When you consider the fact that health insurance was created by hospitals and physicians trying to recover from the Great Depression by selling plans for prepaid healthcare, you understand the system was never designed with patients in mind. Over the years, it’s become a giant institution characterized by skyrocketing costs and ineffective care. Insurance companies pressure doctors to keep patient visits brief and make the connection between doctors and patients more transactional than relational. When health issues arise, people often choose whichever option is least expensive and convenient instead of using the healthcare system the way it was designed. You may be asking why there are so many people without adequate healthcare, even though they have health insurance. Here we’ll explore the breakdown between health insurance and healthcare, how to use the healthcare system effectively, and why insurance seems to be falling short.

How Healthcare is Supposed to Work

Primary care is supposed to be the cornerstone of maintaining good health. Ideally, a patient would have an ongoing relationship with a primary care physician (PCP) to establish a baseline of information regarding their health. During annual physicals or other routine visits, a PCP could quickly discern when something is off and put the patient on the path to recovery with appropriate recommendations, whether it be a simple prescription or referral to a specialist.

Catching cancer or other potentially fatal diseases early saves lives, but if a person has no relationship with a primary care doctor, conditions often go undiagnosed until it’s too late. One of the significant reasons people no longer have relationships with a primary care physician is because of mounting out-of-pocket costs (for example, people with high deductible health plans (HDHPs)). If a patient can’t afford to go to the doctor because they haven’t paid enough to meet the deductible on their insurance plan, healthcare is still inaccessible to them—even with health insurance.

Why the Insured Can’t Afford Healthcare

The healthcare industry is comprised of medical professionals, hospital systems, and pharmaceutical companies that should be dedicated to maintaining and restoring the health of their patients. The way these professionals set their prices has a direct effect on the costs of health insurance. Studies show high drug prices and overpriced services are a major source of waste in healthcare spending—to the tune of $241 billion per year. Unfortunately, other factors like fraud and administrative costs also drive up the price of insurance.

Employers and employees both end up feeling the burden of claims-based health insurance. Premiums and deductibles get higher and higher to offset the costs for insurance providers, and employers pass these costs on to employees because they can’t sustain them in the long run. In short, people end up with high deductible health plans (HDHPs) they can’t afford to use.

For 2020, HDHPs included deductibles of at least $1,350 for individuals or $2,700 for families, with total yearly out-of-pocket expenses between $6,750 for individuals and $13,500 for families. These limits set by the IRS don’t include the expenses from out-of-network services.

As of 2019, 47 percent of covered workers were enrolled in HDHPs at large employers. Thirty percent of those enrolled in HDHPs reported a yearly income of at least $150,000, but that isn’t the norm for most Americans. According to the Bureau of Labor Statistics, the median annual salary for the U.S. worker in 2019 was $47,996. Even if you were an individual with no children, at that income level, you could spend 14 percent of your annual salary on healthcare with an HDHP.

Back to Basics

There are ways to give people access to quality primary care, whether they have insurance or not. Direct Primary Care (DPC) plans have been reintroduced with 21st Century conveniences like telehealth to rebuild the relationship between primary care doctors and patients. By serving as a gap solution to HDHPs, DPC offers employees affordable access to healthcare without having to meet a deductible. It also eases the financial burden for employers because they don’t have to pay insurance claims on the back end.

Employers pay a flat monthly fee for their employees’ membership to the plan, and their people get unlimited doctor visits for minimal costs. With chronic disease management included in some DPC memberships, people with manageable pre-existing conditions like diabetes don’t have to worry about being denied membership. And they can still use their HDHP for services that go beyond primary care in the event of a major catastrophe.

Just because a person has health insurance doesn’t mean they have healthcare. With all of the turmoil in the insurance industry, benefit agents are being forced to explore new healthcare solutions for their clients. DPC is providing peace of mind by helping many get the care they deserve.

If you have questions about how DPC works, contact Healthcare2U for more information.

**Content updated on June 8, 2021

A study* recently illustrated a significant decline in Americans who have primary care providers. Research shows a significant decline in people with a designated primary care physician. Specifically, the number of people in the U.S. with primary care physicians dropped 2 percent between 2002 and 2015. Among 30-somethings, there was an even sharper decline – those with primary care providers dropped by 7 percent during the same time frame.

