Is Direct Primary Care Worth It?
Many people these days have never heard of Direct Primary Care, till now it's a model that has gone mostly unnoticed and in the public eye may just be a fad. This could not be further from the truth, however. So the question is, is Direct Primary Care worth it? I would say that the answer is without a doubt, yes. Before we can go into why it's worth it, it is important to understand what it is and how it works. In a very simplistic form, Direct Primary Care works by separating the income for a medical practice from the services that are provided. That’s really all it is! This simple mechanism is what allows a practice to stabilize their income regardless of how many services are provided and has a wide array of implications. This means that it doesn't matter how many patients a provider sees in a day, it doesn't matter how many times a patient comes to the office, it doesn't matter if they called or texted, it doesn't matter if they received procedures or various other services - the income for the practice is the same. In Direct Primary Care, we utilize a monthly membership plan and then can offer our services at drastically reduced prices. Some Direct Primary Care practices offer their services at no cost, some at discounted prices, at Starlight Health we only charge for the cost of inventory and materials used during your treatment with no additional markup. For those that are unaware, this type of billing mechanism is not possible in the traditional fee-for-service model. In the traditional system, built into the pricing structure of every service and procedure that is done includes all of the marked-up costs and overhead expenses associated with it. Because of that, on average there is an approximately 3000% markup for every service that is provided above the cost of materials to treat you. But with a Direct Primary Care membership, that markup is fixed to a single monthly fee and does not change no matter how much care is provided. This is how patients can stabilize the healthcare expenses for an entire year and drastically reduce the total expense they would've paid during that time. Additionally, since the membership pays the salary of your healthcare provider and there is typically no extra cost to see them, sometimes a visit may not even be required and a simple text message is all that is needed! (Yes you read that correctly, if we don’t have to bill you for a visit, then a text message may be all that is required!) It also becomes much easier to see them for preventative measures and maintenance checkups than what could've otherwise been afforded. Members of Direct Primary Care programs across the nation are finding that increased access, time with their provider, preventative health screenings, and education about important healthcare concepts is leading to healthier lives and lower costs.
One of the big takeaways that you want to get when thinking about Direct Primary Care, is that there is a difference between healthcare and health insurance. The two terminologies are not the same but are often used interchangeably. Health insurance, is what we are traditionally familiar with, it is a monthly payment that you pay to an insurance agency to protect you against major catastrophic events. Typically, there is a premium and some sort of deductible before the insurance will take effect. HealthCARE on the other hand is the actual care you receive regardless of your insurance status. Between the premiums of health insurance and deductibles, the average individual in the United States must pay out between $8000-$10,000 per year before their health insurance takes effect and any healthcare they receive is done out of pocket until that out of pocket limit is met. On the other hand, receiving healthcare from a Direct Primary Care means you can get your services immediately with a single monthly membership fee and at drastically reduced prices on services. Healthcare you receive from a Direct Primary Care provider can be received for the same discounted prices regardless of if you have or don't have insurance. The way that Direct Primary Care's work and can save patients money for insured patients is by operating within their high deductible cost of traditional health insurance. We recommend having a policy that will protect you for any kind of catastrophic event but has a large deductible (Example: >$8000) for you. By supplementing your insurance policy with a Direct Primary Care membership and by paying directly out of pocket with the prices we have, you can save thousands each year without ever touching your insurance deductible. This is what I do personally, I have not used my insurance for anything - including office visits, labs, or any imaging studies in years because I know I can get it cheaper out of pocket. And while yes it is a risk of potentially paying more in the given year because I'm going out of network and outside of my insurance to get the care, the fact remains is that from year to year I'm saving money. Even if I had an event that caused me to pay out more this year I would still save more money in the long run as the years go by.
So back to the original question, is Direct Primary Care worth it? Honestly, this is something that you have to ask yourself. Is it worth it to you to have a healthcare provider that you can call or text anytime and know that they will answer your question? Is it worth it to you to know that sometimes you may not have to go in for a visit and a simple text is all that is required? Is it worth it to you to know that your healthcare provider could come to your home or work and meet you wherever you wanted to go? Is it worth it to you to know that you can be seen on the same day or the next day for up to 90 minutes at no extra cost? Is it worth it to you to know that you can stabilize your healthcare expenses throughout the year and make it less likely to have a catastrophic event that you can budget for? Is it worth it to you that you have a healthcare provider who can see you no matter which insurance you have, and can be there for you for years to come? Direct Primary Care allows us to form a personal relationship with our patients and allows us to save them money when it counts. And while there is a baseline cost for the membership, the amount of care you can receive with it is far beyond anything you could receive in the traditional system. I believe that Direct Primary Care is worth it, the question is, what is it worth to you?
Jason Rogers, PA-C
President, Starlight Health