Direct primary care is expanding throughout the country because it can save patients money.
By Adam Habig
“So doctor, why did you decide to go into health care?”
“Oh, I don’t care for the health part. I just love all the paperwork.”
That’s a conversation that has likely never happened in the history of medicine — because, for doctors, providers, patients, and caregivers alike, the “non-health” parts are the very worst parts of health care.
From unexpected costs to confusion, access challenges, to long wait times, the barriers to seeing a doctor are more than just annoying — they’re actually standing in the way of the health care we need.
In Alaska, two bills in the Legislature are poised to make a major, fundamental change in the broken health care system. It’s a simple change known as direct health care, introduced this session as Senate Bill 45 and House Bill 47.
The idea is straightforward. With these bills, health care providers would be able to enter into service arrangements directly with patients, instead of only through a gatekeeping third party such as a health insurance company or government health care program.
This would allow patients to enroll in a “membership” with their health care provider of choice, including family doctors and primary and specialty care providers. In exchange for a fixed monthly fee, typically ranging from $50 to $100, patients get ‘round-the-clock access to their doctors, guaranteed appointments, and significantly shorter waiting times.
Best of all, because of the direct relationship between the provider and the patient, doctors are able to spend more time with their patients, answering questions and focusing on health, instead of filling out paperwork and fighting with insurance companies. One of the top frustrations felt by patients is not feeling heard by their doctor, which can happen when the doctor has to shuffle people in and out in order to spend more time dealing with paperwork and insurance disputes instead of health care.
The current model squeezes out time for preventative checkups that can catch problems early and improve health overall, and confusion over networks and long wait times for initial visits can cause many people to avoid it altogether.
Instead, the direct health care model has countless benefits for both the patient and the provider, including same-day appointments instead of long waits, transparent pricing, and easier and more reliable preventative care.
Because this administrative change cuts out the middleman of the insurance or government, there’s more transparency for the real cost of the service, rather than complex billing agreements, in-network vs. out-of-network puzzles, and confusion over who to call to actually talk to someone.
This model of direct health care is already at work in 49 states, with 26 states passing legislation to codify that it’s not insurance, and shall not be regulated as insurance.
Alaska is a prime candidate to update its laws and follow in their footsteps. Alaska residents currently pay some of the highest health care costs in the country — one study found that Alaskans pay the most of any state for their health care, at more than $11,000 per person. We’ve all seen horror stories about unexpected medical bills destroying life savings — two-thirds of bankruptcies in America are tied to medical issues.
Up-front, transparent pricing also means fewer surprises when the bill comes, and fewer hidden costs that result from disagreements over what insurance decides to cover.
Unfortunately, this kind of direct model for health care is currently blocked by state law, which treats these provider-patient arrangements the same as health insurance policies. This requirement comes with prohibitive costs, regulations, and — you guessed it — piles of paperwork.
Alaska lawmakers can change that and offer a better way forward by passing the two bills under consideration right now, Senate Bill 45 and House Bill 47.
In 2021, Montana — another large rural state with similar health care challenges — signed direct patient care into law. In just a year, 16 providers decided to offer membership options, at an average membership cost of $77 per month, significantly below the cost of traditional employer-sponsored or individual insurance coverage.
It’s time for Alaska to follow the lead of other states by offering an option for lower costs, faster service, more time with your doctor, and fewer headaches from dealing with insurance.
That way, we can all spend less time on the paperwork and more time on our health.
Adam Habig is the president and co-founder of Freedom Healthworks, an Indiana-based direct primary care community that helps medical professionals start, grow and operate their practices, and a policy advisor to The Heartland Institute. A version of this article appeared in the Anchorage Daily News on March 26, 2023. Reprinted with permission
For more article on direct primary care and health care reform, click here.