Obamacare’s annual open enrollment period for health insurance will begin on November 1, 2016, and will end on January 31, 2017. Americans who do not have employer sponsored health insurance, are self-employed, or have been guided into the individual marketplace by their employers have the opportunity to sign up or renew their insurance plan. Health-insurance exchanges in Colorado, and across the country, haven’t quite worked out as expected since implemented in 2014. Some large insurers have pulled out of the individual exchange market for the 2017 benefits year, and others are asking the Colorado Division of Insurance for as much as 40 percent increases to the premiums they charge to pay for expected increases in costs.
Health insurance may now be more expensive, but basic health care does not have to be. Over 75% of health care can be provided in the primary care setting – your family doctor. Myself and an increasing number of primary care doctors are removing ourselves from the insurance system to spend more time with our patients in exchange for cash payments – without billing third party insurers.
This model of care in known as Direct Primary Care (DPC). An alternative care model, not insurance, that alleviates the increasingly complex, inefficient, restrictive insurance based care experience and goes above and beyond by opening up access and improving care at an affordable cost.
Today’s primary care business model loads each provider with about 2,500-3,500 patients which means visits last between 8-12 minutes. In the DPC model patient loads are limited to 500-1000. Since direct primary care practices see fewer patients, the physician can spend more time on each visit, offer same-day appointments, and get to know patients well. The model aims at restoring the physician-patient relationship and bringing back the human element to medicine --- allowing doctors to focus entirely on caring for their patients. Overall patients receive the benefits of more proactive, preventive, comprehensive, coordinated care.
Within the current insurance-based system, in addition to high monthly insurance premiums, patients are responsible for visit, labs and medicine co-pays and/or co-insurance. DPC can help health-care consumers save on the cost-sharing part. In my practice, we do not have co-pays. The monthly prescription pays for everything we do in the office. We do not charge for tests or procedures done in the office. From the treatment of sore throat to giving nebulizer treatments in office is included in the subscription.
Subscribers to On Point Primary Care clinic also get negotiated savings for labs and medicine. I stock medications that are common for the patient population I care for. We can save hundreds and even thousands of dollars a year for patients by offering essentially “wholesale” prices on medicines. This month I treated a urinary tract infection in my office and the full course of antibiotics cost $0.60. We also restarted a patient on a medication that locally cost $325.00 per month but as a subscriber the patient received the same medication for $30.00 per month!
Many of the common labs that are done to monitor chronic diseases, like diabetes, and that are routinely performed for annual well exams are included in the subscription – I pay for them. Those labs that I do not pay for, patients can pay the negotiated “wholesale” lab prices, use their insurance or pay cash – which ever is the most cost effective, but my negotiated priced are hard to beat.
DPC physicians receive a fixed monthly fee paid by the patient and/or the health plan. This is not expensive: the fees at On Point Primary Care average $57 per month. The average monthly cellphone bill is $73, according to a 2014 J.D. Power report. Eliminating the overhead created by insurance billing and high patient volume, which typically eats up 30%-40% of revenue, helps greatly to achieve these reduced prices for care and makes the model affordable for the masses.
DPC is certainly not for everyone — patient or doctor. But it is one model and it has proven very effective for many. For me, education is the foundation of my practice. I see it as my responsibility to educate people about their options to personal healthcare so as to live the fullest life possible. I strive to listen, to explain, and to provide support for decisions and changes regarding health on physical, emotional and spiritual levels. I passionately enjoy what I do as a physician. And with the DPC model I have found the environment to do this better, unrestricted and unhurried. The model makes sense and is the right first step in making changes to the current system.
This information is provided by Dr. John E. Thomas with On Point Primary Care a Direct Primary Care clinic. Feel free to contact Dr. Thomas at firstname.lastname@example.org or go to www.onpointprimarycare.com if you have questions or would like further information about his practice or to schedule your free consultation to see if On Point Primary Care is right for you and your family.