Navigating the United States healthcare system can oftentimes be frustrating and complicated. Many of us go to the doctor without a clear idea of how much that visit will cost or what will happen with insurance. Prices seem to be high and keep on rising, and it can be difficult to receive an itemized bill from hospitals describing exactly what you are being charged for.
Enter the concept of direct primary care. First introduced in the early 2000s, direct primary care is a type of healthcare plan that removes insurance companies from the healthcare equation. The idea is that patients can be better be connected with their doctors by getting rid of unnecessary bureaucracy and complex hospital systems.
Traditional Fee for Service Systems
Traditional fee for service (FFS) systems are set up where patients pay a monthly health insurance premium to an insurance company and receive health coverage. The type of insurance plan and amount of the premium determine how much patients have to pay for deductibles, co-payments, and coinsurance, all of which are out-of-pocket costs that are separate from the premium. Health care plans such as 80/20 mean that patients pay 20% of costs after they meet their deducible, and once they hit their out-of-pocket maximum, the insurance company pays for 100% of costs moving forward. Regardless of out-of-pocket costs, the premium must be paid every month to keep the health insurance plan active.
Benefits of Direct Primary Care
Direct primary care differs from FFS systems in that it works as a membership plan. Patients pay one monthly fee directly to their doctor and receive care from that that doctor. They can pay with a credit card rather than filling out insurance forms, and many monthly direct primary care plans are cheaper than a cell phone bill. This affordability comes from the fact that direct primary care plans eliminate administrative overhead such as insurance companies and other third parties. As a result of this structure, patients have a clear understanding of the cost for direct primary care, and the monthly fee does not change based on the services that were provided.
Another benefit of direct primary care is that patients spend more time with their doctors. Most FFS systems have a 2,000 – 3,000 patient panel size, but direct primary care physicians only have a 600 patient panel size. To put those numbers in perspective, the average time with an FFS physician is only 7 minutes while the average time with a direct primary care physician is 45 minutes.
This direct primary care system encourages patients to build a relationship with their doctor, helping them to not only feel more comfortable but also to receive more individualized care as well. Direct primary care physicians will run preventative tests, prescribe medicines, and coordinate referrals to specialists and hospitals. Best of all – doctors can view their patients’ health comprehensively; rather than simply referencing medical records, doctors will have made a shared connection with their patients to draw back upon when considering their health at large.
Needing Additional Health Insurance
Direct primary care is beneficial for regular visits to the doctor, yet it can leave patients vulnerable in the case of a medical emergency. Rather than relying solely on an FFS system or solely a direct primary care system, many patients balance direct primary care with High Deductible Insurance Plans (HDIP) or Health Savings Accounts (HSAs).
High Deductible Insurance Plans are characterized by lower monthly premiums and higher deductibles, so it makes sense to pair this plan with a direct primary care plan whose monthly subscription cost acts loosely as a premium. Direct primary care plans do not insure against ongoing health issues such as cancer and heart attacks, nor do they cover expenses related to emergency care for broken bones or stiches. Though these events do not happen regularly, it can be beneficial to have a High Deductible Insurance Plan to prevent against financial ruin should they occur.
Health Savings Accounts accumulate contributions made before income tax is deducted from paychecks, and individuals can only use the money in this account for health-related expenses such as prescriptions, deductibles, co-pays, or medical equipment. In some instances, patients can use money in their HSA account to pay for direct primary care monthly costs, though this differs from savings account to savings account.
Broadnax Primary Care
If you are looking for a fresh, innovative way to handle your health, consider Broadnax Primary Care! Reach out to us today to find out how you can maximize your benefits and receive high-quality care from doctors who care deeply about you!