Figuring out the right model of care for you is something physicians can struggle with. There are pros and cons to both, but studies show the Direct Primary Care (DPC) model is rising in popularity. In part two of our three-part blog series, Healthcare2U’s Dr. John Rodriguez shares why he thinks physicians are distancing themselves from the traditional fee-for-service care model and some of the “bad debt” they can carry. If you haven’t read it yet, don’t forget to check out our first blog in this series, which discusses the benefits of working with a DPC model.

Q: Why are physicians interested in moving away from fee-for-service care to direct primary care?

A: Currently, the majority of clinics operate under the fee-for-service arrangement with insurance companies. In other words, we see a patient, submit that visit to the insurance company, they reevaluate the charges at a significantly reduced rate, and if we are fortunate, they send a payment to us maybe 30 days later. Unfortunately, those payments have not kept up with the pace of medical inflation. Over the years, many physicians have had to leave health care altogether or become employed by hospitals or insurance companies.

Some practices have adopted a DPC model, which involves receiving payment from either the employer or individuals for healthcare services. Payments can be structured as monthly memberships, or individuals can pay per visit. Considering many high deductible plans, it makes a lot of sense to engage a physician practice under a DPC model because that’s going to, in the long run, save money and keep you healthier because you have meaningful and quality time with the provider.

There are different types of arrangements that can be made through hybrid models. This can be a combination of partial insurance payments and/or a membership payment in addition. All this helps to lower the cost of health care and improve the time spent with patients, which improves patient satisfaction as well as physician satisfaction.

Q: Can you talk us through the “bad debt” that many physicians carry?

A: Bad debt is one of the many struggles physicians have suffered with for years, and if it’s not dealt with properly, can break a clinic. That debt is made up of two components: insurance companies not paying their bills or patients not paying their share of the bill. Ultimately, it’s the physician or the clinic who goes unpaid. To try and overcome it, physicians must hire more employees to try and capture that bad debt – you would hope and think that we shouldn’t have to do this. Unfortunately, debt collectors do exist in society, and it’s even more problematic in health care because we have a battle of wages against insurance companies, which are never nice to independent practices. Again, bad debt will make or break a clinic, and to be able to be paid for your services is extremely important.

Stay tuned…

Make sure to stay tuned when we feature our third and final blog with Dr. Rodriguez, where we discuss how he started his journey of working in a DPC practice. For more information on Healthcare2U’s Direct Primary Care membership, check out some of our other blogs.

While the cost of goods and housing continues to rise, so does the cost of healthcare. The cost of other necessary items has increased, such as groceries rising 20 percent since 2021 and a significant surge in the cost of utilities and gas in 2022. Healthcare costs have been steadily rising since 2012, with the average monthly cost of traditional insurance being $659 in 2022. This has resulted in financial stress for many Americans. Of those insured, more than two-fifths of working adults consider themselves “inadequately insured”. How can we reconcile spending so much money on health insurance that isn’t fulfilling our needs?

In this blog, we’ll discuss why health insurance plans have a hard time being inclusive, why they’re not the best option for today’s workforce, and how traditional plans and Direct Primary Care (DPC) memberships can partner together to create the perfect solution for everyone.

It’s expensive for a health insurance plan to be inclusive

The soaring costs of healthcare in the United States have become a major concern for individuals and communities across the nation. With health insurance premiums reaching unprecedented levels, finding a sustainable solution has become a priority.

The typical cost per year employers paid for employee insurance in 2022 was $7,911 for single coverage and $22,463 for family coverage. Employees and employers contribute this money, but sometimes the benefit is not utilized, resulting in a waste of finances for both parties.

There are five main factors that affect a plan’s monthly premium: location, age, tobacco use, plan category, and whether the plan covers dependents. These factors make it difficult for employers to keep up with the expensive premiums, as each employee affects the cost differently.

Traditional health insurance plans are not adaptable for a modern-day workforce

Traditional insurance simply isn’t working for today’s modern workforce. Apart from traditional insurance being expensive, it’s also confusing. Fifty-eight percent of Americans say they’ve run into problems when using health insurance within the past year. This includes problems with denied claims, provider networks, and pre-authorization. Through traditional insurance, employers also suffer from surprise bills like “shock claims”, which are claims that are unexpected financial blows to the insured.

Traditional insurance doesn’t prioritize the patient’s experience, affecting people’s motivation to book appointments and seek the medical care they need. Whether it’s because of a lack of flexibility like virtual options, or doctors not having ample time to discuss underlying issues with the patient, traditional insurance doesn’t foster the patient/doctor relationship, and that leads to people being less inclined to access care.

Traditional health insurance is rooted in fee-for-service delivery, not value-based care

Traditional insurance operates by a monthly payment to cover the health plan, with the member paying a fee for each service. The insured are required to meet a deductible before their insurance starts pitching in, and you can also get hit with unexpected bills after treatment or service.

The cost of health insurance and the level of satisfaction people feel toward it are also not equal, and it doesn’t seem like insurance companies have any interest in helping solve this problem. Fee-for-service delivery treats the insured like they’re just another number, but with DPC, the patient/physician relationship is at the forefront, and employers know their employees are receiving quality care.

