular doctor. Depending on your needs and their availability, you may be linked up with your PCP for a telemedicine visit or connected with another doctor for that short-term need. Either way, you’ll have access to a qualified physician who can get you what you need.

Cost Sharing

Cost Sharing is another “new” idea that’s actually quite old. It’s a model that allows you to pay into a pool of funds for medical expenses in the form of a monthly payment. The monthly payment is typically much lower than an insurance plan payment. If you have a medical emergency, you can bill for coverage like an insurance plan. This is a great solution for people without chronic conditions who are relatively healthy. Combined with a DPC membership, this can usually cover an average healthy person’s healthcare needs.

However, for those with chronic or severe illnesses, this may not be the best financial option for healthcare coverage.

The Final Word...

If you’re in relatively good health and are fed up with status quo healthcare, a combination of DPC membership and a cost-sharing plan may be just the cure you’ve been looking for! Side effects may include a more personable relationship with your doctor, improved access to preventative care, more time to spend with family and friends, and more money in your budget at the end of every month.

Our plans provides discounts at certain providers for healthcare, wellness, and lifestyle services. Members must pay for all services at the time of service, but will receive a reduced price from those providers who have contracted with the program operator. Providers may not be available in all locations. Offers are subject to change without notice.