The trend raises concerns that the inconsistency in primary care doesn’t bode well for the long-term health of the population or the sustainability of the current healthcare system. Ideally, primary care is supposed to be the underpinning of all healthcare because it gives people the opportunity to identify and manage health concerns before they turn into unmanageable or deadly conditions. People with a designated primary care provider tend to be healthier, live longer, and feel more satisfied with their care than people who don’t. So how do we encourage primary care utilization and provide more access to better health and longevity?

Provide clients with Healthcare2U’s Direct Primary Care membership

Healthcare2U’s Direct Primary Care Plus (DPCplus) membership is a solution to these concerns. DPCplus encourages patients to establish a relationship with a primary care physician by removing the barriers to affordable and convenient care. The membership provides unlimited access to primary and urgent care, wellness and chronic disease management through Healthcare2U’s nationwide Private Physician Network (PPN)™.

Within these clinics, Healthcare2U provides doctor appointments for acute issues at $10 a visit for primary care, $25 a visit for urgent care and around-the-clock bilingual Virtual DPC (such as telehealth and video chat) for $0 out-of-pocket cost. In addition to unlimited acute visits, Healthcare2U physician partners also treat 13 of the most prevalent chronic disease states for the same $10 visit fee. Healthcare2U practices generic-first protocols to reduce pharmaceutical costs for employers and their employees.

Employers across the nation can offer their employees unlimited access to Healthcare2U’s DPCplus membership for a monthly fee starting at $45.

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Are you a benefits agent interested in offering your clients a nationwide solution to primary care? Contact Healthcare2U for more information about our integrated hybrid direct primary care membership that provides organizations of all sizes with unlimited primary and urgent care, nationwide. Download our membership details here.

* A JAMA Internal Medicine study by Dr. David Levine, an instructor in medicine at Harvard Medical School and an associate physician at Brigham and Women’s Hospital in Boston.

**Content updated June 3, 2021

As large segments of the population age and life becomes more stressful, chronic diseases are becoming increasingly prevalent across the U.S. With 75 percent of typical primary care visits for multiple chronic illnesses, primary care physicians are feeling this rise more than anyone else. And because of mounting pressure from insurance companies to see a high volume of patients, doctors are finding it hard to give their patients the primary care they deserve.

The foundation of healthcare should be the relationship between a doctor and his patient, and primary care physicians know they are the gatekeepers to healthcare. Honorable physicians want to serve patients to the best of their abilities. Still, with the current healthcare machine, it seems many doctors are caught up in a system designed to serve big insurance companies instead.

Eighty-five percent of primary care physicians admitted they don’t have enough time to dedicate to their patient’s chronic disease management needs. Not only does this lead to frustration and burnout for doctors, but it also leads to dissatisfaction for patients. The impending possibility of being denied insurance coverage because of their conditions can also add to a patient’s stress and frustration.

Currently, the Affordable Care Act (ACA) has provisions that protect people from coverage denials for pre-existing conditions. Many Americans struggling to keep up with the cost of chronic disease management are waiting anxiously to see if the ACA will be repealed. If these ACA provisions are overturned, people with pre-existing chronic conditions could find it even more challenging to secure health insurance.

With primary care physicians struggling to provide effective care and many patients struggling to find affordable insurance coverage to manage chronic illnesses, what can be done to remedy the situation? Many primary care physicians are walking away from the bureaucracy and red tape of the current health care system and adopting the direct primary care (DPC) model.

The DPC model is a win-win for primary care physicians and patients because it allows doctors to take their practices out of the hands of big insurance and offer services at a reasonable and transparent cost. Another benefit is the ability to provide patients affordable medication at a fraction of the average rate. In other words, they can simplify things and get back to putting patients first and focus on the impact of primary care.

Benefits for members can vary, but typically include lower out-of-pocket costs for a wide range of primary and chronic services. Chronic diseases aren’t only putting a huge dent in the wallets of the insured, they also cost employers millions.

In addition to lowering costs, DPC also removes additional barriers to healthcare such as transportation and scheduling limitations for patients who need care. Through additional services like Virtual DPC or Telemedicine, doctors can see patients who don’t have access to transportation or who may be traveling. Patients can even call after hours to get guidance over the phone.

