When we think of insurance, it’s usually for things that are rare and expensive. You never want to use your car insurance, fire insurance, or disability insurance and you don’t use file a claim for routine things like changing the oil, buying a fire extinguisher or missing a day of work with a sore back. Insurance works best when it spreads big risks over a large pool of people.
But healthcare is different, and health insurance covers even small, routine things like primary care physician visits. Direct primary care practices change the model because they are paid directly by the patient, not the insurance company. That keeps costs down and increases the alignment between doctor and patient.
I like the idea, and in fact I interviewed an early practitioner of primary care back in 2009, before the Affordable Care Act!
Recently, I spoke with Dr. Jeffrey Gold, of Gold Direct Care in Marblehead, MA. He filled me in on how his practice works and why he’s a proponent of the direct model.
- (0:10) What do you mean by “direct” primary care?
- (0:47) How does that feel different from a typical primary care office? Is it the same thing as a concierge practice?
- (4:58) You don’t accept insurance. Does that affect your overhead and enable you to be more cost effective?
- (7:08) What happens when a patient goes out of your orbit to see a specialist or be hospitalized? Do you still have to deal with insurance companies then?
- (9:38) Are there particular kinds of patients that are a really good fit for a direct care model?
- (11:22) What would be the impact on the overall healthcare system if every patient were a direct care patient?
- (14:10) Does the Affordable Care Act help or hinder what you are doing? What changes would you like to see in the healthcare law?
—April 6, 2017