B2B Payments

Are Primary Care Practices Ready To Ditch Insurance Companies?

Healthcare payments make sense to almost no one—a highly regulated and mediated system that sends money or promises for future money through so many hands and systems that every attempt at making them more clear, somehow makes them more complex and thus more opaque. Primary care physicians have a direct incentive to free themselves of the cycle of complexity, and are adopting a radical solution—cutting insurers out of the process.

So, what exactly is direct primary care, and why should medical organizations – and their patients – want to understand it?

According to Dr. Brian Forrest, CEO of Access Healthcare, direct primary care offers an opportunity for long term health care management with out the use of medical insurance: DPC is a different type of payment model. Instead of treating the purchase and management of health care costs as insuring against a disaster, instead DPC relies on a model for coverage that is more similar to a gym membership.

Essentially, patients pay a monthly fee that covers all services that can be handled in a family medicine practice, including lab tests, Forrest explained, as reported by AAFP. Should patients apply for a fee-for-service model in the gym environment, that would require a practice employee to follow the patient around and charge a fee every time the patient jumped on a machine.

Forrest explained that he decided to adopt the new model in the late 1990s, when he saw that he didn’t have enough time to treat all of his patients every day, and fully meet their needs. Now, the CEO said his practice is either paid a monthly fee by individual patients or by an employer that will often pay for one full year of care. According to Forrest, an insurance company has not paid him for 13 years. However, he said that approximately 50 percent of his patients have insurance.

“We’re not getting more out of the system,” Forrest observed. “We’re getting rid of the waste associated with getting paid.”

A ‘New’ Trend

The DPC is not a new idea, but according to experts in the field, it is definitely becoming more popular.

Dr. Chris Larson, who runs the Texas-based Austin Osteopathic Family Medicine, explained to Community Impact that doctors haven’t always used health insurance as a way to determine compensation. Larson said that patients used to have to barter for services, and that the industry is coming to a point where that is becoming popular again.

“There are a lot of unexpected things when you are the first [to do something],” Larson told the news source. “But as people hear and read more about [DPC] they will get excited because it offers things other clinics can’t.”

Direct MD Austin owner Dr. Michael Garrett agreed, saying that he thinks this model will really “explode in the next two to five years.”

According to Garrett, the DPC model reduces expenses and lets doctors spend more time on patient care, and less time on filling out forms and rushing patients so they can receive payment.

“I’m not saying this [model] has all the answers, but it is part of the solution,” Garrett told the news source. “It doesn’t solve all of the problems [with the current health care model], but it solves a lot of them. This is one way people can take control of their health care and save some money.”

A Changing Industry

Whether or not the DPC model will be adopted by all medical facilities in the U.S., one thing is definitely clear – the health care payments methods are changing.

Health care organizations are working to find options that benefit patients, as well as themselves. Earlier this month, PYMNTS.com discussed how Aver Informatics received $8.5 million in funding, which is expected to help the organization with its bundled payment options.

Aver sells software that it packages into “episodic bundles,” which are designed to simplify the payment process. It will then generate a bill for the entire process of treating a health condition, instead of producing a separate charge for each step in the process. Aver states that its software significantly shortens the amount of time to implement bundled payments using existing claims infrastructure.

So are “episodic bundles” the best choice? Or is it the return to the barter system? The answer won’t be answered overnight, but those in the medical field are working hard to find the solution.


Latest Insights: 

Our data and analytics team has developed a number of creative methodologies and frameworks that measure and benchmark the innovation that’s reshaping the payments and commerce ecosystem. Check out the February 2019 PYMNTS Digital Fraud Tracker Report

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