Direct Primary Care

Editor's Note: Insights for this article were from a discussion with Dr. O'Boyle, Family Medicine M.D., and were combined with the thoughts and opinions of the author.

In a world of over-complicated healthcare causeways, we as patients are left to trudge through the muck. As patients, we are often pushed around within the “network” that we are subscribed to via insurance. We are told what doctors we can see or, what medications we can take and how much we will pay, to pay more later. If we can choose our other subscriptions, like cable and music streaming, shouldn’t we be able to pick our healthcare subscriptions? The answer is, yes, we should--and we can.

There are many doctors that are as fed up with the system as patients are; those that have chosen to leave the systems that limit the quality of care and connection with patients. It’s a renaissance, a redirect towards care that’s for the betterment of the patient. It’s called, the ‘Direct Primary Care’ model, this is an article on what it's all about.

What happened to the health care industry?

In short, what happens to every industry happened in healthcare: conglomeration. The healthcare industry developed networks of doctors, backed by universities, funded by pharmaceutical companies and then subsidized to the patient through health insurance subscriptions that allow access to the networks. The result is a really complicated system that is difficult for patients to understand. However, many of us know the consequences.

Insurance holds so much power over a patient's care and often prioritizes other motives before a patient's health. It’s a system that seems to benefit everyone involved, except the community of patients that it's meant to serve. Too often, patients are told their insurance won't cover a medication that works for them or they lose their insurance because of changing jobs. There are other options though, but you won't see or hear their advertisements anywhere, they don't have the extra money for that; which is good.

What is direct primary care?

Direct primary care is all about transparency and quality care for the patient, with a direct and open transaction. It cuts insurance out of the equation. As a result, patients are told the prices of every service upfront, before care is administered, like a menu at a restaurant. You know exactly how much a service costs before you are billed for it.^1,2 There are no co-pays, but it’s more affordable.

How can that be?

It’s simple: cut out the 'middle-man’ and they don’t need to be paid.¹

Without insurance being involved, there's no reason for extra money to go to them because they provide no service. Also, with insurance not deciding what medication they want to pay for, that power and decision rests entirely with the patient. So, the patient pays less for the service that they choose, but the doctor actually makes more for the service; the beauty of direct transaction.

The motivation for most DPC doctors is not entirely money, though. Many chose to be doctors to care for patients, but, because of quotas set by medical institutions, they could only spend a short amount of time with a patient, limiting their ability to form a relationship and partnership in healthcare. So, many chose the independent DPC model, so that they could be more effective as doctors.¹

How does it work?

Like a subscription! Many DPC doctors have a monthly subscription model. With this subscription, the patient is covered for all check-ups and most services. While each doctor is different, in many cases, the deal is pretty sweet--especially because you aren’t navigating how much your insurance will cover or mysterious bills that come weeks later. Everything is transparent and you know, before you get treatment, how much it will cost and why.^1,2

What about surgery, imaging and specialists?

Something that insurance has always been helpful for is covering the expensive cost of surgical procedures and imaging. Although, these services are not exempt from the DPC model. Most often, there are specialists and imaging centers within a local network of DPC doctors, all working with the same price transparency.

There are even surgical centers that operate with the DPC model. The Surgical Center of Oklahoma, for example, offers a wide variety of procedures, with all prices listed online. That means there are no hidden costs; every bit of the procedure and hospital stay is covered under one price, which can be financed.¹

Who is direct primary care for?

Every day people struggle with the mess that insurance makes of their health care. Patients lose access to the medications and network that work for them because of a change of insurance policy or the loss of a job; things that are totally out of their control. This is a model for any patient who wants more control over their healthcare at a more affordable cost. It's a possible solution for those without insurance, those that want transparency and simplicity, as well as those who want a closer relationship with their doctor.

If you are interested in looking for a direct primary care physician in your area, there are resources like DPC frontier that can help you find a good fit for you.

If you are struggling with navigating the healthcare labyrinth, know that you're not alone. Many people struggle with and are subject to the unpredictable and expensive system. Also know that there are other options, like DPC, that can help. However, because they are smaller, localized, and independent healthcare systems, it might take some research to find the best one for you. Now you know, and knowledge is powerful.