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3 Ways Primary Care Is Overcoming Health-Care System Roadblocks

The pronounced difference between coverage and care


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As the battle over health insurance rages on Capitol Hill, members of Congress believe they have the solution to make health care affordable and keep health insurance markets from collapsing. Unfortunately, the focus among politicians during the great health care debate has centered on health insurance coverage rather than actual health care.

Over the past couple of decades, health care has moved away from a comfortable doctor-patient relationship an unfriendly corporate, insurance-based, fee-for-service model that seems to increase costs and decrease the length of visit times. In some cases, the fee-for-service model actually contributes to diminished service and lower clinical outcomes. 

In order to meet the actual medical needs of patients, it’s time to work directly with the providers and the folks “on the front line.” It is necessary to turn the tide toward membership-based primary care that focuses on the doctor-patient relationship, reduces costs and eliminates the obstacles that keep people from seeing their doctors, thus improving the health outcome and experience for everyone.

ECONOMICS

In our current state of fee-for-service health care, volume has become more important than quality. Many doctors routinely see 20, 25 and even 30 patients each day in order to bill enough to sustain financial viability. As a result, the actual time they spend with patients has dwindled — sometimes to less than five minutes. Plus, the average wait time to get in and see your doctor is about three weeks. These problems lead to patients using urgent care facilities and emergency rooms for routine primary care, which results in higher costs, lack of care coordination and less focus on wellness.

When the complexity that insurance brings is no longer the focus, conveyor-belt style medicine is no longer necessary. Doctors no longer need to focus on the volume of billable appointments and procedures in order for a clinic to survive. Membership-based primary care takes these complexities out of the equation. When you do that, it brings health care to an affordable solution that often costs less than a cellphone bill.

UNLIMITED ACCESS TO A PHYSICIAN

Experts in membership-based primary care saw how fee-for-service health care visits were becoming shorter and shorter, and responded. In the membership model, doctor visits are typically 30-60 minutes, not only giving the patient plenty of time for their exam and to ask questions about their illness, but also to address any additional concerns and gain valuable education from the doctor. By allowing more time and unlimited access to a patient’s physician, trust is enhanced and the connection between a doctor and their patient improves.

Communication is also centric in this new primary care model. Once a doctor-patient relationship is established, telemedicine can be utilized frequently so patients can communicate with their doctors day or night. If the primary care physician treated one child in a family for strep throat recently, a parent can just text, email, video chat or call their physician for a consult if more family members begin exhibiting symptoms. A prescription medicine might just be a phone call away instead of taking a midnight trip to the emergency room.

IMPROVED EXPERIENCE

Making changes to health care economics and increasing access to providers leads to improved experiences for both patients and physicians. The patient experience starts at the front door. 

A 2016 survey of Google reviews of physicians found that 96 percent of patient complaints center on customer service, including frustration with clinic communications and waiting room wait times. Membership-based primary care is taking a new approach to improve the patient experience. No more waiting rooms. Sitting with a bunch of sick people for a half-hour or more is a thing of the past. When we decrease the number of people the doctors see and increase the total appointment time, a typical clinic waiting room is no longer even necessary. 

A monthly-membership model means patients won’t see an additional bill to cover what insurance doesn’t. It is a flat-fee structure for all of a patient’s primary care needs. From annual checkups to disease management and getting treatment for an infection, primary care services are included in your monthly membership fee.

For physicians who work in the membership-based primary care model, getting away from conveyor-belt medicine where patients are rushed in and out of the exam room is a welcome relief. This new look at health care offers doctors the opportunity to give quality care where patients have the time to ask questions and to even discuss wellness instead of sickness. Doctors are empowered to provide the medical treatment they believe is necessary rather than a treatment that brings in significant billing for insurance. 

Creating a better experience in health care leads to happier physicians, better care for patients and doctor-patient relationships that are strong and long-lasting.

The health care world is ripe for change. Patients are disappointed in their care, physicians are overworked and frustrated and costs are at a tipping point. It’s time to tear down the roadblocks that are killing health care and build up solutions like reduced cost, 24/7 access to physicians and longer appointment times that that improve care and experience for everyone involved.


Andrew W. Kallestad is the executive vice president of broker and employer engagement at PeakMed, a company that provides membership-based primary care with LifeCenters in Denver and Colorado Springs.

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