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Anecdotal data point about primary care: About a year or so ago I subscribed to "direct/concierge primary care practice". I pay $80/month and in exchange getti

Anecdotal data point about primary care: About a year or so ago I subscribed to "direct/concierge primary care practice". I pay $80/month and in exchange getting an access to a primary doctor who takes care of keeping an eye on me, my blood pressure, all my prescriptions (some of which used to require monthly visits to specialists). I am also getting access to really cheap prices on labs, typically 30 min visits same or next day if I wanted (unlimited visits per months), EKG when I wanted to put my mind at peace right there in the office ($25 one time fee), etc. Doctor is available over the phone, text or email. Does not dismiss me when I mention "I've read on internet..." something and actually explains things. Basically, I think it will take care of the most of my health care needs, as well as puts my mind at ease thanks to easy access to the doctor. The doctor also refers me to specialists who's cash-prices were often below my co-pays. For major accidents I still have a traditional health insurance with high out-of-pocket limit bought at the marketplace (self-employed). This practice existed for quite some time and thanks to the subscription-based fees (not episodic described in the article), I expect it to be a long-term sustainable business. It is also owned by the doctor as far as I am aware. They explicitly do not deal with private or public insurances. (Although by recent law changes I can charge monthly fee to HSA account). There are a few practices like that in the area. Can't say if others are similar in experience, but fees - are. So it looks like it is possible to build sustainable business around primary care. But it takes a different approach.

tristor 6y ago
I’d be interested in enrolling in a similar service. How do you find out about these services in your area?
- DoreenMichele 6y ago
  Your best bet to find a direct primary care physician is to do an online search including “direct primary care” and the name of your state. https://www.nextavenue.org/direct-primary-care-time-with-doctor/#:~:text=Online%20directories%20of%20providers%20exist%2C%20but%20their%20quality,have%20a%20good%20handle%20on%20your%20personal%20finances https://www.nextavenue.org/direct-primary-care-time-with-doc....
  - deleted 6y ago
    [deleted]
  - atlasmd 6y ago
    https://dpcalliance.org/directory/#!directory/map/ord=rnd https://dpcalliance.org/directory/#!directory/map/ord=rnd or www.dpcfrontier.com/mapper/
- hippich 6y ago
  "concierge primary care" might also be useful, as some places use "concierge" and "direct" interchangeably.
- deleted 6y ago
  [deleted]
- Coldgamr 6y ago
  DPC Frontier has a mapper with many, many practices on it along with prices, open date, and if it’s a “pure DPC” (i.e. no insurance) or hybrid (i.e. they also accept insurance for Medicare or other reasons). https://mapper.dpcfrontier.com/ https://mapper.dpcfrontier.com/ Disclosure: I am the founder of Akute Health which makes software for DPC practices. https://www.akutehealth.com https://www.akutehealth.com
ackbar03 6y ago
In the future they'll also come armed and ready to rock and roll like the trauma team in cyberpunk 2077. I'm only half joking, with privitized military now a real thing I can see this being an actual service for the super rich
- hippich 6y ago
  As long as "cheaper" option (i.e. without armed team) is still available, i guess it is still a good outcome, considering everything 2077-else? :)
Coldgamr 6y ago
Thank you for sharing this anecdote. I don’t think enough people understand the value of direct primary care. Of note, concierge primary care is more associated with something like one medical where you pay a membership in addition to your regular insurance co-pays. Direct primary care, or DPC, is full stop no insurance, only membership. And the doctor will limit their patient panel (the patients they see) to about 600 or even less to ensure they can provide amazing service to those patients. Generally, primary care doctors see 3000 or more patients. Disclosure: I am the founder of a DPC software company. I absolutely love this model for so many reasons. I’d love to answer questions people have.
- ackbar03 6y ago
  How does this work with the insurance dynamics though? You say no insurance full stop, does that make the cost prohibitively high for some? I feel like insurance in a way is similar to a membership model for the patient in terms of cash flow although definitely not the same for the doctors. I'm not in the US so I don't really understand how medicaid works over there
  - Coldgamr 6y ago
    The average price for a DPC membership is about $65/month. In most states, the doctor can even dispense prescriptions at or near wholesale cost. The idea is that higher utilization of primary care results in lower hospitalizations and specialist visits, which are very expensive for all parties. This has actually been proven in studies comparing total health spend by large employers before and after adding DPC for their employees. So spend a bit more in primary care, get high touch service, and lower cost in the long run. Medicaid, btw, is our social safety net health insurance program. Most Americans have insurance though their employer which is usually a high deductible plan. Meaning, you have to spend thousands of dollars before insurance will start helping to cover the cost of healthcare for you.
  - hippich 6y ago
    Everything my doctor can do in the office, is part of the monthly fee. Everything on top of it - either cash or insurance. Labs are very cheap when ordering through my doctor (I am talking about $4-$8 for typical stuff). Prescription drugs - i fill through the insurance (fixed co-pay in my case) and if something major will happen, like accident or such, my regular insurance will kick in (after paying several thousands out of pocket) The thing is - the most expenses I had throughout the years I lived in the USA were on primary doctor and labs. Only in one year out of 10 I had an accident where without a regular insurance I would be screwed. So high-deductible plan + direct care is the most optimal setup for me right now.

