Navigating the New Healthcare Landscape

The healthcare landscape looks quite different than it looked 20 years ago. Healthcare wasn’t nearly as expensive. Insurance premiums have increased every year for the last two decades.

These increasing rates have caused some Americans to choose to forego health insurance altogether. With the end of the required mandate to carry health insurance this year, the number of Americans choosing to forego health insurance will undoubtedly rise even more quickly.

The increasing cost of health insurance has also shifted the type of health insurance that employers offer their employees. The number of employers offering high deductible health plans to their employees has gone up from 8 percent to 29 percent from 2009 to 2013 according to a study by the Kaiser Family Foundation.

A high deductible health plan or HDHP is a plan where an individual or a family pays a deductible or “out of pocket” expense before medical services are covered. Employees sometimes have lower monthly premiums with these high deductible health plans but generally pay thousands of dollars before any medical services are covered. These plans are less expensive for an employer to offer but more expensive for employees in the long run.

Direct Primary Care can offer some solutions to these concerning trends in healthcare. Direct Primary Care is an innovative membership model of primary care medicine that does not require health insurance.

A Direct Primary Care office charges a monthly fee for unlimited office visits, management of acute issues, management of chronic conditions such as asthma and diabetes, coordination of care with any specialists and minor procedures such as joint injections, skin tag removal, drainage of an abscess.

Many direct primary offices also provide wholesale prices on medication (for certain medications this could mean a reduction in cost by sometimes 50 percent or more) and wholesale prices on routine blood work and imaging.

Lastly, a monthly membership provides you direct access to your doctor via phone, web, and email. The model is based on highly personalized care, with less bureaucracy and direct access to your doctor. Many of these offices cap their patient panel size to less than a fourth of the patient panel size of insurance based practices to ensure that the care remains personal.

The question is, can DPC or Direct Primary Care provide a low-cost solution to uninsured Americans and the increasing number of American families that have high deductible health plans.

Let’s look at an example to see how a primary care system like Direct Primary Care could save an uninsured patient or a patient with a HDHP money.

Uninsured 33-year-old patient Joe Smith has high blood pressure and diabetes. These medical conditions generally require visits to your primary care doctor every three months as well as bloodwork. Joe Smith is taking metformin, lisinopril, and lipitor which are common blood pressure and diabetes medications.

The traditional way

An office visit of Joe’s complexity can cost him $234 every three months if he goes to a traditional primary care office. If Joe Smith shops around at local pharmacies for the best cash pay prices, a ninety day supply of Lisinopril could cost $17, Metformin $14 and Atorvastatin $30. Joe’s bloodwork would cost him about $70 every three months. In total, Joe’s medical costs including office visits, medications, and labs are $359 every three months.

The DPC way

If Joe was a member of a Direct Primary Care practice that also dispenses medication, Joe could pay $3 for his metformin,$3 for his lisinopril and $10 for his atorvastatin for a ninety day supply. With his Direct Primary Care membership, he would pay on average $60 a month for a total of $196 every 3 months. His bloodwork every three months would cost approximately $22.

The rates are low because Direct Primary Care doctors negotiate for wholesale pricing on labs and medications with local lab companies and wholesale pharmacies. Joe’s total medical costs every three months with a DPC would be $234.

Besides the minimum costs savings of over a hundred dollars a month, Joe Smith has great access to his primary care doctor with same day or next day urgent appointments available and the ability to text or call his doctor directly. If Joe needed to see his doctor more frequently than every three months, he could with no additional cost to him.

If Joe needed his doctor in a traditional primary care practice, he would pay hundreds of dollars for each office visit making the cost savings with a Direct Primary Care practice even greater.

A patient with a high deductible plan can find similar savings with a DPC membership. Remember patients have to pay their deductibles for their medical services before their medical services start to be covered. Therefore, they are acting almost like uninsured patients until their deductible is paid.

Is Direct Primary Care an option for Americans who are facing rising healthcare costs? The answer is yes. Though each patients’ needs and medications are different, many uninsured with chronic medical problems will find cost savings with a DPC. Sadly, when people are uninsured or have high deductible plans they avoid going to the doctor.

If they avoid their chronic medical issues that require management on a regular basis they could develop serious medical complications and even higher medical bills in the long run.

It is important to note that Direct Primary Care does not replace insurance. It is wise to carry health insurance for catastrophic illnesses or events (for example a diagnosis of cancer which requires a consistent visit to an oncologist or a broken bone that requires surgery).

To learn more about Direct Primary Care you can contact Dr. Joi Johnson-Weaver, owner and family physician of Resolve MD: Direct Primary Care. You can also go to www.dpcfrontier.com to find direct primary care offices near you.

Dr. Joi Johnson-Weaver is a family physician in Columbia, Maryland with a Direct Primary Care practice that works outside of the traditional insurance model. You can learn more about her practice at resolvemd.org