With the cost savings and added benefits to primary care physicians, patients, and employers, DPC is becoming a more accessible and valuable option for organizations of all sizes and structures. For more information on making healthcare more accessible and affordable for your employees, contact Healthcare2U.

A study published in JAMA on Waste in the U.S. Health Care System shined a light on what we’ve known for years: the healthcare system in America is broken. By their estimates, nearly 30 percent of healthcare spending is wasteful and is bleeding the U.S. healthcare system. When you break down that statistic into dollars, it’s a staggering $760 billion annually.

The top three offenders were the failure of care delivery at $102 to $166 billion, pricing failure at $231 to $240 billion, and administrative costs at an estimated $266 billion wasted annually. While the study predicted interventions in the most wasteful categories could save the healthcare system up to $282 billion per year, they excluded solutions to mitigate administrative costs.

Ultimately, these administrative expenses will be passed on to the people in need of healthcare within a system many already can’t afford. With an estimated $500 billion being lost annually due to out-of-control pricing and administrative costs, what can be done to stop the bleeding?

While there are many theories on how to solve inefficient and overpriced healthcare, many thought leaders are implementing DPC to cap employer healthcare expenses.

While there are many theories on how to solve inefficient and overpriced healthcare, many thought leaders are disrupting the status quo by implementing direct primary care (DPC) to cap employer healthcare expenses. A couple of hallmarks of this monthly healthcare membership include eliminating administrative fees for primary and urgent care and containing the exorbitant cost of shock claims by detecting, treating, and managing chronic illnesses before they become serious. The model is an alternative gap solution to high deductibles for services covered by health insurance, and a cost-containment feature for the rising cost of claims filed against employers’ insurance plans.

For more information on how to make healthcare more affordable, contact Healthcare2U – the nation’s fastest-growing integrated direct primary care organization.

While direct primary care (DPC) is not new, some employee populations have not heard about DPC, or they may not be well-educated on the membership benefits. Most employee populations are familiar with fee-for-service models where they have premiums, deductibles, claims, and co-pays. So how do you introduce direct primary care to an employee population and educate them on the value it delivers them and their families? There are a few things you should highlight for employees to ensure they have a sound understanding before enrollment.  

Pricing Structure 

One of the most critical questions employees have is how much this plan will cost them. A benefit to direct primary care plans is that they are often more affordable than insurance premiums, averaging $77.38 per month. Be sure to explain the pricing structure for different tiers of enrollment from a single employee to family coverage and what those fees cover. Everyone will be glad to hear that this new benefit is less expensive than paying out-of-pocket for primary care (especially if they have a high-deductible health plan).  

Direct Services 

Services will be next on their list of questions. Now they are aware of the cost of the membership; they need to understand what it includes. It’s important to stress that direct primary care memberships provide quality services and quick access to primary care physicians (PCP), where employees will regularly go for acute issues. Showcase what services they will be getting for free (labs or physicals), as well as what services will be cheaper compared to their other coverage.  

Elaborate on how inclusive services encourage each of them to build a strong, trusting relationship with their physician. From pediatrics to family practitioners, primary care physicians help maintain employee health through preventive care and early intervention. Research has shown that individuals that  regularly see their primary care physician manage their chronic disease better, spend less time in the hospital and less time away from work. You can share the mission behind direct primary care by informing them of the value primary care physicians serve in their overall health.  

 Differentiation of Plan Offerings 

Employees have now grasped two significant concepts of direct primary care: 1) how much it’s going to cost, and 2) included services. Now differentiate how this plan differs from their other coverage (major medical insurance, minimum essential coverage or medical cost sharing membership). Employers, or their employees, pay a monthly membership fee for direct primary care to serve as a gap solution, providing primary care within this membership arrangement. This membership grants members access to their physician, eliminating claims for all services performed within the direct primary care environment. Don’t forget to explain that, with direct primary care, fees for appointments and services will be transparent – as their membership fees and included services are disclosed.  

At first, direct primary care can sound intimidating or confusing to a group of employees. By covering these three topics, you can ensure they have an overview of the model and plan offering. We suggest expecting more questions as they explore their new benefits. However, it won’t be long until they’re acclimated to direct primary care and able to enjoy the benefits of this innovative healthcare membership. 

If you are interested in offering direct primary care to your employer groups, contact Healthcare2U or download more information on our nationwide DPCplus membership.

**Content updated June 3, 2021