Patients are generally seeking lower cost and more convenient care. However, health plans are trending toward promoting higher cost, less convenient care. Health insurance and government third party payers are evolving toward more narrowed networks of doctors who are increasingly being incentivized, and distracted, to do less for more patients. Patients are paying more in deductibles and copays. Along with more limited access to doctors come other limitations such as what prescriptions and services will be covered.
Also, there is more “managed care” that many individuals experience as a system that creates a demoralizing rationing thorough inconvenience. Individual’s options for convenience, frugality and excellence are increasingly being blocked by the rules and regulations imposed by some third party payers. It is out of this dissonance between Individuals wanting more choice and many health plan goals to limit them that more Direct Private Care options are emerging. Patients pay directly for their preferred services not available via their health plans. With these options, health professional’s focus can shift more on patients rather than outside, third party demands.
One trend is that medical practices based solely on cash payment at the time of services are reemerging. ( http://www.drjohngaston.com/Dr-Gaston.html) Other medical practices have converted to Concierge Models where patients pay a membership fee for non-covered services, and then health plans are billed for covered services. The membership fee allows the practice to offer more convenient care to a smaller panel of patients. (http://www.mdvip.com/stuartbensondo )
Another emerging practice model is Direct Primary Care (DPC) where patients, or their employers, pay a membership fee in order to be served by a primary care physician who offers more conveniences. (http://www.johnfurlow.com/) Again, this is possible because the physicians better serve a smaller panel of patients. There is still need for some sort of wrap-around health insurance or a health share, such as LibertyDirect.Org, to protect against catastrophic events.
Because the DPC practice does not have the expenses associated with health plan participation, and because they often facilitate better health care coordination, the total cost to patients is often 20-60 percent less than with traditional healthcare models. These practices do not do any insurance billing, but typically provide a claim form for patients to submit independently.
In some states health plans are seeing the advantages to this model in its ability to lower total costs while improving quality. More insurers and government pilot projects are collaborating to offer and promote more affordable wrap-around, catastrophic health plans to accompany the patient’s choice of a DPC membership. This is in essence a “capitation” of primary care expenses, and has been proven to actually improve patient access and care coordination relative to other models. Because a DPC is relatively inexpensive ($20-$100/month), it increasingly is also beginning to serve as a safety-net for those unable to afford health plan offerings costing much more.
The outcome of last November’s election promises to de-centralize control of healthcare a bit. This will likely enhance, rather than interfere, with doctor-patient relationships. More support for direct private care relationships is expected. As a result, there is likely going to be a growth in Hybrid Models combining third party health plans with patients paying a membership fee to obtain enhanced, and often more flexible-convenient services.
Specifically, medical practices are now creating new LLC entities that can hire their clinicians to provide services that are separated from and not covered via third party contracts. Medical practices are discovering this can be a means of transitioning out of their more toxic health plans over time. Epiphany Health is a prime example of one type of Hybrid Direct Primary Care (HDPC). http://www.beckershospitalreview.com/hospital-physician-relationships/understanding-the-hybrid-direct-primary-care-practice.html .
Other hybrid, transitional approaches involve using a new, additional LLC as the business entity to be able to provide non-visit services such as more telephone visits and online communication such as virtual home visits while still being able to more traditionally bill the patient’s insurance for regular office visits as usual. Patients pay about $50/month which pays enough for the LLC to employ staff to manage more of the non-visit services that an increasing number of patients are seeking.
This also promotes more coordination of care as well as allowing for longer patient visits by less distracted and less burned-out clinicians. Medical practices are thus able to transition and extend beyond their “Banker’s Hours” while better serving individuals preferring more “Uber-like” communication and services. The delegation of tasks and increased efficiencies can also allow for clinicians to serve a larger patient population than is typically served other direct patient care models.