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Direct Primary Care Delivering Lower Costs, Better Patient Experience

October 12 | 3 mins

Personalized health care. Lower costs. No insurance claims.

Driven by market forces and demand for personalized quality health care, direct primary care is growing across the United States.

The direct primary care model provides an affordable, meaningful alternative to fee-for-service medical insurance billing. While “concierge” care is often characterized by hefty retainers, direct primary care is an affordable alternative for individuals and employees of companies of all sizes.

Direct primary care – or DPC – provides an alternative to medical insurance as the company or individual pays an affordable monthly fee that covers the treatment of acute and chronic illnesses and preventative care.

“Direct primary care benefits patients by providing substantial savings and a greater degree of access to, and time with, physicians,’’ according to the American Academy of Family Physicians.

With direct primary care, no claims are filed with the employer’s health plan. When compared to the traditional fee-for-service model of the medical insurance world, direct primary care has the potential to provide better medical care for patients while reducing the paperwork and administrative red tape associated with filing insurance claims.

In managing insurance claims in a fee-for-service model, the traditional primary care physician’s overhead costs usually run as high as 60 percent of monthly collections. At the same time, physicians typically see more patients to cover overhead with less time spent with each patient.

Because of these challenges, more and more physicians are selling their practices to hospital systems, retiring early or converting their practices to a direct primary care model. The direct primary care model provides several benefits.

More quality time with a physician

By avoiding the bureaucratic complexity of health insurance, more time can be spent on treating disease.

Physicians can dedicate more time to each patient, which enables a more thorough discussion of health issues and helps mitigate patient anxiety.

For example, a patient scheduled an appointment to be evaluated after months of abdominal pain. With concerns of everything from cancer to inflammatory diseases of the colon, the patient was seeking a referral to a specialist to undergo expensive colon testing and a CAT scan of the abdomen. After a thorough evaluation and exam with simple blood tests, it was clear the patient’s abdominal problems stemmed from multiple life stressors. Prescribing medication – which cost about $4 per month — significantly improved her life.

Financial savings

When diagnosing illness, a little extra time in the examination room can save thousands in health care costs. A little extra time can help a physician get to the root of the problem, which often eliminates the need for pricey specialists, surgical procedures and expensive medications. This helps keep health care costs low for both the patient and the employer by reducing the claims filed against an employer’s health insurance plan. At the same time, healthy employees take fewer sick days – which flows to the employer’s bottom line.

Health care advocacy

Direct primary care improves the physician-patient relationship and enables the physician to be an advocate for the patient – including making specialist referrals only when needed and prescribing less expensive generic medications when appropriate.

At Healthcare2U, our team of doctors acts as health care advocates for employees and employers in reducing the number of unnecessary tests and procedures as determined by the American Board of Internal Medicine Foundation’s “Choosing Wisely” campaign.

“It is urgent that health care providers and patients work together and have conversations about wise treatment decisions,’’ according to Choosing Wisely. “That means choosing care that is supported by evidence showing that it works for patients like them; is not duplicative of other tests or procedures already received; won’t harm them; and is truly necessary.”

A health care advocate can make a huge difference in helping to prevent adverse outcomes that can arise from prescribing medications or unnecessary procedures.

A healthier and engaged patient

With greater access to health care and a doctor-patient relationship – particularly with employer-sponsored direct primary care programs – it is important for patients to get a biometric screen for any risk factors. By focusing on prevention, chronic diseases like diabetes, hypertension and heart disease can be identified early and aggressively managed to improve the patient’s life and help prevent future hospitalizations and catastrophic events such as a stroke or heart attack

Direct primary care is redefining the delivery of medicine and is key to achieving lower costs, better health outcomes and an improved patient experience.

Direct Primary Care Delivering Lower Costs, Better Patient Experience

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