How traditional insurance plans and DPC memberships partner together

DPC is a healthcare membership that gives its members access to unlimited primary care for a low monthly fee. DPC, at its core, is centered around chronic disease prevention and championing the doctor-patient relationship, supporting members to live a healthy, happy life.

Here’s a quick breakdown of the benefits of DPC:

• Low monthly membership fee and cost transparency
• Unlimited access to primary care for a minimal fee and virtual visits for no fee
• Unlimited access to primary care, urgent care, and chronic disease management for a minimal fee
• Easy-to-understand benefits
• More one-on-one time with your healthcare provider
• Upfront pricing
• In most cases, appointments to see a physician can be made within days
• Continuity of care
• No deductibles

With DPC, you’ll receive continuity of care and a physician who takes the time to listen to you and assess your concerns, whether it’s virtually or in person. This, combined with traditional insurance, allows employees to receive day-to-day care as well as peace of mind for more serious health concerns.

DPC is an answer to many challenges we are facing in healthcare today. To learn more about DPC and how it can partner with traditional insurance, click here.

Navigating the healthcare system can come with several challenges for both doctors and patients. Physicians can encounter hurdles when providing care, patients can be overwhelmed when receiving care. A viable solution has been Direct Primary Care (DPC). This model is growing in popularity because it provides a multitude of benefits for physicians and patients. In a three-part blog series, Healthcare2U’s Dr. John Rodriguez shares his insight on what the current burdens are regarding healthcare, some difficult barriers physicians and patients are currently facing, and his perspective on Direct Primary Care.

Q: What are the benefits of working with a direct primary care model?

A: The current fee-for-service model of seeing a patient, then billing that to the insurance company, having that re-priced, and then sent back to us maybe in 30 days, if we’re lucky, has not kept up with our costs of running a healthcare facility. The direct primary care model has been very attractive to many practices because doctors receive payments on the day of service or through a pre-arranged and low monthly retainer fee – this is a novel concept! It’s very attractive to most practices because we feel as though we do finally get paid for our work, and we get paid in a timely fashion. This helps us to keep our overhead much lower in the form of fewer staff as well as being able to provide the care that patients truly need and desire. Being able to receive payments from a cash perspective on time and at the prices that we feel are fair is an extremely attractive way to practice health care. Direct primary care is becoming more advantageous and beginning to take off, not to mention its prices are coming down.

Q: What are some burdens that physician-owned practices must work through regarding insurance?

A: One of the biggest challenges that we have faced for years is poor insurance reimbursement. We have to make our payments when it comes to rent, salaried employees, hourly employees, tax payments, malpractice insurance payments, etc. All these come at a heavy price to us, and unfortunately, insurance reimbursements don’t keep up with the rate of inflation. Now that a physician has dwindled visit time down to about seven minutes, there’s just not enough time to adequately deal with many conditions. This leads to poor patient satisfaction surveys and poor outcomes, and in some cases, important diseases can be missed or misdiagnosed. The stress that comes with this for the providers has forced many to leave the arena of health care, and now they become employed by insurance companies, hospitals, or just leave health care in general.

Stay tuned…

Make sure to stay tuned when we feature our second blog with Dr. Rodriguez where we discuss fee-for-service clinics and the “bad debt” that many physicians carry. For more information on Healthcare2U’s Direct Primary Care membership, read our blog.

A company provides its employees with healthcare benefits – now what?

It is imperative that employees understand how to use these benefits easily and efficiently to get the most out of them. A survey conducted by LIMRA found that 53% of employees felt their employer didn’t effectively communicate their medical benefits. When an employee understands their benefits, the healthcare utilization rate increases, employees’ overall well-being increases, and healthcare expenditure by the company can even decrease.

In this blog, we’ll discuss why it’s important that employees understand their health benefits, how employers can aid in benefits education, and a solution that takes the stress out of benefits education and lowers costs even more for employers.

Why employers should care about benefits education

When employees understand their health benefits, they’re more likely to use them correctly. Knowing about and properly using benefits increases the overall well-being of employees as they are receiving the care they need to stay healthy and happy. Benefits education helps both employees and employers. A MetLife study reported that 51% of employees who feel their health is holistically considered were more likely to continue working for their current organization for at least one more year. This is just the tip of the iceberg when uncovering the residual effects benefits education has for companies.

When employers prioritize benefits education, employees feel empowered to take charge of their health. When an employee doesn’t understand their benefits, they sometimes put off getting the care they need. For many health issues, namely chronic conditions, employees who put off care can end up costing employers a great deal of money down the road. By seeking medical attention and taking control of their wellness journey, employees can improve their mental health, which increases productivity.

How employers can assist in benefits education

Healthcare utilization only works if you work it- this means that employers must aid in benefits education for their employees. Employers should care about benefits education as it can directly result in a decrease in spending for employees and the company. Setting up a meeting to discuss benefits is a great tool that helps employees understand what they’re getting with their benefits. Some benefits companies also offer benefits education campaigns and periodic check-ins, which takes the pressure off employers to coordinate everything themselves.

