How Can A Direct Primary Care Membership Fix Healthcare?
Hello, fellow victim-of-the-current-healthcare system. Before we get into what the heck this “direct primary care” is, we have to get one thing straight about American healthcare—we don’t have it.
But I’m pretty sure I don’t have to convince you that the system we have sucks, because if you know anything—you know that.
But why does it suck?
The Middle Man has been butting in the way of our doctor-patient relationship for too long, and we’re going to teach you how to revive that relationship and get your health back on track. You can thank us later.
Sickcare is what we really have. It profits the system over your health. In this system, doctors get paid a fee per service instead of being paid based on the amount of care given. So, as a result, they prioritize only treating patients and reacting to big problems instead of preventing the problem in the first place.
But we’ve always been told that showing is better than telling—so let’s break it down that way. Can I get a volunteer from the audience, please? You, right there sitting in your living room on your laptop, come on up! Everyone—meet Cindy, she’s going to roleplay our examples throughout this article, so get acquainted. Cindy is a 40-year-old accountant and mother of three, she keeps pretty healthy, but her life can get stressful. Sometimes she even has heart palpitations.
Cindy tries to push through the palpitations, because she doesn’t have time to go to the doctor between her job and wrangling her three kids. She waits for months, and the heart palpitations only worsen.
So she Googles her symptoms—could it be Anemia? Hormonal imbalance? A fatal heart condition? She finally decides to take off work, goes into the doctor, and waits in the waiting room for an hour to see her doctor—all while keeping her kids from bouncing off the walls.
Finally, she’s called back. She explains her symptoms, and the doctor asks her a series of questions. He has her chart but isn’t well acquainted with her lifestyle or medical and family history—he couldn’t possibly be; he has more than a thousand other patients.
So, he orders an EKG for Cindy and several other expensive tests. After nearly a month of tests, huge copays, specialist visits, and waiting on results, he calls her back in to discuss the results. They were all negative; the palpitations are just anxiety—try to take it easy for now on, he says, as he prescribes an overpriced antianxiety medication.
In a healthcare system, Cindy would be to consult her doctor on the symptoms immediately after they start. There would be no wait to see her doctor, and it wouldn’t be expensive. Her doctor would know her, her health history, her lifestyle, like really know her. Her doctor be able to immediately pinpoint the problem as anxiety, and prescribe medication to help her at the lowest available price. Her doctor would have prevented the issue before it became a problem that impaired on Cindy’s life so badly that she was forced to do something about it and spend a whole lot of money.
Prevention—that’s the difference. That’s healthcare. The act of preventing in medicine instead of just reacting is so powerful that even statistics stand behind it.
In fact, 71% of hospital visits could be avoided, according to Becker’s Hospital Review.
“The more affordable health care is, the more accessible it is, so the better the care is going to be.”
Direct Primary Care
But how can we get there? The reason doctor’s can’t develop relationships with their patients is because they’re overworked, they have too many patients, and they’re constantly doing insurance paperwork.
We have three main areas of healthcare that need fixed in order to revive the system’s integrity—the price, the inconvenience, and the rushed doctor.
Now here’s how Direct Primary Care comes in and offers a solution for all three. Direct Primary Care (DPC) is a membership-based model where members pay one monthly fee to get unrestricted access to their own primary care doctor—through text, call, video chat, or in-person.
Direct Primary Care is pretty new—72% of DPC practices in the U.S. have only been open for three years or less. But it’s growing fast. And there are already more than 1150 DPC practices across 48 states.
Why? Because it works—for both the patients and the physicians by solving the three problems—the price problem, the inconvenience problem, and the rushed doctor problem.
Solving The Price Problem
Price is the pretty obvious problem. We’re overpaying, and we’re all complaining about it—in prescriptions, lab fees, copays, premiums, office fees, you-name-its. Yet, we put up with it and accept that “this is just the way it has to be.”
But as David Goldhill argues in his book “Catastrophic Care: Why Everything We Think We Know about Health Care Is Wrong,” healthcare should be just as market-based as shopping for a car.