tristor 6y ago

I’d be interested in enrolling in a similar service. How do you find out about these services in your area?

DoreenMichele 6y ago
Your best bet to find a direct primary care physician is to do an online search including “direct primary care” and the name of your state. https://www.nextavenue.org/direct-primary-care-time-with-doctor/#:~:text=Online%20directories%20of%20providers%20exist%2C%20but%20their%20quality,have%20a%20good%20handle%20on%20your%20personal%20finances https://www.nextavenue.org/direct-primary-care-time-with-doc....
- deleted 6y ago
  [deleted]
- atlasmd 6y ago
  https://dpcalliance.org/directory/#!directory/map/ord=rnd https://dpcalliance.org/directory/#!directory/map/ord=rnd or www.dpcfrontier.com/mapper/
hippich 6y ago
"concierge primary care" might also be useful, as some places use "concierge" and "direct" interchangeably.
deleted 6y ago
[deleted]
Coldgamr 6y ago
DPC Frontier has a mapper with many, many practices on it along with prices, open date, and if it’s a “pure DPC” (i.e. no insurance) or hybrid (i.e. they also accept insurance for Medicare or other reasons). https://mapper.dpcfrontier.com/ https://mapper.dpcfrontier.com/ Disclosure: I am the founder of Akute Health which makes software for DPC practices. https://www.akutehealth.com https://www.akutehealth.com

ackbar03 6y ago

In the future they'll also come armed and ready to rock and roll like the trauma team in cyberpunk 2077. I'm only half joking, with privitized military now a real thing I can see this being an actual service for the super rich

hippich 6y ago
As long as "cheaper" option (i.e. without armed team) is still available, i guess it is still a good outcome, considering everything 2077-else? :)

Coldgamr 6y ago

Thank you for sharing this anecdote. I don’t think enough people understand the value of direct primary care. Of note, concierge primary care is more associated with something like one medical where you pay a membership in addition to your regular insurance co-pays. Direct primary care, or DPC, is full stop no insurance, only membership. And the doctor will limit their patient panel (the patients they see) to about 600 or even less to ensure they can provide amazing service to those patients. Generally, primary care doctors see 3000 or more patients. Disclosure: I am the founder of a DPC software company. I absolutely love this model for so many reasons. I’d love to answer questions people have.

ackbar03 6y ago
How does this work with the insurance dynamics though? You say no insurance full stop, does that make the cost prohibitively high for some? I feel like insurance in a way is similar to a membership model for the patient in terms of cash flow although definitely not the same for the doctors. I'm not in the US so I don't really understand how medicaid works over there
- Coldgamr 6y ago
  The average price for a DPC membership is about $65/month. In most states, the doctor can even dispense prescriptions at or near wholesale cost. The idea is that higher utilization of primary care results in lower hospitalizations and specialist visits, which are very expensive for all parties. This has actually been proven in studies comparing total health spend by large employers before and after adding DPC for their employees. So spend a bit more in primary care, get high touch service, and lower cost in the long run. Medicaid, btw, is our social safety net health insurance program. Most Americans have insurance though their employer which is usually a high deductible plan. Meaning, you have to spend thousands of dollars before insurance will start helping to cover the cost of healthcare for you.
- hippich 6y ago
  Everything my doctor can do in the office, is part of the monthly fee. Everything on top of it - either cash or insurance. Labs are very cheap when ordering through my doctor (I am talking about $4-$8 for typical stuff). Prescription drugs - i fill through the insurance (fixed co-pay in my case) and if something major will happen, like accident or such, my regular insurance will kick in (after paying several thousands out of pocket) The thing is - the most expenses I had throughout the years I lived in the USA were on primary doctor and labs. Only in one year out of 10 I had an accident where without a regular insurance I would be screwed. So high-deductible plan + direct care is the most optimal setup for me right now.