BenefitsPRO Expo preview: How direct primary care is revolutionizing health care 

Join Andy Bonner and Nathan Houghton for their Motivation session, “The Direct Primary Care Revolution: What’s Next“ on May 1, 2024, at 9:30 am.

There are roughly 142,927 health insurance agents currently employed in the United States. How will you stand out?

Health care, and how individuals receive it, has been at the forefront of public concern for many years. Now, more than ever, a priority should be placed on discovering solutions to address the incomprehensible challenges impacting this nation’s health care system. Direct primary care (DPC) holds the potential to improve the way Americans access and experience health care. An article published by Medical Economics says DPC memberships are seeing an average annual growth of 36%, reaching a total growth rate of 241% from 2017-2021. 

Not only can DPC change how Americans access health care, it is also a game-changer for benefits advisors. It provides an easier, more accessible health care option that brokers can sell the membership year-round, even during the off-cycle season. No more waiting until open enrollment to start selling!

DPC has been around for many years. Today, it is gaining momentum as a viable alternative to the traditional fee-for-service health care system. It shifts the focus from the complications of insurance billing to the heart of health care itself: the doctor-patient relationship.

During a session at the upcoming BenefitsPRO Broker Expo in Colorado,  Nathan Houghton of One Medical and I will be discussing why we should continue to promote DPC options for employers and how seven main tenets of DPC are revolutionizing the health care industry.

1. Patient-centered care: DPC puts patients first. In a traditional health care system, patients often feel neglected and lost in a maze of paperwork. DPC changes that; it provides patients with a direct and personal relationship with a primary care physician. Doctors can spend more time listening to patients and understanding their concerns. This approach enhances the physician’s knowledge of the patient’s health history and lifestyle, enabling them to better deliver personalized care. This open dialogue encourages patients to continue regular visits with a physician, leading to routine health monitoring that can be beneficial in the early detection and treatment of serious issues.  

2. Accessibility: One of the most frustrating things about scheduling an appointment with a doctor is the lack of availability on a physician’s schedule. Oftentimes, individuals must wait weeks if not months to be seen. One advantage of DPC is that a member can usually  see a physician within a few days. This ensures that individuals and families can access health care quickly and without the fear of navigating the claims process, receiving surprise bills, or the need for extensive insurance coverage. When coupled with an offering of virtual care, it’s a model that makes health care accessible and affordable for everyone. 

3. Preventive care: With better access to physicians, DPC improves the frequency with which patients see a provider. Proactive monitoring of their health can reduce their health care costs down the road. Through DPC, members receive regular check-ups and screenings to help guide them through and keep them informed about their personal well-being. Continual monitoring of chronic health conditions, and the discovery of serious health issues before they become severe, helps prevent costly treatment and possible hospitalizations, a cost no one wants to incur.  

4. Quality of care: Unlike traditional health care where doctors are overwhelmed with processing patients quickly, primary care physicians in a DPC model have the flexibility to spend more time with their patients. It allows them time to truly engage and delve into their concerns and ailments. This leads to more accurate diagnoses, strategic treatment plans, and improved patient outcomes. When doctors are not burdened by paperwork and insurance requirements, they can concentrate on providing an enhanced patient experience.  

5. Cost-effectiveness: When you consider the cost of one urgent care visit or emergency room visit, often in the hundreds of dollars, the cost of a one-year DPC membership is negligible. According to the Society of Actuaries Report, Millman Study, DPC members experience approximately 40% fewer emergency room visits than those in traditional plans. 

6. Enhanced doctor-patient relationships: As previously mentioned, DPC fosters a strong doctor-patient relationship built on trust and communication. Patients have more time with their primary care provider, so the access to care is enhanced. DPC also leads to extended appointment times, minimal wait times, and a more intimate relationship with the health care provider.   

7. Reduced administrative burden: In a fee-for-service model, health care providers are burdened by dealing with insurance companies and coding complexities. This can lead to “bad debt” that is made up of two components: insurance companies reevaluating charges at a significantly reduced rate or patients not paying their share of the bill. DPC eliminates the claims process and allows doctors to focus on what they do best: providing medical care. 

It’s important to note that DPC does not replace health insurance, but is a great complement to traditional insurance health care plans. Patients still need insurance for specialized care, hospitalizations, and emergencies; however, by covering primary care through a DPC model, we can make health care more accessible, efficient, and affordable. 

Andy Bonner is president and CEO Heathcare2U.