Benefits of the Direct Primary Care and Direct Specialty Care Model

August 11, 2022

Authored by:
Rorah Ndungu
Presidential Scholar | Georgia State University
Honors College | Class of 2024

Edited by: 
Ndidiamaka Obadan, MD, MS, FASN
CEO, Youngerself MD,  Health and Wellness Center

Jargons like high premiums, low deductibles, and copays are phrases that we have all heard when trying to find health insurance. These words can be confusing and can leave many frustrated with the health insurance system.  Why does it have to be so complicated? It might provide little comfort to know that patients are not the only ones angry with insurance companies; physicians are just as annoyed! These long-held grudges against the increasing control that insurance companies have on patient care have led to the development of new healthcare models aimed at eliminating the burdens associated with health insurance. 

There are many benefits to having health insurance. For individuals who have expensive healthcare costs, health insurance may provide a means to pay for a few health-related expenses.  However, the high cost of having health insurance and the lack of flexibility for patients’ health care options, are some drawbacks to purchasing health insurance. 

For most, receiving medical care starts with making an appointment with their primary care doctor. Occasionally, what seems like a relatively easy first step is made exponentially harder by the hurdles placed by health insurance companies. Before visiting a doctor, a patient must see if the physician is covered by their health insurance (or is in-network). If a patient chooses to visit a physician who is not covered by their insurance company (or is out-of-network), they are usually met with either higher service prices or a refusal from the insurance company to cover any of the costs. 

Now let’s say you do find a doctor in your network that you absolutely love, but then…you change careers or lose your job. In most of these cases, you cannot continue seeing your current doctor because they are no longer covered by the insurance company. The loss of a trusted, loved, and respected physician is very frustrating and devastating for many people. 

Insurance companies also make it difficult for physicians to be upfront with the amount to pay per visit. With traditional health insurance plans, a patient typically leaves the doctor’s office without knowing how much their insurance will be billed. It is only after deductibles, copays, and discounts are negotiated between the provider and insurance company that the patient will receive their medical bill, a process that sometimes takes MONTHS to complete. And for some, the amount on the bill can be a lot more than what they initially expected. Supplemented with the costly premiums paid every month, this prompts many to wonder: Does my health insurance actually help me?

Insurance companies frustrate both the patients and doctors. After many years of medical school, residency, and sometimes fellowship training and certifications, doctors have become experts at providing medical care for patients. Insurance companies undermine physicians’ medical authority by dictating which medications, tests, and operations patients can get. If a physician prescribes a specific service for a patient, medical insurance can deem that service as “medically unnecessary”. In these cases, insurance companies refuse to pay for these services and leave doctors unable to administer the treatments that they consider the most beneficial for their patients. 

Furthermore, billing insurance companies prove to be a hassle for many doctors. After performing a service, physicians must file a claim requesting the insurance company to pay for the services they provided. In some instances, these initial claims are not paid in full. This forces health care providers to invest time and money to sort out any rejected or disputed claims, preventing them from seeing patients.

This violation of doctors’ autonomy and the struggle over reimbursements have made physicians look for alternatives to the traditional health insurance system. 

The Direct Primary Care (DPC) and the Direct Specialty Care (DSC) Model address all these issues from both the patient and physician perspectives, creating a win-win situation. The DPC/DSC model helps to improve access to high-quality healthcare services. The model focuses on providing value and unrestrictive access to their health care providers, usually with little to no wait time. As a result, DPC/DSC also eliminates much of the frustration associated with insurance-based practices. Pricing is upfront and transparent. Furthermore, DPC/DSC offers long-term relationship building with their physicians, unhurried visits, and ample support from the team dedicated to helping patients achieve their health care goals.

The value of building a real long-term therapeutic relationship between physicians and patients, cannot be overemphasized. This is made possible with the DPC/DSC model because physicians can save the time spent on filing insurance paperwork and bureaucratic hassles and instead, invest their time into providing in-depth visits and consultations with their patients, allowing physicians to know their patients’ histories and stories in so much more detail and creating opportunities for personalized care. 

To ensure coverage for medical emergencies, most DPC/DSC patients have catastrophic insurance coverage. This, and similar insurance plans, prevent financial devastation in the event you need emergency, serious, or extensive care. 

Youngerself MD utilizes a Hybrid model which combines DPC/DSC and insurance-based care to provide comprehensive, holistic, and integrative health care services at an affordable cost. We are currently accepting new patients. Experience all the great services Youngerself MD has to offer and schedule an appointment today, at www.youngerselfmd.com or call 404 566 4623. We can’t wait to assist you in achieving your health care goals. 

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