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Consider Direct Primary Care’s Advantages During Open Enrollment

Many people are asking for a solution that won’t break the bank but still provides the health care they need


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The open enrollment period is underway in Colorado, and it always seems confusing. Consumers are presented with new health insurance programs and lengthy lists of benefit options, which can be overwhelming. Which health care choice is the right one for you and your family? What’s the right amount of health insurance? Do you simply select the least expensive option and hope for the best? If you don’t select the optimal plan, you’re stuck with your decision for the whole year.

While we pore over our limited options, many people are asking for a solution that won’t break the bank but still provides the health care they need. Enter direct primary care (DPC).

DPC removes fee-for-service influences (like insurance) from the primary care marketplace, allowing patients to access medical care for a monthly, quarterly or annual fee. Patients can see their physician as often as they want, and they are often able to spend more time with their doctor one-on-one. But there are other important differentiators when considering adding DPC to your health-care portfolio:

HEALTH INSURANCE VS. HEALTH CARE

While many people assume that health insurance and health care are synonymous, health care and health insurance are quite different today. Over the course of several decades, a gap between health insurance and health care has been created and it has only grown wider in recent years.

Health insurance increasingly focuses on the paperwork, billing and coverage involved in receiving health care. While it is important for people to have health insurance to protect themselves in the case of a cancer diagnosis or another catastrophic health event, the long wait times to get an appointment, the shortened doctor visits and increase in out-of-pocket payments, may cause people to avoid, delay or get the wrong level of care. For most people, health insurance is a vehicle to finance sickness, when really it should only be used when you have a life-changing event.

Health care, on the other hand, keeps you healthy and creates quality of life, focusing not just on longevity, but on how much quality you have inside that lifetime. Removed from the health insurance system, DPC is a direct connection between a doctor and patient that provides real health care and eliminates the complexities of a system that oftentimes creates a barrier between doctors and patients.

INNOVATIVE PRIMARY CARE OPTIONS

Rather than utilizing insurance, DPC practices charge an affordable fixed fee for unlimited visits, prescriptions and lab work at cost, along with other benefits that unlock innovative primary care options. From same-day and next-day appointments with no wait time, to regular access to doctors via text, phone, and mobile apps, innovative primary care options can result in the avoidance of most ER visits and virtually every urgent care visit — and the associated costs.

DPC arrangements eliminate third-party influences from the doctor-patient relationship, and enable your doctor to keep their patient panel at low numbers. This allows them to regain autonomy and ownership of their patients in a manner that they feel is most appropriate for the health and well-being of their patients through a clinical lens. DPC practices typically offer conventional care, such as checkups, physicals and diagnoses, but also wellness care, urgent care and much more. With DPC, you and your family receive unlimited visits — and improved care — for less than what you might pay monthly in copays and out-of-pocket expenses alone.

PRIMARY CARE BENEFICIARIES

Patients enrolled in DPC practices benefit from improved accessibility and more personal attention for their routine primary care needs. Additionally, DPC provides fast access to care for patients who need a lot of medical attention.

If you find yourself or a family member visiting the ER or an urgent care facility more than once a year because your traditional clinic is closed or you can’t see your physician in a timely fashion, consider the advantage of having the ability to reach out via text, phone or email after hours offers.

If you have a family with children, you know how costly treating every bout of strep throat, ear infection and flu can be — especially with multiple kids. All of those copayments, bills and perhaps even overages can become incredibly expensive in the traditional health care system.

Proponents even say the DPC model may work particularly well for patients with complex medical conditions who need careful monitoring and help coordinating multiple specialists. Consider patients with diabetes who need to have their blood sugar and blood pressure checked frequently. DPC affords patients the time and comfort to discuss the complicated medical needs without feeling like they are running out of appointment time.

Finally, people working proactively on their health and preventative care benefit as DPC practices are creating an innovative platform for doctors and patients to communicate and collaborate on individualized care plans that shift reactive care to proactive health. Spending time with a doctor discussing disease prevention and illness is something many people don’t do in the traditional health insurance world because of the copays and deductible payments involved. But with DPC’s open platform to allow for frequent visits up to an hour long, working on proactive health makes sense.

Clearly, a myriad of patients would benefit from this innovative primary care option to get the health care they actually need.

Fortunately, during this year’s open enrollment period, there are direct primary care practices that exist in Colorado, like Denver’s PeakMed, offering innovative primary care options. Consider the contrast between health insurance and health care as well as the innumerable patients who would benefit from this innovative option when poring over your options this year.


Steve Adams is the CEO of Denver-based Prime Health, a community of more than 3,000 health care administrators, entrepreneurs, technologists and more, who are interested improving patient health and engagement at a lower cost.

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