WARSHAW, MD: “Direct Care Physician runs into some clear obstacles by being excluded from insurance enrollment …”

docpreneur institute dpc

Posted by Joel Warshaw, MD on Aug 5, 2015 3:49:00 PM

In today’s environment, health insurance and concierge/direct care physicians are (for the most part) mutually exclusive. Many insurance companies will not accept concierge physicians to their plan, due to the model of practice itself. Also, many Concierge/Direct Care physicians are bypassing insurance all together, in an effort to avoid the ever-growing demands and constraints placed on practicing physicians by insurance companies.

warshaw webinarSo, is it best that Concierge/Direct Care physicians simply go their separate ways? Not so fast. A complete separation does not necessarily make sense, as there are several ways both parties can benefit from each other. Furthermore, drawing a line in the proverbial sand could create issues for patients, who are the ultimate benefactors, since they utilize the services of both health insurance and Concierge/Direct Care medicine.

While the Concierge/Direct Care Physician runs into some clear obstacles by being excluded from insurance enrollment, such as getting advanced authorizations for tests and procedures, in-network referrals to specialists, and debt collection from individual patients, the insurance company is also at a loss in not working with their client’s primary care physicians and promoting their benefits.

Benefits of Concierge Medicine to Insurance Companies

Concierge medicine and direct care practices present significant benefits to healthcare insurers:

#1: Superior level of Patient Care /Satisfaction

NEW RELEASE -- now available! It took nearly 3 years to write ... The Doctor's Guide to Concierge Medicine (nearly 400 pages of industry insight plus, over two dozen physician contributions compiled in one book) -- On Sale $129.95 (Reg. $189.95)

NEW RELEASE — now available! It took nearly 3 years to write … The Doctor’s Guide to Concierge Medicine (nearly 400 pages of industry insight plus, over two dozen physician contributions compiled in one book) — On Sale $129.95 (Reg. $189.95)

Traditional primary care providers are overburdened with large patient census and administrative responsibilities. This leads to packed schedules, long wait times for general physicals, and less than ideal time spent with patients in the office to provide the service they require.

The core design of the Concierge/Direct Care Practice is to provide patients with the highest level of service they deserve.  By keeping a limited membership, patients are treated to guaranteed same day/next day office visits, on-time appointments with ample time to spend with their physician. They also get highly comprehensive physical examinations with a detailed one on one review of all findings and a written report. In addition patients receive direct contact information to the Physician, bypassing answering services and long holds on office lines. The level of patient, physician, and staff satisfaction is far superior in the Concierge/Direct Care Practice.

#2: Insurance companies save money!

Traditionally, health insurance companies have not placed an emphasis on preventative medicine, choosing to reimburse for medical care that is reactive more than proactive. When a patient is enrolled with a concierge/direct care physician, there is a tremendous emphasis on yearly physicals and preventative care. Many of these services are not even billed to the insurance company, such as certain blood work, EKG, PFTs, Vision/Hearing assessment, and selected immunizations. Not to mention the Physician’s own time spent with the patient.  Aggressive preventative care leads to significant benefits for insurance companies, as preventable (read: costly) chronic diseases are less likely to get out of control or occur altogether.

Studies have proven a reduction in ER visits and hospital admissions. According to a recent studies by MDVIP, patients with a concierge physician experience a 70% reduction in hospitalizations. That’s a lot of money saved by the health insurance companies!!

#3: Reduction in Healthcare Resources/Errors

Despite Physician’s best intention and effort, medical errors are a growing concern, especially in today’s complex medical world. Often, medical errors lead to greater utilization of healthcare resources, not to mention patient risks and dissatisfaction. One of the ways to avoid and reduce errors is to spend enough time making medical decisions, which includes time spent with the patient, time spent looking over records, consulting with specialists and detailing medical records. Paying attention to detail is a simple solution that greatly reduces medical errors. Yet, not all physicians have the time in a day to provide this level of care all the time, while meeting administrative demands and keeping a personal life. The Concierge/Direct Care practice allows for the necessary time and therefore reduction in errors leading to increasing healthcare resources, redundancy, and liability.

In conclusion, there is a great opportunity for healthcare insurance companies and concierge/direct care physicians to work together. Insurers should embrace the concierge/direct care model and consider alternative arrangements to the current system. For many insurance companies to “snub” the Concierge/Direct Care Practice does not make practical sense, both from a service and economical standpoint.

What kinds of opportunities do you see for insurance companies and concierge physicians to work together?


Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s