Direct Primary Care and Concierge Medicine

Primary Care Types in the US | Direct Patient Care and Concierge Practice

September 21, 2020

Harsha Moole, M.D., MBBS

What are the Types of Primary Care in the United States?

In recent years, there has been a tug of war between the traditional, insurance based health care model and other newly developed membership models such as Direct Primary Care and Concierge Medicine. Both types of health care models assure superior service and quality patient care, but which model follows through with its promise?

This new primary care model gives providers the time to deliver more personalized care to their patients and pursue a comprehensive medical approach – one in which the provider’s incentives are fully aligned with the patient’s incentives. - Norm Wu, CEO of Qliance Medical Management

Which Health Care Model Offers the Best Primary Care?

The traditional health care model is the insurance based, fee-for-service system we’re all familiar with while Direct Primary Care and Concierge Medicine are health care models which require a membership fee (typically paid on a monthly, quarterly or annual basis) in exchange for a slew of exclusive perks and benefits.

Insurance has been the main currency of health care for the longest time, with the earliest signs of employer-sponsored insurance dating back to the 1920’s.

Per Commonwealth Fund, “nearly 92% of America is estimated to be covered by health insurance as of 2018”. Since then, the insurance based, fee-for-service health care model has morphed into a subpar system that has seemingly misplaced the well-being of two of its most important stakeholders: family care physicians and their patients.

Third parties such as insurance companies and corporate hospitals have made setting foot in a primary care clinic an agonizing experience for patients. Ever since these intermediaries have taken over the system, health care prices have continued (and are still continuing) to rise while the quality of patient care has dwindled. What the insurance based, fee-for-service health care model has created is a system that is based on fear.

The norm is that if you do not have insurance, you will not have access to health care, especially when you need it most. Patients are then encouraged to submit to outrageously expensive premiums and copay fees, in exchange for what? Surprise, surprise. Long queues at their local primary care clinic, unexpected out-of-pocket expenses, and overall lousy patient care.

Meanwhile, primary care physicians are consistently overworked, kept out of the loop, and bogged down with unnecessary paperwork. What do we make of an industry that is looking a little worse for wear? Is this new health care model capable of delivering the promise of high-quality patient care or will they go down the same road as its traditional, chaotic counterpart?

Join us throughout this blog as we uncover the importance of primary care – preventive and routine care, that is – and which of the two models are able to deliver the level of primary care which patients deserve.

Primary Care

The Importance of Visiting a Primary Care Clinic

Primary care is such an important aspect of health care because it nurtures that fundamental relationship between doctor and patient, one that is responsible for maintaining the health of patients and keeping any catastrophic problems at bay.

Upon completion of their family medicine or internal medicine residency, primary care physicians have sworn an oath to their patient advocacy, taking on the responsibility of safeguarding the health and well-being of their patients.

Treating ailments and taking care of patients – this is what they expect to do once they set foot in the industry and it frustrates them so much when they are not able to do so.

This is why direct patient care is so important when it comes to primary care. Without the intervention of any intermediaries, family care physicians are able to conduct their practice in a manner of integrity, compassion, and diligence.

Patients, on the other hand, are able to save on time, effort, and cost when they are able to deal with their family care physicians directly. The goal of primary care is to nip diseases and potential illnesses in the bud before they lead to ER trips, major surgeries or hospital confinement.

Choosing the Best Primary Care Provider for You

What is Traditional Insurance Based, Fee-for-Service Primary Care?

The traditional primary care model we are all familiar with is one that charges a fee for every service a patient avails. This fee can either be settled as an out-of-pocket expense or via health insurance. Typically paid for by way of monthly premiums, most health insurance plans are sold under the premise that it will cover almost all health care services so that you do not have to shell out much in terms of out-of-pocket expenses.

This might look like a good thing, but many (all) insurance companies, to this day, have completely blown this principle out of proportion. Insurance companies are notorious for charging unexpected out-of-pocket expenses on top of outrageously expensive monthly premiums and copay fees, leaving many Americans in medical debt and without practical / financial access to quality primary care.

Take the experience of Susan, for example, who is a 27 year-old from Vermont. “I simply don’t understand what happened. I pay my premium every month. Now that I’m really sick, I can’t go to work and have very little income. It turns out I can’t go see my doctor without paying because I haven’t yet spent $2,000 this year out of my own pocket—after paying all my premiums.

