What is the Value of DPC?

Direct Primary Care (DPC) is a relatively new model of care where a physician directly cares for, communicates with, and bills a patient. I wrote about DPC on my blog earlier this year, and it would probably be good to read that before reading this. I won't get into the details of what DPC is in this as much as why I think it is a good investment for almost anyone, both for their health and financially. 

Full disclosure, I'm joining a DPC practice this summer because I truly believe in it! The DPC I am joining has the following features:

  • Physicians provide primary care to patients for a set monthly fee
  • Typical services
    • Unlimited visits with no co-pays or hidden fees
    • Annual screening labs are included
    • Imaging, labs, and medications are offered for near or at-cost cash prices 
    • Same day and next day availability
    • Patients have direct (text, call, email) access to their physician
    • Wide scope of care
      • General wellness: annual physical, lifestyle counseling
      • Women's health: birth control, pap smears, etc.
      • Infections: pneumonia, UTI's, strep throat, ear infections
      • Orthopedic: Minor fracture care, joint injections, gout 
      • Skin: lesion removals, eczema, toenail removals, suturing
      • Chronic disease: hypertension, diabetes, etc.
      • Mental illness: counseling and medications
      • And much more
  • DPC is not medical insurance (and insurance is not health care)

"Why Should I Pay MORE For Health Care?"

You shouldn't, and you don't have too. You can actually save money with DPC! Here's how: STOP PAYING SO MUCH FOR MEDICAL INSURANCE. Hey, don't get me wrong, insurance can be great. My family has gone through some real hairy stuff this year and insurance has saved our butt from financial ruin. 

And that is what insurance is for: surgeries and hospitalizations, the big unexpected bills. We are insuring ourselves that if something bad happens, someone will help us pick up the tab. But what about staying healthy? Insurance tells you what doctor you can see and makes you pay a fee to see them. If anything is ordered (labs, xrays, etc.) you are on the hook to pay for part of that until you've spent several thousand dollars and met your out-of-pocket maximum. 

Notice I haven't used the phrase "health insurance" as that is a silly thing if you think about it. You aren't insuring your health, you are insuring yourself for medical expenses. Medical insurance is not health care! It is access to the insurance driven medical world we have become accustomed to for all of our health care needs. 


So, back to the point. Stop paying so much for insurance. Opt for a lower monthly premium "high deductible" plan, and supplement this with DPC. In 2018, an un-subsidized bronze plan on healthcare.gov cost $163 less a month than a gold plan according to eHealth. Most patients have subsidized insurance through their employer, but can still save significant dollars on changing coverage. The Affordable Care Act requires bronze plans to cover 60% of medical costs, silver to cover 70%, and gold to cover 80%. So no matter your plan, you still pay a portion of your bill. For example, if you get into a car accident and break your femur, you're gonna pay a few thousand out-of-pocket. Yes, the gold plan will be less out of pocket at the time of the accident, but you paid $2000 more for it in monthly premiums in one year. And don't forget, medical debt has no interest and can therefore be paid off over a long periods.

DPC patients can still utilize their insurance, for instance:

  • If a woman wants an IUD like the Mirena, they can get it 100% covered by most insurance plans. Pap smears are also covered. 
  • Colonoscopies and other cancer screenings are covered by most insurance plans.
  • Patients can continue to see their specialists who bill the patient's insurance.
In other instances, a patient may choose not to use their insurance. For many scans like X-Ray and MRI, it may be cheaper for the patient to utilize the cash price offered by the DPC than to pay the insurance co-pay, especially if they are unlikely to reach their yearly deductible. 

DPC physicians can help you stay healthy, stay out of the ER, and keep you from getting a big bill at an urgent care. They can help you stay on top of your blood pressure and help you stop smoking. They give you access to deeply discounted medications and testing. Most importantly, you have a primary care physician who will care directly for you. 

As a colleague once told me, "you either see the value in DPC or you don't." So, let's stop talking about its financial merits. The real benefit to DPC is the relationship one can build with their physician. A typical primary care physician in the insurance model has a patient panel of 2000-3000 patients, whereas a DPC physician has a panel ~600 patients.  Visits are easy to schedule, with same day and next day availability. Patients have access to their physician's cell phone and email. A new patient's history and physical exam is usually an hour or more, office visits are usually 30 minutes. All of this allows your physician to get to know you well. Building trust and understanding with one another is key to successful health care. 

Thank you for reading this blog on the value of DPC. I hope to announce soon the DPC practice I am joining. Follow me on instagram and twitter for updates. 

Useful Links

For physicians interested in DPC, check out DPC Alliance, a physician organization devoted to the growth of DPC. Also check out the AAFP FAQ on DPC. 

If you have any comments or questions, please leave them below. You can find my Instagram, Twitter, and LinkedIn at il.ink/hazenshort

Hazen Short is a resident physician in Family Medicine, graduating in 2019. He plans to start practice in Kansas City in Direct Primary Care.


Comments

  1. Really nice article and I agree with DPC being a "good investment". I do disagree with the solution of pairing it together with a high deductible (Bronze) health insurance plan for many people. Those that are in need of pre-existing condition coverage or receive a financial subsidy this makes sense. For those that do not qualify and are considered healthy can do this much more affordable with medical cost sharing + DPC.
    I feel its important for DPC practices to make this recommendation to its members not only for the benefit of the DPC, but also their member. A lower expense and better solution for catastrophic coverage benefits both sides. This particular one does a great job of pairing and working together with DPC practices https://zionhealth.org/direct-primary-care/
    Good luck in your new venture!

    ReplyDelete
    Replies
    1. Thank you for reading! Yes, I agree with cost-sharing plans being a great option. I will likely write another blog specifically about these plans, and I will update this post to point them out as a great option.

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