Another easy yet effective way to help employees learn and utilize their benefits is to have literature available either in the company’s intranet/SharePoint or similar platform or in a communal area in the office with the contact information for the company that is providing health benefits. This way, employees can easily access that information instead of having to search for it. The fewer obstacles a person has to navigate, the more likely they are to access it.

Although these simple actions can make a significant difference in benefits utilization, if the foundation isn’t right, it won’t matter. Choosing the right health benefits for each company is the first step in providing the best experience for employees.

How Direct Primary Care can help lower cost containment and aid in benefits education

If companies are looking for an affordable healthcare option, Direct primary care (DPC) memberships have been steadily rising in popularity due to their higher utilization rates and ease of use. DPC is a type of healthcare membership where patients pay their physician directly for their primary care services, as opposed to paying an insurance company.

DPC lowers a company’s cost containment by operating on a fixed monthly fee. This allows a company more clarity when trying to plan financially for the future. On average, employers can save up to 20% annually in healthcare costs by adopting a DPC model. To take that a step further, proper benefits utilization can help save even more in healthcare costs. Since DPC also focuses on preventative care, companies can worry less about shock claims, which are expensive claims that aren’t common, but employers must pay when they occur (i.e., cancer treatment, organ transplants, etc.)

Below are a few examples of benefits utilization that offer more savings:

• Scheduling yearly physical exams: Most DPC memberships offer these for a small fee or for free, and they are vital in the early detection of chronic diseases. If left undiagnosed, these diseases could end up costing you a lot down the road (treatments, surgery, etc.)
• Utilizing virtual care appointments: If an employee has a cold, instead of running to urgent care, they should try virtual care first. In many cases, these visits are free through DPC, whereas an urgent care visit can average $150 – 250 for some DPC memberships. In some cases, you are also able to get a prescription through virtual care instead of scheduling an in-person visit with your physician, which typically costs about $100 – 150 through insurance, a high-deductible health plan, or out-of-pocket.

DPC is a lower-cost healthcare option for companies looking to cut down on expensive and, in many cases, wasteful costs associated with healthcare. Benefits utilization is another necessary ingredient to healthcare savings that is often overlooked by companies as it can take time and effort to plan. To learn more about DPC and benefits education, click here.

Eighty-five percent of Americans are planning vacations this summer. As we all know, you can plan your flights, hotels, etc., but one thing you can’t plan for is a surprise sickness. Let’s cover common health issues when traveling, common barriers to healthcare, and how a Direct Primary Care (DPC) membership can bring peace of mind for your next vacation.

What are some common health problems for travelers?

When we travel, our immune system is weakened. Several factors can play into this: we’re not in our typical habitat (i.e., a change in altitude, weather, allergens), we experience an altered sleep schedule, our diet changes, etc. These factors open the door to many illnesses that can sneak in due to our weakened immunity.

Here are some common health issues people face when traveling:

• Common Cold: Our immune system is weakened during travel, leading to a higher likelihood of contracting an illness. Colds are among the most common. They’re only present for a few days and are usually mild. However, these symptoms can worsen if the proper measures aren’t taken.
• Stomach pain: Changing your diet while traveling or eating rich and unfamiliar foods can lead to stomach problems. The most common problem among them is diarrhea. If you’re traveling outside of the US, drinking contaminated food or water can lead to “traveler’s diarrhea.” It typically isn’t severe, but if you experience symptoms like a fever or persistent vomiting, seek out medical help.
• Environmental allergies: Most people travel to a different climate, so staying outdoors for an extended period can lead to allergies. Most people take allergy medication for this problem, like an antihistamine. However, sometimes further steps are needed, and medical treatment is advised.

Common barriers people face when they need healthcare while traveling

When you’re on vacation, the last thing you want is an illness or medical emergency. One of the most significant issues people face is not understanding how to use their benefits while on vacation. For example: what clinics can you visit and, if necessary, how much will an urgent care visit cost? Another barrier is needing continuity of care. This means you might see a doctor in another city or state, and they need to know your previous medical history. This issue can be complicated, resulting in you spending more time filling out paperwork so the physician can understand your medical history and best assess your current health issue.

Direct Primary Care memberships offer benefits at home and on the road

Healthcare2U’s nationwide Direct Primary Care (DPC) membership combines affordability and convenience to create a healthcare solution especially beneficial while traveling. Healthcare2U’s membership offers unlimited benefits such as virtual care for no out-of-pocket cost and in-office visits to participating physicians across state lines for $10 per visit.

At Healthcare2U, our DPC membership starts with a call to our Patient Advocacy Line (PAL). PAL is staffed by bilingual certified medical professionals who walk you through benefits and point you in the right direction. Since our DPC membership is nationwide, you’ll have access to any physician within our network. If you prefer a virtual option, you can always use telehealth. For any care coordinated by Healthcare2U, those Electronic Health Records (EHR) live in Healthcare2U’s system, so you receive continuity of care no matter where you are.

If you’re interested in learning more about how DPC can give you peace of mind for you and your family while you travel, click here.