“We seem to accept what we pay as an inevitability, as something somehow generated outside the business decisions that drive healthcare. Healthcare seems too complex to have prices in the sense that other industries do.” – David Goldhill.
To illustrate, we pulled a real bill from a patient using their insurance and pinned it side-by-side with a bill for the same labs with us. And as you can see below, the patient using their insurance was WAY overcharged.
Same with prescription pills. Direct Primary Care doctors search for you to find you the most competitive or wholesale rates. Because here’s a little secret—you’re definitely overpaying for those too.
And when it comes to prescriptions, DPCs get you drug prices at wholesale costs and find you competitive prices from GoodRx and other programs. Don’t believe us? In 2017, Business Insider reported on a DPC member whose six-month supply of a drug fell from $120 to $20 after joining. And that’s typical for any member.
And of course, DPC cuts out premiums, deductibles, and copays—no more of those!
I don’t think I have to convince all that costs a heck-of-a-lot of money, but here I go anyway.
In 2017, the Kaiser Family Foundation reported that the average annual premium was, on average, $6,690 for singles, and $18,764 for families. And it’s been on a steady, scary incline since 1999. Oh, the things we could buy instead with all that money.
All DPC requires is one monthly payment (usually starting at $75), and that covers all your doctor visits, questions answered, and in-house procedures. Freaking score.
Solving The Inconvenience Problem
If you haven’t noticed, it’s super inconvenient to visit your doctor or just to get a simple answer.
DPC says, forget the waiting room altogether. It’s inefficient and inconvenient for everybody.
DPC lets you call, text, video chat, or visit your doctor (without the wait). It’s like having your doctor in your pocket. A pocket doctor.
So how does this make the experience more convenient? Time for another anecdote example to really drill in the point. Where’s Cindy? Did she get distracted by an Ad? Gosh darn it, okay, you right there in the blue shirt—come on down! This is Rodney, everyone.
Rodney is in his late 20s, he and his wife recently had their first-born, a little girl who just turned three. They’re anxious to get everything right and keep her healthy, at any cost—just like any good, new parent.
His daughter, as bouncy and reckless as a toddler can be, suffers a nasty fall down the stairs. A bump swells up on her head, and Rodney begins to panic—should he take her to the ER? Sure, even if she’s fine, it’ll be expensive, but her safety is worth it, right?
Good news—Rodney has Direct Primary Care. So, he pulls out his app, snaps a photo of the bump, and sends it to his doctor. She immediately responds, and they video chat. Rodney’s physician examines his daughter’s head and has her do a series of exercises.
She concludes that it’s nothing serious and not a concussion. There’s no reason to rush to the ER. She schedules an appointment to see his daughter first thing the next morning to thoroughly examine her—free of charge, of course.
And that’s the majority of cases. Hence, DPC members being 65% less likely to visit an emergency room and 35% less likely to require hospitalization, according to a study reported by Bankrate in 2016.
That’s a real patient-doctor relationship as it should be.
How It Solves The Rushed Doctor Problem
Whether you’re Cindy or Rodney, no one likes the waiting room. I mean, for goodness sakes, what is taking so long back there?
Simple answer—the doctors are overworked. Most doctors see an average of 20 patients a day, according to a 2018 survey by the Physicians Foundation. And nearly a quarter of their time is spent filling out insurance paperwork.
They’re so overworked that they actually have some of the highest rates of depression and suicide among any other profession.
But they have to keep up seeing an overwhelming number of patients and their long hours to get paid what they’re worth. It’s, well, a broken system.
So what does Direct Primary Care do to fix that? DPC doctors are capped at a much lower amount of patients—at First Primary Care, no doctor has more than 600 members to take care of. Any more and the relationship becomes impersonal. We get that.
- That’s why DPC doctors spend an average of 35 minutes with members each visit, instead of the average 8 minutes.
And because DPC cuts out the Middle Man, doctors spend less time filling out loads of paperwork and more time caring for patients. Just as it should be.
What about the big, bad, ugly stuff?
If you’ve made it this far (cheers, you’ve leveled up!), but you’re probably wondering—what about the big, bad stuff? What if I get in a car accident or have a life-threatening emergency? How will I pay for that without insurance?
