It’s About Health Care, Not Health Insurance

9/28/09

Health care reform discussions almost always revolve around health insurance, as if care and insurance are synonymous. Understanding the difference can lead to the delivery of better care for less money, and help break the health care reform logjam in Congress.

An amendment introduced this week by U.S. Senator Maria Cantwell to America’s Healthy Future Act, currently being considered by the Senate Finance Committee, understands the difference. Senator Cantwell’s amendment would provide for coverage in a ‘direct primary care medical home’ plan, provided that plan is coupled with a quality wrap-around insurance program to cover non-primary care services.

What are direct primary care medical homes? They are primary care practices offering patients comprehensive primary care coverage outside of the traditional insurance system. They provide preventive and primary care, as well as chronic disease management and coordination of care with specialists and hospitals. Patients who elect this health care delivery model pay a flat monthly fee (ranging from $49 to $79 at my affiliated practice, Seattle-based Qliance Medical Group) for unlimited access to a primary care physician. This monthly fee covers everything from regular check-ups, women’s health exams, sprained ankles and broken arms to flu shots, and arthritis or diabetes management.

Direct primary care medical homes are already accomplishing what everyone wants health care reform to do:

• Lower costs

• Improve access

• Increase the quality of care

As a nation, we spend over $2 trillion a year on health care. We want to improve access, lower costs and expand quality coverage to the almost 50 million people who are currently uninsured – but we need to find a way to do this without breaking the bank.

There are ways to lower the overall cost of health care. An astonishing 40 percent of every dollar spent on primary care goes toward paperwork – either on the provider or insurer side – to complete the insurance reimbursement process. By eliminating the insurance payment mechanism and forming a direct relationship between a provider and patient, direct primary care medical homes have more resources available to spend on patient care.

The savings allow practices to offer more providers and longer office hours, even opening seven days per week. Smaller patient loads enable same-day appointments and unhurried 30 to 60-minute office visits. Other savings can be invested in electronic medical records, on-site lab and imaging equipment or drug dispensaries. With efficient business models, this can all be accomplished while charging surprisingly affordable monthly fees.

Insurance does play a valuable role in paying for specialists and hospital care in those rare circumstances when it’s needed, like when people suffer injuries from car accidents and need to go the emergency room. Insurance spreads the risk and cost of this type of more expensive, less predictable health care. Not surprisingly, a “wrap-around” insurance plan people can buy to protect themselves from an unpredictable health catastrophe is much less expensive than a traditional comprehensive insurance plan.

Combining an affordable direct primary care medical home practice with a low premium wrap-around insurance plan provides the best of both worlds: Quality, low-cost primary and preventive care that will cover 90 percent of what most patients need to see a doctor for; and cost-effective comprehensive coverage for serious, expensive illnesses.

In Washington state, some direct practice patients are realizing total out-of-pocket savings of 40 to 50 percent for such comprehensive health care coverage, and employers are routinely seeing 20 to 35 percent savings, all without any government subsidy.

By eliminating insurance where it isn’t needed and optimizing it where it is, we can save loads of money, and provide better care. Direct primary care medical homes should be a key element of broad-based health care reform and be included as an option for Americans and employers. Senator Cantwell’s #C-9 amendment will allow the combination of a non-insurance, direct primary care medical home plus a wrap-around insurance plan to be offered inside the proposed insurance exchange. This will promote low-cost, high-quality health care as an option for all, and help attract physicians and medical students back into primary care.

Please ask your representatives in Congress to support such an option. You can easily do that by clicking here.

Norm Wu is the CEO of i-Human Patients, a health IT/e-learning company. Follow @

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  • http://www.northseaforme.com Steve Knobler, LAc

    Qliance sounds like a great idea. As a member of the Community Acupuncture Network (www.communityacupuncturenetwork.org), we too are circumventing the insurance model, offering low-cost treatments ($15-$40 sliding scale) without any paperwork/approval hassles. All, while providing the same high quality care people have always expected and deserve. Currently, there are 7 community acupuncture clinics in the Seattle area and almost 100 across the United States. Good job Qliance – The public needs a reasonable, affordable alternative for primary healthcare.

  • Audrey

    Government run health care – the so-called “public option” – presents serious challenges for us. The private sector and competitive market forces are the best means to meeting health care needs. Watch this video from the U.S. Chamber http://www.friendsoftheuschamber.com/media/

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  • Bell Ayers

    Cities, counties, states would be financially better off to deliver health care directly to uninsured than to put them in “health insurance” that may or may not provide care with greater expense. Public clinics and public health initiatives can help stem costs by direct care and education…removing much of the very expensive administrative costs. Health insurance has never equated with health care.