How Direct Primary Care Providers are Bringing New Meaning to Healthcare Accessibility  

Food on My Mind
January 25, 2018

The Current Healthcare System

Consider your most recent visit to your primary care provider. Did the scheduler know you? Were you able to see the provider you chose? How long did you wait? How much time did you have with your provider? Did he or she know you? If your experiences are like millions of other American patients’ experiences today, the answers to these questions will likely leave you frustrated. Perhaps you weren’t able to choose your doctor or your appointment time; nobody recognized you at your primary care clinic; and your appointment was rushed and impersonal. However, because you’ve experienced healthcare that looks like this for so many years – perhaps even your entire life – you’ve never taken the time to ask yourself, “Am I satisfied?”

Although many would agree that the nascent healthcare system met patient needs, much has changed since the pre-insurance (think Dr. Quinn, Medicine Woman) days. Although your primary care doctor likely aims to provide you with the same call-me-anytime level of service, the restrictions placed on primary care clinics (all clinics, for that matter) by insurers make it all but impossible to deliver.

Today’s system of healthcare delivery is more complicated than ever before. Providers need a full team just to submit and process insurance claims, and despite this investment reimbursement remains low. Because of low reimbursement, providers need to conduct medical practices at a high volume of patient office visits each day. A high daily patient load produces serious problems: increased wait times, shortened appointment times, rigid structure, rushed environment, and inability to address multiple diagnoses or issues in a single appointment. Additionally, extensive and costly testing is often mandated before measures can be taken to improve health and wellness. Each of these factors contributes to the way you experience healthcare today: poor access to the providers you want, high costs – of both insurance and healthcare, lengthy wait times, rushed appointments, and perhaps most importantly, lack of personal care.

No clinic can operate without financial viability, and today’s system of healthcare has made it impossible for traditional clinics to achieve both real, quality patient care and financial viability.

Breaking Away from the System

As a Direct Primary Care practice, Boston Direct Health has been founded to right the wrongs in the healthcare system and bring the focus in medicine back to lasting patient wellness. Direct Primary Care, also known as DPC, aims to address the factors patients value most when it comes to healthcare: the doctor/patient relationship, the convenience, the cost, and the outcome.

The direct primary care movement began nearly 20 years ago and has revolutionized healthcare for participating patients. How does direct primary care work? It’s quite simple: patients pay an affordable monthly or annual fee to become members and receive access to a wide variety of wellness, preventive, and problem-focused services and benefits at no additional cost per appointment or service. If you’ve heard of concierge medicine, you may be wondering if there’s a difference between that model and the direct primary care model, and the answer is yes – concierge medicine charges a membership fee to free up longer appointment times but still collects on each visit.

Direct primary care providers create memorable experiences, positive patient outcomes, and significant cost savings for their members by focusing on these critical aspects of direct primary care:

  1. Exceptional patient service characterized by long-term relationships, extended hours, short or no wait times, and extended appointment times.
  2. Elimination of the volume-over-value culture in healthcare by elimination of fee-for-service incentives.
  3. Complete transparency when it comes to scheduling, pricing, medical decisions, and every aspect of your care.
  4. Robust patient advocacy that ensures you’re fully informed and your expectations are met or exceeded throughout every step in the system, including when you’ve been referred to an outside expert.

Boston Direct Health isn’t the first organization to offer this service in Massachusetts. As a matter of fact, several other clinics have successfully implemented direct healthcare services, achieving high patient satisfaction rates while maintaining low patient costs, including GoldDirectCare and Infinity Family Medicine.

So, what’s the catch?

Like most things in life, direct primary care offers extensive benefits but also poses some challenges, both for the provider and for the patient. First, patients who choose direct care membership aren’t able to completely forego their health insurance policy; they need it to satisfy the Affordable Care Act requirements and to cover services that aren’t provided in their direct care clinic, like hospitalizations and major surgeries. This means most patients can decrease their monthly premiums by choosing a major medical policy, but still have to maintain health insurance. However, even with health insurance, particular Health Maintenance Organization (HMO), patients may find it difficult to satisfy their insurance carrier’s demands for referrals and other formalities when they receive care from a direct care clinic due to their independent nature.

Major insurers like Medicare directly drive quality standards in clinics and hospitals. As a matter of fact, along with profit, quality is often a requirement for participation with carriers and the “culprit” for rigid, cumbersome, and costly rules and regulations. Direct primary care clinics have to find a way to leverage the freedom from insurer bureaucracy with quality to ensure that patient safety and satisfaction remain high without the rigidity.

While these factors may at first glance seem to be necessary evils associated with Direct Primary Care, it is important to note the ways in which they can be navigated to provide each patient with the best care possible. Having an accessible provider that can spend more time identifying and meeting your needs often times decreases the need for urgent care visits, referrals to specialists, and emergency room visits. However, if you would still like the added security of a health plan, opting for a PPO health plan can do away with any red tape when it comes to referrals. With a PPO, patients have peace of mind while enjoying the freedom to find suitable care. Pairing a lower premium plan of this type with a DPC membership can actually reduce your healthcare costs, considering that having a DPC provider can obviate many exorbitantly priced medical visits and procedures.

Choosing a direct primary care provider

Boston Direct Health was founded with a single mission: to provide excellent care that’s both accessible and affordable. If you’re ready to see a provider who is relentless about whole-person wellness, transparency, and authentic connection between doctor and patient, schedule a consultation with Boston Direct Health today

Wishing you health and wellness,
Dr. Zivich

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