Paying for health insurance and monthly membership SAVES you money

Full disclosure: This topic has been discussed many times and the best article I have read on this question by far is by our fellow direct primary care doctors at CovenantMD. Please feel free to read their full article by clicking the link. 

The most common question of all questions I get is "Why would I pay a monthly membership when I already pay for health insurance premiums?" The first thing I do is remind people that most people with insurance already pay twice for health care. Once for your premiums and then the second time for prescriptions medications, labs, imaging, and anything else outside of the premiums. So, direct primary care aims to decrease the amount you pay the second time you pay for health care, while adding significant value to your investment. 

Most people will save on insurance premiums by selecting a high deductible plan, use the direct primary care practice to save money on 80-90% of medical needs, which includes discounted medications, laboratory, and imaging. They reserve their health insurance for expensive items like surgery or procedures. 

It is difficult to place a quantitative value on medical services that would be prevented with good direct primary care. This is the whole idea behind this model. Be accessible and affordable to prevent catastrophic complications, unnecessary testing, and reduce hospitalizations. The lay public has no idea how a small open wound, a few high blood pressure readings, few high blood sugar readings, ignored leg swelling or other symptoms, can lead to horrible complications if not diagnosed and managed early in its course. 

Regardless of how much I educate and teach about the importance of primary care and prevention, people want to see savings in dollars or don't bother thinking about it until they experience a health crisis. So here it goes:

These figures are estimates and certainly can fluctuate on a case by case basis. But, overall, the savings increase as we age simply because you might require more office visits, which are FREE in our direct primary care practice. Most in-clinic procedures like breathing treatments, skin biopsy, joint injection, etc are also FREE. These visits are not 10-15 minutes, instead the 30-60 minute visits might allow us to avoid unnecessary testing and specialty consultation. If specialists are involved, then a direct model allows better communication between the specialist and the patient. It truly is rewarding to see patients become more empowered, more enthused about the physiology at play and learn how they can make an impact in their health with a few steps; ultimately, they feel more in control of their health. 

What about those who are very complicated and have a lot of health issues with multiple specialists?

You mean like someone with multi organ failure with a large abscess that needs to be drained, liver failure, kidney failure, malnutrition, high blood pressure, and progressing malnutrition...complicated like that? Yeah, we have that case and in fact we are celebrating his recent hospital discharge and every organ that was injured is now healed. More importantly, his hospital stay on average would have been 7-10 days and we were able to get everything tuned up in 3 days. Direct care allows the primary care doctor to organize an effective team and arrange procedures that have to be done efficiently for that patient. Again, saving 5 days of a hospital stay is very significant, not mentioning the peace of mind of having your leader who you see in the clinic take charge in the hospital as well with smooth communication throughout your stay.  

Did you say massive stomach bleed, severe anemia where all the diagnostic procedures can't find a source of bleeding, or the rash that no specialist would take her case because she has no insurance and ultimately needed a strong medication that at times is used for chemotherapy from our office to treat it....and now the rash has cleared...cases like that? Yup, we take care of them too! 

By all means, the point of all this is not to brag, but to illustrate a very important point. Primary care is extremely effective if there is time, no 3rd party influence dictating care, and the patient and physician have a strong relationship. Primary care is not just treating common colds, joint aches and pains, and other minor issues. Good primary care takes charge of multiple issues and focuses on preventing chaos. The more complicated the case, the more value you get! 

What about Medicare? 

Our Medicare patients who have additional supplemental insurance will say that the accessibility and leadership of their care is what attracts them to our practice. The cost of care is still cheaper with a direct practice as illustrated above. Specialist visits likely will be reduced and the focus is to reduce the number of hospitalizations by preventing medical illness. House calls are a known benefit which save people time and money. 

Stop by, ask questions, and see how we can help you stay healthy or help manage any health trouble you might be experiencing. Monthly membership too much for you? Then, consider pay per visit rather than monthly membership plan. 

We are here to help and have a model to serve everyone. Cost should not be a barrier to join if one really understands this model of primary care. We will be honored to serve you and help you to live a happy and an enriched quality of life. 

Dr. Ahmed