by Davis Graham
A primary care provider or an agent of a primary care provider is not required to obtain a certificate of authority or license under the Florida Insurance Code to market, sell, or offer to sell a direct primary care agreement…This agreement does not qualify as minimum essential coverage to satisfy the individual shared responsibility provision of the Patient Protection and Affordable Care Act. Signed into Florida law, March 23, 2018
Our healthcare system is analogous to the American diet. It’s a known fact that 6% of our salt intake comes from the salt shaker, 10% naturally in foods, leaving 84% of our salt intake comes from convenience. We have given our diet over to processed foods, just like we have given our healthcare to our employer, who in turn has given it to insurance companies for convenience. It has become unhealthy.
There is a triple aim approach, coined by Donald Berwick, MD, to take back our health care. The three achievable goals: improve the experience of care, improve the health outcome, and reduce health care cost. There is an innovative model available allowing us to achieve the triple aim goals and start to make our health care healthy called Direct Primary Care (DPC).
Primary care doctors are one of the most important decision-makers we have in health care, yet are also one of the lowest paid in the industry. According to Forbes magazine, 74% of healthcare can take place in the primary care space and this is where quality medicine starts. Quality healthcare starts with a patient-physician relationship, while healthcare regulations have been trying to regulate the patient to the network provider in hopes they will regulate their behavior.
DPC was permitted under the ACA, also known as Obamacare. DPC starts by putting the patient back in charge of their money and the product they purchase. The membership fee or a subscription fee is between a patient and the physician or a corporation and a physician. Membership fees range from $50-$150 per patient per month, in some cases lower than a mobile phone bill.
This relationship between patients and a physician allows for communication to be clear and understood. Dr. Gross in Northport, Florida provides 25 office visits which include a wellness visit including labs all for $60 a month or $720 a year. DPC doctors can start to explain to their DPC patient the “chargemaster” bill they received for a CT of Abdomen and Pelvis w/o contrast of $2,212.00 from a hospital is drastically inflated. The hospital, in reality, is paid a global fee (everything included) by Medicare for the CT Abdomen & Pelvis w/o contrast only $217.72 in Florida, while the insurance companies pay even less.
Now the unhealthiness of our health becomes real when we receive increases in premiums and in deductibles. The average deductible in Florida for a bronze ACA plan is capped at $5,861 for an individual and $12,186 for a bronze family plan. There is no reason someone would not want to pay $720 a year on the west coast of Florida or even traveling to North Port, Florida for retaining a primary care physician for less than most health insurance deductibles.
The DPC model operates outside of “health insurance,” while it is important to have umbrella coverage for chronic disease or to cover hospitalization like a designated “health care sharing ministry” starting at $45 a month. For a corporate self-funded plan to incorporate the DPC model, the plan becomes a healthier model because of access to a primary care physician with significant savings.
In America, we pay one of the highest costs of healthcare per person in the world, yet the US is rated 37th in terms of quality. We are in a crisis in healthcare and the DPC model is one solution which makes sense. We need to put our money where quality will count and the quality of our health care be directed by what we pay. We need to think DPC while the old system begins to fade away.