Before insurance companies, and co-pays, and filing claims, the relationship between doctors and patients was simple. Those who needed medical care would visit their doctor’s office or request a house call. Once that care was provided, the doctor was paid directly.
Some physicians are bringing that model into the 21st century by offering direct primary care to their patients on a subscription basis.
Dr. Matt Falkiewicz is a physician with Nova Direct Primary Care in Grand Rapids. His practice offers a membership-based model where patients pay a monthly fee in exchange for almost unlimited access to their primary care physician without co-pays.
Individual monthly subscriptions are based on age, and patients can expect to pay anywhere between $29 to $79 per month. Any care needed outside of their office, say a surgery or a specialist visit, would have to be covered by the patient or their insurance.
But Falkiewicz says many direct primary care offices do offer procedures like X-rays and lab work, and at a cheaper rate.
If you need to check what we call a basic metabolic profile, if you go through a hospital system or an insurance-based system, that can easily cost you $40-100 on an outpatient basis. But through us, it’s $2.50, Falkiewicz explained.
Another major difference between direct primary care and insurance-based models is the amount of time that doctors can spend with their patients. Falkiewicz says insurance guidelines generally allot about 20 minutes per visit. Direct primary care doctors have fewer patients and no time limit on visits, and that means they can spend more time talking through medical needs and concerns with the patient.
Falkiewicz argues that the direct primary care model works well for people who are uninsured, have high deductibles, or who generally aren’t happy with their current healthcare.
But Marianne Udow-Phillips, director of the Center for Healthcare Research and Transformation at the University of Michigan Health System, notes that this model isn’t affordable for everyone, particularly because direct primary care doesn’t replace insurance.
The patient will usually still have to buy insurance because this only covers a limited set of primary care services, Udow-Phillips said. So, if you need surgery or you need most medications, you would still need to either pay for that out of pocket or pay for insurance.
According to a 2019 report from the Center for Healthcare Research and Transformation, just 4% of physicians in Michigan say they’re participating in a direct primary care, but nearly one in four expressed interest in that model. Udow-Phillips suspects that’s because physicians are drawn to the idea of having a more intimate relationship with their patients.
It says to me that many primary care physicians feel frustrated with the current structure that they’re living under. That they feel pressed to see a lot of patients in a short period of time, that they don’t feel like they can build those personal relationships [like] the old days when primary care was seen as a very personal relationship, Udow-Phillips said.
Although the United States pays less for primary care compared to other countries, Udow-Phillips says that demands on primary care are going up while the actual number of primary care physicians is dropping. As newer health care models like direct primary care, patient-centered medical homes, and accountable care organizations are put to the test, Udow-Phillips says the focus needs to be on one broader question:
How do we better support primary care so we have viable numbers of primary care physicians for the future?
CORRECTION: A previous version of this post misspelled Dr. Matt Falkiewicz's last name. The error has been corrected above.
This post was written by Stateside production assistant Isabella Isaacs-Thomas.