How Direct Care Can Help Lower Health Care Costs

How Direct Care Can Help Lower Health Care Costs

By eliminating the middlemen and bureaucracy involved in billing insurance, patients in direct care save on overall healthcare costs.

Montana’s seventh Direct Primary Care clinic recently opened in Whitefish, representing a growing trend of Montana doctors opting out of insurance to help give their patients more choice and lower the cost of health care.

What exactly is Direct Primary Care (DPC)? Right on Healthcare’s latest in-depth breakdown explains how DPC is a direct care model where patients bypass insurance entirely to pay doctors, in the form of a membership, in exchange for unlimited access to primary care services for as little as $70 per month.

Dr. Cara Harrop, owner of PureHealth DPC in Polson, puts it even more simply: “at it’s very basic level, DPC is an agreement between you and your doctor. I work for you, not your insurance company.”

While DPC is not insurance, many patients use DPC memberships to supplement their insurance plan and reserve insurance for the “big ticket” items like emergencies or hospitalizations. With a DPC membership, patients gain access to routine care and testing 24/7, and save on costs without the co-pays and deductibles of insurance.

By eliminating the middlemen and bureaucracy involved in billing insurance, patients in direct care practices have the opportunity to form a stronger relationship with their doctor, which can prevent expensive conditions and save costs over the long run.

“The average emergency room charge in this country now is like $2,600. That is three years of your primary care paid for if I can prevent you from going into one emergency room,” explains Dr. Carol Bridges, founder of CostCare Direct in Missoula.

Another benefit of eliminating the insurance middleman is transparent prices. Without the documentation, coding and billing of insurance, direct care practices are able to regularly post the real cost of services on their website, and not just estimates.

As Dr. Morgan Coleman, owner of Big Mountain DPC in Whitefish puts it: “It’s simple and people know exactly what they are paying for. I can tell you right now for example that the cost of a cholesterol panel is $7.50, no more, no less.”

Direct care also appeals to many doctors. By taking insurance out of the equation, providers are able to save money and focus on their patients. Dr. Todd Bergland of Fountainhead Family Medicine, another DPC clinic based in Whitefish, offered some reasoning for why Direct Care made sense to him: “I went to medical school to take care of people, not to break their bank accounts.”

Despite the growing popularity of DPC with both patients and doctors, government roadblocks still prevent the widespread adoption of direct care in Montana.

Montana is one of the few states that has not yet authorized Direct Care in state law, creating uncertainty for patients and for employers who want to offer DPC as a benefit to their employees.

The Montana Legislature has passed several proposals to authorize DPC, but both were vetoed. In 2017, Insurance Commissioner Rosendale allowed DPC by issuing regulatory guidance which clarified DPC is not insurance and cannot be regulated as such. Since then, seven DPC clinics have opened in Montana, providing care to thousands of patients. But to permanently authorize direct care in Montana, legislation is required.

Another barrier is Medicaid rules which prevent DPC providers from accepting membership payments from Medicaid patients, despite the potential health benefits and cost savings.

By authorizing DPC and other direct care arrangements in law, direct care will continue to be another tool in developing a better doctor-patient relationship and a supplement for Montanans who face healthcare plans with higher and higher deductibles.

Moreover, there’s room for lawmakers to go further and request a waiver from the Federal Government to include DPC memberships as an option for Medicaid patients. This would allow Montana’s taxpayers and patients to take full advantage of what could be huge cost savings for the program.

Click here to read more in our policy brief.

Want more? Get stories like this delivered straight to your inbox.

Thank you, we'll keep you informed!