Why Direct Primary Care and Health Insurance Are Creating a Buzz in ABQ?
ALBUQUERQUE, N.M.– Do you have health insurance for your employees? If not, are you planning to get one?
Employers offer various employee health benefit plans through a health maintenance organization (HMO), exclusive provider organization (EPO), point-of-service (POS), and preferred provider organization (PPO).
Some employers also consider indemnity plans, health savings accounts (HSAs), health reimbursement arrangements (HRAs), qualified small employer HRA (QSEHRA), Individual coverage HRA (ICHRA), and group coverage HRA (GCHRA).
These third-party organizations provide small business health insurance plans as well as for large organizations But there’s also direct primary care (DPC). It’s an innovative alternative for your employees’ health insurance plan.
Compared to health insurance, DPC, like Well Life Family Practice, is less expensive.
Focus: Patient-Centered Vs. Production-Oriented
DPC’s distinct feature is its patient-centered focus. DPC practitioners aren’t concerned with the number of clients they need to attend to every day. Instead, they emphasize the quality of care they give to each client.
DPC practitioners treat your employees as individuals with unique needs, unlike practitioners under a health insurance plan. The latter treats your employees like generic products in an assembly line. It's because medical service reimbursements are based on the number of clients.
Quality of Care: Personal Vs. Impersonal
DPC has a smaller patient panel of 898 clients. In contrast, practitioners under a health insurance plan receive about 2,303 clients in their panel.
It means your employees spend more time with a DPC practitioner. They get full and undivided attention for about 40 minutes. They discuss their medical concerns in great detail which creates more personalized or customized care.
Find out why you should choose direct primary care over insurance-based care.
Kind of Care: Preventive Vs. Reactive
DPC offers more than acute care. It promotes a healthy lifestyle through disease prevention. According to the British Medical Journal report, DPC clients experienced 65% fewer ER visits, 35% fewer admissions, and 82% fewer surgeries.
DPC offers more than acute care. It promotes a healthy lifestyle through disease prevention. According to the British Medical Journal report, DPC clients experienced 65% fewer ER visits, 35% fewer admissions, and 82% fewer surgeries.
Practitioners under health insurance usually only see employees for emergencies. Additionally, they often overbook appointments to break even with only 10 minutes of a face-to-face encounter with each client. Thus, they rarely have time to discuss disease prevention due to larger patient panels. Added to this time constraint is insurance billing paperwork.
Continuity of Care: Long-term Vs. Short-term
DPC provides long-term care. Well Life Family Practice clinicians prescribe medical interventions for your employees. When your employees return for follow-ups or other medical concerns, they see the same clinician. So there’s continuity of care.
Health insurance allows your employees to be assessed by different practitioners depending on their conditions. For example, a practitioner attends to your employee in urgent care for a gout attack, like excruciating joint pain, in the ER. But another practitioner gives recommendations to the same employee for joint deformities during a scheduled check-up. It’s short-term fragmented care.
Convenience: Convenient Vs. Inconvenient
DPC practitioners give timely care whenever your employees need it. For example, your employees can book an appointment through a call. Then, they visit the clinic the following day without waiting in line for a long time.
In comparison to insurance-based practitioners, your employees book an appointment at least a week before they can visit a clinic. Additionally, they must wait in line due to many clients scheduled on the same day. Most often, these practitioners offer face-to-face consultations during work hours only.
Do you still have questions about DPC? Here are the 10 myths to enlighten you.
Accessibility: Accessible Vs. Inaccessible
Your employees can opt in for virtual consultations or 24/7 telemedicine. It saves them effort and time going to and from the clinic. It also prevents your employees from ER visits for urgent care.
As a result, it doesn’t affect their productivity at work and saves on travel and ER expenses. Unfortunately, these remote electronic services are not readily available under a health insurance plan.
Involvement: Third-party Interference Vs. Autonomy
Third parties like health insurance companies and government agencies have no direct control over DPC providers. They cannot dictate or modify the services offered by DPC providers.
DPC providers think about your employees' best interests and not the interest of third parties. Third parties often interfere with the care offered by practitioners under a health insurance plan. They mind the cost of services, whether included within the coverage or not.
Costs: Transparent Vs. Hidden
Your business doesn’t have to be covered by insurance to benefit from DPC services. DPC is a separate healthcare provider that offers several services.
DPC’s monthly fee per employee is fixed. It has no co-pays, deductibles, mark-ups, or hidden charges. For example, Well Life Family Practice pegs the fee at $75 per month per employee.
In contrast, health insurance companies do not publish charges outright. It boils down to how the third-party payer (insurance) system works. Your employees only get to see the cost of the medical service when they receive the bill. Additionally, this also means huge out-of-pocket cash expenses.
Surprise medical bills could drain your budget. What has been done to curtail it?
Other Healthcare Services: Many Vs. Limited
Specialist
Your employees may be suffering from complicated medical conditions. A DPC provider refers your employees to an in-house specialist in cases like this. However, there’s still continuity of care even if a specialist sees your employees.
The DPC provider coordinates with the specialist on your employees’ case. In comparison, a health insurance plan typically covers your employees’ basic healthcare costs. A specialist is an add-on expense.
Preventive Care and Chronic Disease Management
The top chronic diseases prevalent in Bernalillo are asthma, hypertension, diabetes, cancer, and arthritis. DPC offers chronic disease management for your employees who may be suffering from any of these conditions.
They benefit from unlimited consultations to control their symptoms so their conditions won’t worsen. DPC also caters to your healthy employees. As a result, they gain information based on chronic diseases prevention. These preventive services consist of screening and labs.
Not all health insurance plans cover preventive care and chronic disease management. Most private health insurance companies cover only short-term medical care for acute conditions.
Some of them may offer screenings and diagnostic tests as add-ons. It’s best to inquire about health insurance organizations in Albuquerque if they include preventive care as an essential benefit.
Nutrition Counseling and Weight Loss Management
The Bernalillo County Community Health Profile includes obesity as one of the prevalent chronic conditions. Therefore, DPC offers nutrition counseling and weight loss management. These services help mitigate obesity, which increases the risk of developing other chronic conditions.
The Affordable Care Act requires most health insurers to cover overweight screening and dietary counseling. This stresses the importance of looking into health insurance plans for these specific services.
Integrative Medicine
Some DPC providers may apply an integrative medicine approach. For example, Well Life Family Practice combines conventional and alternative therapies in addressing various medical conditions.
Some insurers may cover chiropractic therapy, acupuncture, or massage. But many health insurance companies in Albuquerque do not cover holistic medicine and complementary or alternative therapies.
Listen to the TRUTH about prescription costs or how to get DISCOUNTED meds.
Perks: Discounts Vs. None
The cost of medications is skyrocketing based on RAND Corporation, a research organization. They reported that US drug prices were 256% higher than 32 other nations combined.
The great news is DPC providers can offer discounted medicines at wholesale cost. But wait, there’s more. It also includes discounted diagnostics and lab works of up to 50%.
Health insurance companies in Albuquerque charge extra fees for these services. Prescription medications are at full prices, too.
Takeaway
Employers are finding cost-efficient ways to provide health benefits for their employees. For example, many health insurance companies in ABQ offer various packages depending on your employees’ needs within your budget.
You may have existing health insurance or consider an alternative healthcare provider at less cost. We have shown you the 10 differences between direct primary care vs. insurance. As you have read, DPC has its advantages over a health insurance plan.
DPC can be a viable option or complement your existing health insurance. It offers more services at a fixed and affordable rate. Moreover, a combination of both can be less expensive than a full-coverage health insurance plan.
