On the bright side, Obamacare has enabled thousands of Americans to get the health insurance that they were not able to get in the past. The sticker shock of the price of the premiums as well as the extremely high deductibles may, however, prevent some from seeking the care they need.
The idea of having everyone have health insurance is to enable them to go to their health care provider on a regular basis to prevent small problems from getting bigger and out of hand before they are treated.
But some health care providers including Susan Hart, family nurse practitioner, in Bend are concerned that between the monthly premium and the large deductibles, many people won’t have enough money left at the end of the month to pay, under their deductible, to go to their primary care provider for their health concerns.
Some innovators, however, started addressing the U.S. health care system problems years ago, pre-Obamacare, and continue to advance the model, as the solution to the ever escalating health care costs. The Affordable Care Act itself, buried in its thousands of pages of document, recognizes this model, known as Direct Primary Care, as legitimate and working hand in hand with health insurance, yet without being insurance itself.
Susan Hart of ProActive Health LLC is the only early adopter, of this model of health care in Bend. Direct Primary Care (DPC), explains Susan, refers to the direct relationship between patient and provider. Instead of working for the insurance company, the provider works directly for the patient. She states that Direct Primary Care has three basic principles: accessible, affordable, and quality health care.
Someone who is a Direct Primary Care provider is accessible because they limit the number of member patients for whom they provide care, often about a quarter or less than the number they would have in a traditional practice. This frees up the appointment schedule to be able to get patients in even for same day appointments when needed. It also frees up the providers time to be able to be more responsive to phone calls.
By eliminating the need to bill insurance companies, there is less overhead in the way of staff to do billing and follow up billing. The savings are passed on to the patient. Even more savings are passed on to the patient by eliminating the need for billing the patient. The patient simply pays a monthly retainer fee by automatic deduction and signs a 12 month membership agreement similar to a fitness center membership.
Different DPC providers have variations on exactly how this is done. Susan explains that ProActive Health offers two options. One option is a $39/mo membership and $20 per visit. The second option is $60/mo and no per visit fee. Both options include an initial complete physical and history.
Both options also include at no extra cost any of the few basics labs that are done in the office (such as a simple urinalysis or strep test.) This is a considerable savings over the usual fee for service approach that quickly adds up under what the patient has to pay before their insurance kicks in. Many patients go years paying for their health care without ever reaching their deductible limit.
For Susan the last principle, quality, is the most exciting and fulfilling. “Because I have fewer patients to deal with, I can give them the time and care they deserve and need” she says.
“Instead of the patient waiting 30 or more minutes to see their provider seven minutes (that’s the average time spent with patients in a typical fee for service practice), my patients generally wait less than seven minutes and every appointment is for a minimum of 30 minutes, just in case they need that time.
“Since my focus is on keeping them healthy or restoring their health I may need time to do some teaching. I was never able to do that adequately when I only had a few minutes with each patient. It’s exciting to see that the studies that have been done on patient outcomes bear out what common sense would tell us. That when patients get more thorough, personalized care, adequate teaching, and develop a real relationship with their provider they get healthier.”
Susan Hart of ProActive Health LLC at 62968 OB Riley Rd., Bend, www.proactivehealth@earthlink.net