So, even after paying premiums which are thousands of dollars, and paying the $2,000 deductible, I still have to bring money with me for co-pay.” Hers is a story we are all familiar with. If you haven’t experienced this yourself, we bet you know someone else who has.

It’s gotten so bad that in 2019, over 137 million Americans have declared themselves in medical debt. This is mainly because many of them end up spending more on hospital care rather than preventive care, treating the emergency room as their primary care physician.

In case you are wondering why this is a problem, it is because hospital care is twice as expensive, making up one third of all health care costs in America.

Case in point, when chronic heart problems are not proactively tended to, this can often lead to heart surgery and costs range from $44,000-$500,000, depending on which hospital you are admitted.

The cost of your insurance plan varies based on how comprehensive it is – take note: the more comprehensive, the more expensive. Most insurance plans in the United States cover “essential health benefits”, which include the following:

  • Emergency services
  • Hospitalization
  • Laboratory tests and procedures
  • Maternity and newborn care
  • Mental health and substance abuse treatment
  • Out-patient care (physician appointments and other medical services conducted outside of the hospital, such as routine check-ups and some diagnostic tests)
  • Pediatric care (dental & vision)
  • Prescription drugs
  • Preventive care and chronic disease management
  • Rehabilitation services

Many insurance plans have extremely complicated clauses and loopholes. For instance, there are certain tests that come for free within your insurance plan but only if you are 0ver 50 years of age. In the event that you avail of the service and you are below 50 years old, you will have to pay for a copay fee as well as the screening test when you consult with your primary care physician.

The rule of thumb is to always check the inclusions of your health insurance with your insurance provider to avoid being caught off guard with unexpected expenses.

Apart from cost, here are other defining factors of the insurance based, fee-for-service health care model you must be aware of should you decide to avail of an insurance plan:

A primary care provider, on average, sees around 3,000 patients in total. In short, do not expect to have long, meaningful conversations with them when you see them. Long queues as well as rushed appointments that last 5-10 minutes are a given whenever you visit your local primary care clinic. Primary care physicians also have a tendency to pass on patients from one specialist to another to reduce the risk of liability. If you’re wondering why this is so, traditional primary care physicians do this to eliminate any risk of liability. In this regard, be ready to spend much time, effort, and money on repetitive diagnostic tests and specialist physician appointments.

In order to see your traditional primary care physician, patience is a must. Be prepared for tedious booking procedures, being put on hold, and going straight to voice mail. In some insurance providers, you don’t really have a say as to which primary care physician you get to see. They will be the one to provide a primary care physician based on your preferred schedule.

Anticipate lead time (as in, 3 to 4 weeks – there is no such thing as urgent in traditional primary care) when booking an appointment with your traditional primary care physician. As per AARP, Americans wait about 24 days before they get to see their family care physicians. When visiting your doctor, make sure to rack your brain for follow-up questions as there is no other way to reach your primary care physician once you are out of their clinic, other than go through the entire booking process all over again.

What is Direct Patient Care and Concierge Practice?

In contrast to the complicated, frustrating world of traditional primary care, the Direct Primary Care and Concierge Medicine model is a more refreshing alternative. This new and improved health care model puts the patient as its top priority and creates an easy, seamless health care experience for them.

More and more family care physicians are turning to this type of practice because it offers a very important thing which the traditional insurance based health care model does not, and that is time with their patients.

With this new health care model, patients get 24/7 unrestricted access to their family doctor via their personal line. What makes Direct Primary Care and Concierge Medicine physicians different from traditional family care physicians is that the former successfully establishes a direct relationship with their patients.

No problematic middlemen. No frustrating insurance billing and corporate intervention. Just pure, genuine trust, care and concern between doctor and patient.

This exclusive doctor-patient relationship is also made possible by the fact that primary care physicians limit the number of patients they see to ensure that every patient is given the time and attention they deserve.

True to its name, the Direct Primary Care and Concierge Medicine model allows family care physicians to deal with their patients directly, saving them time, cost, and effort, and most importantly, restoring the close relationship that naturally develops between doctor and patient.

What makes this health care model simple and straightforward is the fact that patients pay for a flat subscription fee on a monthly, quarterly, or annual basis.

All Direct Primary Care and Concierge Medicine subscriptions cover everything with regard to preventive and routine care without the intervention of third parties such as insurance companies and corporate hospitals. Trust us, you’ll be shocked to know how affordable quality health care can get without the influence of intermediaries.

