Healthcare is affordable today (if you know where to look)
Looking for some good news amid all the pandemic headlines? Here it is—direct primary care is meeting the health care needs of more and more Americans, at an affordable price.
Direct care makes health care more affordable because it’s transparent in pricing, eliminates unneeded middlemen, and leverages technology to communicate (through telemedicine).
Some will say that direct primary care (DPC) is just a concierge service for the wealthy. Nothing can be further from the truth, as employers, Medicare and Medicaid beneficiaries, and those finding themselves uninsured due to job loss from the government-induced economic shutdowns, have discovered by joining a DPC practice. Concierge and corporate models differ from DPC because insurance is still involved in the equation. The D in DPC stands for direct—and that means both the clinical and financial relationships are between doctor and patient, with no middlemen.
The movement in direct care has expanded into other service lines as DPC has grown substantially over the years. Specialists, imaging services, surgical procedures, and now prescription medications are being included, as opting out from third party insurance for these services allows providers to offer substantially lower rates, making needed care options affordable for patients.
The key elements that make these offerings game changers are their ability to post pricing publicly, deal directly with their patients without interference from a middleman (think insurance or government agency) and the freedom to communicate remotely via apps similar to text messaging and video conferencing.
There is currently a battle going on between the Trump Administration and the American Hospital Association. The President issued an order to make negotiated prices between insurers and hospitals publicly available and easy to access. The hospitals and insurers claim that posting prices will be confusing to the American public—but this practice is one of the reason why direct care models are continuing to thrive. If you’d like to know the cash price of a CT of the abdomen without contrast or the bundled price of a surgical ACL repair, you simply need to go to the websites (referenced above) to know before you go. Without transparent pricing, market forces are limited at best.
It’s important to know these negotiated rates because they often are far more expensive than if the patient were to pay cash. In addition to the financial savings to the individual, there is less bureaucratic heartburn associated with all of the hurdles posed by the insurer or intermediary. Patients and providers are all too familiar with the headaches associated with preauthorizations and subsequent denials by insurance companies. These obstacles are eliminated when using direct care models because the patient is paying directly and making decisions based on the advice of their doctor.
Perhaps the greatest advance by Health and Human Services (HHS) this year as a response to the COVID-19 pandemic has been the remarkable progress made in telehealth. More people in the country have been able to access their physician and other medical professionals in a convenient manner from the comfort of their own home. This will certainly change the way health care is delivered in this country and how patients will interact with their doctors, especially in rural communities. Direct care models commonly use telehealth modalities and use the technology to maintain connection and community with its patients.
Transparent pricing, convenient communication, and a direct relationship are all hallmarks for a model that is proving to make healthcare less expensive, more accessible, and highly efficient for many Americans.
This is good news. Direct care is working, it’s growing and we need to support it as a viable option to fix our broken health care system. Health care is affordable today (if you know where to look).
David Balat is the director of the Right on Healthcare initiative at the Texas Public Policy Foundation.