What is Direct Primary Care? (Part 3 of 3)

This post will conclude my three-part series, “What is Direct Primary Care?”  In the first post, I defined Direct Primary Care (DPC) and talked about the first of three distinctives that will set CovenantMD apart from other practices:  adequate time with your doctor.  In the second post, I talked about access to your doctor.  In this post, I’ll talk about value in primary care. 

Photo by Brian Jackson/iStock / Getty Images
Photo by Brian Jackson/iStock / Getty Images

I’ll start with a question that I often get when I present the idea of Direct Primary Care:  “Why should I pay twice for my health care?”  In other words, people ask why anybody would pay insurance premiums AND Direct Primary Care fees.  Why not stick with insurance and see a doctor that is “in network”, so that you pay only once?

My answer to that question is that they, most likely, are ALREADY paying twice.  They are paying the first time when they pay their insurance premiums.  (Though for some, their employer or the government is paying for or subsidizing this “first payment.”)    Then they are paying the second time when they pay for anything else related to medical care, whether or not it goes toward their health insurance deductible.   For many people this “second payment” has increased in recent years due to a) higher deductibles, which they have to accept in order to try to keep the first payment (health insurance premiums) from breaking the bank, and b) more "cost sharing," i.e. health insurance companies shifting some of the cost of care to the patient.  

So here’s the key question:  How do you keep that second payment (the money you continue to pay out for medical care after you pay your insurance premiums) as low as possible, and yet continue to enjoy high-quality medical care?  Enter Direct Primary Care, which not only offers low costs for the second payment, but can help to control them for the first – if you pair DPC with a lower-premium, higher deductible insurance plan.

“Wait!  You are suggesting that I pick an insurance plan with a high deductible?!  Yikes!”  If the prospect of having to pay cash for more of your medical expenses causes you anxiety, you are not alone.  But I think times are changing.  I think we are moving into the era of the self-pay healthcare consumer.  This is occurring because, as deductibles get larger, and people are beginning to pay out-of-pocket for their medical expenses, they are beginning to realize that there are tremendous savings to be had if they pay cash for the common stuff, and reserve their health insurance for the uncommon, expensive stuff (just like auto and homeowners insurance – go figure!)  The fact is that doctors and other healthcare entities that are freed from negotiated, often price-inflated health insurance contracts are less expensive than their insurance-taking contemporaries.  

So back to CovenantMD.  What are the ways that we can provide value for your medical care, thus saving you money on the “second payment’ while still providing high-touch, high-quality care?  We will not charge a copay for any office visits -- you will no longer be DISincentivized to come to the doctor over fear of medical bills.  And if you want to just call your doctor with a question, or text a picture of your rash, or arrange for an e-visit, you can.  (In most practices your doctor doesn’t make any money unless you come into the office, so they are not inclined to “waste their time” talking with their patients on the phone.)  We will offer an in-house pharmacy of greatly discounted medications.  For some of our patients, the savings on medications might just pay for their membership.  We also offer greatly discounted labwork, with many common lab tests, like cholesterol panels and hemoglobin A1c (a test for diabetes), offered at no additional cost to your membership (see sample medication and lab prices here).  And if you have a chronic disease, like diabetes, you will have plenty of time with your easily-accessible primary care doctor to keep it under control so it doesn’t land you in the hospital.  Our after-hours availability might save you an Urgent Care or ER visit.  And we will do house calls and worksite visits, saving you the time and expense of piling the rug rats into the car, or potentially missing that project deadline. 

Now, remember I mentioned that Direct Primary Care can also help you to lower costs on the “first payment” – your health insurance premiums.  This is best illustrated with concrete examples, so take a minute and visit our Cost Benefits page, where we consider a year of medical expenses for a family of five in Lancaster County under three different scenarios, a “platinum plan” with no deductible, a “bronze plan” with a high deductible, and a “bronze plan” paired with CovenantMD. 

Since March 2015, when I decided to begin making my dream of creating a Direct Primary Care practice a reality, we’ve seen many instances in the lives of our friends and family in which they would have greatly benefitted from the convenience and cost savings of Direct Primary Care.  One such instance was a friend who suffered a gash on her leg.  She had to go to the ER to have it stitched up.  When all the bills had finally trickled in, her family was sidled with an $1800 bill, despite the fact they have health insurance!  The same injury could have been treated at CovenantMD for $20 (our fee for stitches).  What she ended up paying to the ER would have purchased more than a full year of primary care for her whole family at CovenantMD.  Another example was my wife, Lynn’s annual preventive visit.  On the day she went, she did not have a copay (as insurance plans must provide one preventive visit per year without a copay).  But because she had routine labwork performed, and because she needed a referral to a specialist for a procedure, the bill came to about $500.  Despite the fact that a Direct Primary Care practice would still have needed to refer my wife for that procedure, such a practice would have saved my family a lot of money on these visits.  Finally, my 4-year-old son, Nathaniel, had a well-child visit recently.  We were billed $50 for a vision screening which took a medical technician about 5 minutes to perform!  

If you are considering CovenantMD for your family, and you've looked at the Cost Benefits page as I suggested above, you may find that there may be years in which you might pay a little more for your family’s healthcare if you go with CovenantMD -- those years in which you were blessed with very little medical expenses.  But there will be other years that you might come out way ahead, especially if we can save you from an Urgent Care or ER visit, or arrange an MRI for a fraction of what you would pay through your insurance (and without the hassle of convincing your insurance company of the necessity of the study!)  And if you come out roughly even on paper, wouldn’t you rather do it with a doctor that can offer all the amenities of Direct Primary Care?

I’ve been mainly addressing individuals and families in this post, but the same cost savings can be had by employers.  If you think your employer needs to hear about Direct Primary Care as a potential health benefit for their workers, steer them to our For Employers page, or give them our contact information.  We would be happy to speak with them!

So that wraps up my three posts on “What is Direct Primary Care?”  If you have any questions, or if you think there is something I didn’t address, comment below, or give me a call at 717-287-1983, or shoot me an email at pmr@covenantmd.net.  I would also be happy to sit down with you and talk Direct Primary Care in person.  Join our email list, or check back often for updates as we move closer to opening our doors in January 2016!