Take, for example, the story of Kevin Boyd, 64, from WebMD, “When I fell down the stairs and broke my rib, I didn’t have to go to the emergency room. Instead, I called up my Direct Primary Care physician, who told me to come to his office. He referred me nearby for an X-ray and dispensed pain medications at his office. Everything cost me a total of $70.”

While, yes, the myth is true that your Direct Primary Care and Concierge Medicine subscription does not replace your health insurance, you are definitely able to save more with this kind of set-up. For one, your Direct Primary Care and Concierge Medicine subscription is your safeguard against catastrophic illnesses.

As long as you have Direct Primary Care and Concierge Medicine as your ally, you finally get to minimize interaction between you and your insurance company by reducing your insurance plans to cover hospitalization expenses and subspecialty services only.

The formula to better preventive care is easy – you cut down your insurance plan to a more affordable one and get yourself a Direct Primary Care or Concierge Medicine subscription, which costs as much as a couple of dinners out only.

Moreover, the Direct Primary Care and Concierge Medicine model offers a bunch of long-term financial benefits to its patients, such as heavily discounted out-patient services and medication at wholesale cost.

As per DPC Nation, a Direct Primary Care or Concierge Medicine subscription covers the following services:

1. Treat common problems such as colds, flus, strep throat, rashes, burns, joint injuries, and other wounds.

2. Keep you updated with all recommended preventive screenings and tests, like colonoscopies, pap smears and EKGs.

3. Create personalized, long-term management plans for chronic conditions, such as asthma, diabetes, high blood pressure, high cholesterol, or thyroid disorder.

4. Perform minor procedures like mole removal, joint injection, and stitches.

5. Provide a variety of additional services and benefits, like chronic pain treatments, sleep disorder treatments, minor cosmetic procedures, osteopathic manipulation, migraine treatments, osteoporosis treatments, and athletic performance testing.

6. Manage and coordinate specialized care – this means that in the event that you need more specialized care, your Direct Primary Care physician will refer you to a specialist and coordinate all the important details of your health to them. Instead of shooing you out their door, they will work closely with the specialist to ensure that the continuity of care is seamless and your best interests are of top priority.

Differentiating DPC from Concierge Practice

While the Direct Primary Care and Concierge Medicine models are highly similar in many respects, what sets the two health care models apart is demography, insurance participation, billing methods, and the amount of services offered within the subscription.

A Concierge Medicine subscription covers all the preventive and routine care services a Direct Primary Care subscription has.

The major difference is that Concierge Medicine subscriptions tend to be high-end service-focused and added-value oriented while Direct Primary Care subscriptions are more cost-efficient.

A Concierge Medicine subscription comes with a ton of added perks, such as in-depth personalized executive physicals as well as having your Concierge Doctor accompany you to specialist visits.

Another differentiating factor between these two membership models is that Concierge Medicine subscriptions are still sometimes able to bill insurance for particular covered services while all payments for Direct Primary Care subscriptions are dealt with directly between doctor and patient.

Direct Primary Care and Concierge Medicine subscriptions are also known to give you the freedom to quit anytime you choose. DPC subscriptions range anywhere from $30-$300 while Concierge Medicine subscriptions go for about $101-4,000 a month. Many membership practices are hybrids – meaning, they possess a combination of Direct Primary Care and Concierge Medicine characteristics.

Most times, the services offered by a DPC doctor’s practice and a Concierge doctor’s practice overlap. It’s all about finding one that covers of all your health care needs at the price point you can afford.

Summary | To Choose Direct Patient Care is to Choose Optimal Overall Wellness

When choosing which primary care provider to go with, it is crucial to consider which one has your best interests at heart. A good primary care provider should take the initiative to check up on their patients consistently, track any changes in their health, create personalized, long-term health management plans, and advise you regarding any medical matters you may need to pursue or follow.

Remember that your relationship with your primary care physician is your stronghold against debilitating illnesses, which is why it is imperative that you feel like your primary care physician genuinely cares about your health.

Join the movement for better primary care and get yourself a Direct Primary Care/Concierge Medicine subscription. Here at FindMyDirectDoctor.com, we connect you to a comprehensive list of DPC/Concierge Medicine physicians that have your best interests at heart. Visit www.findmydirectdoctor.com to see a Direct Primary Care/Concierge Medicine doctor near you today.

Authored by Harsha Moole, M.D., MBBS

Advocate of healthcare models that promote direct relationship between patients and doctors. Founder @ FindMyDirectDoctor, LLC.

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