First off—healthcare has three tiers—0,1, and 2.
- Tier 0 is all the preventable stuff— all the well-woman exams, screenings, and maintenance stuff.
- Tier 1 is the predictable stuff (this is the majority of what we use our doctor for—70% to be exact). It’s everything we need our doctor for–sickness, pink eye, the flu, all the non-emergent stuff.
- Tier 2 is the unpredictable stuff—the big, bad, and catastrophic things that we can’t predict. These only take are only about 10% of our health issues.
Direct Primary Care covers ⅔ of these tiers. But not the unpredictable stuff. That’s why most DPCs recommend you still keep some form of catastrophic health insurance to cover you in super expensive emergencies.
However, other DPCs like First Primary Care, give their members access to a Cost Sharing Community, which is an alternative to health insurance.
Medical cost-sharing communities have been around for over 25 years, and 2 million members currently share medical expenses.
They’re a way to pay for the unexpected without having insurance. As a member of one, you pay a monthly fee (at First Primary Care, it just adds a little extra cost to your existing monthly fee) and—boom—you’re part of the community.
If a catastrophic event were to come up, you’d pay your pre-determined Initial Unshareable Amount (IUA). First Primary Care partnered with the community of Sedera Health, and IUAs begin at just $500. That means if you’re ever hit with a chunky hospital bill, you only have to pay the first $500 per incident, and the community’s monthly charges help you pay for the rest. If you can’t tell, that’s a huge saving.
But again, most everyday needs will be taken care of directly by your First Primary Care physician. And when there is a need for higher-level care, your doctor will help you source that, and be with you every step of the way.
So who needs direct primary care?
Three types of people can benefit from DPC (more accurately, you can benefit from DPC in three different ways). From the individual to the family to the business owner, there’s a lot DPC has to offer.
- Individual: Health insurance (at its best) gives us expensive premiums, absurd wait times, and rushed consultations. So why bother? We’ll just try to stay out of harm’s way, right? But healthcare is designed to prevent bad things from happening, not just pick up the pieces when the damage is already done. Primary care physicians are supposed to be your personal doctor who knows you inside and out (literally). They’re supposed to be your healthcare fighters, who guide you through this complicated system. And you need it cheap, you need it convenient, and you need it easy.
- Family: Whether you’re a parent still trying to convince their kid that they’re not a monkey or you’re juggling parenthood as a hypochondriac (bless your heart), life ain’t easy. And Googling your child’s symptoms is often just scary and misleading. Having a doctor in your family—someone affordable to text or call when you’re freaking out and unsure—sure beats rushing Little Timmy to the ER over every little concerning bump.
- Business: Whether you like it or not—employee benefits packages play a huge role in the quality and dynamic of your team. And I know, I know, it’s costly and hard to find a good healthcare plan amid the broken system. But don’t give up on your employee’s benefits just yet—there’s still hope. And your team will thank you later.
We’ve been through a lot together in this article—2,750 words to be exact—so let’s summarize.
Here’s what DPC is in a nutshell:
- Membership based
- That means no deductibles or copays. Just one predictable monthly fee. Don’t even mention the D-word. And no more “fee-for-visit” bull crap. The membership fee is fixed, so you’ll always pay one fee no matter how clingy or curious you are.
- Unrestricted access
- Text, call, video chat, in-person, however you prefer to communicate with your doctor, you can. DPCs recognize that we live in the 21st century, and things don’t have to require commutes or be so difficult anymore, gosh darn it!
- Personalized care
- Our medical needs are just as unique as our fingerprints. We all require different treatments and prefer different approaches. Having a one-on-one relationship with your doctor means you get that personalized treatment.
- No wait times
- Because DPC doctors have a lot fewer patients, they’re able to dedicate more time to seeing members one-on-one with longer appointments while cutting out the dreaded waiting time.
So there you have it, folks. That’s Direct Primary Care. And we love talking about it and sharing it with people. So give us a call or visit our membership page. And if you’re not in the Houston area or just want to see some other options, see all the U.S. locations here. Let’s revolutionize healthcare, shall we?