As premiums continue to increase and plan designs are tweaked to keep costs under control, today’s health insurance policies are quickly turning into catastrophic coverage. They’re great if you have a big, unexpected medical expense but aren’t all that useful for some of the day-to-day needs like doctor visits and prescription drugs. Sure, members do get the benefit of the carrier’s negotiated rate if they stay within the insurance company’s shrinking provider network, but consumers are beginning to realize that there are other options outside the health plan that might help them save money while receiving better care. And as health insurance plans cover less and less, we’ll see more and more of these non-insurance solutions.

One solution that’s growing in popularity is direct practice medical care, sometimes called “concierge medicine.” Without the predictable office visit copayments that consumers have relied on for years, many people have started paying a monthly fee for unlimited access to their family physician.

So how does this work, and is it a good solution for your clients? To answer that question, it would be helpful to differentiate between direct primary care and concierge medicine – they’re not exactly the same thing, but both can be great options for consumers who want more attention from their doctors than they’re currently receiving under their health plans.

What is Direct Primary Care?

The American Academy of Family Physicians (AAFP) defines direct primary care as retainer-based arrangements that “offer patients the full range of comprehensive primary services, including routine care, regular checkups, preventive care, and care coordination in exchange for a flat, recurring retainer fee that is typically billed to patients on a monthly basis.”

The AAFP goes on to explain that, since “DPC physicians are no longer generating revenue solely on the basis of how many patients they see per day,” they have “significantly more time to spend with patients in face-to-face visits.” They also point out that not all services are covered by the retainer and “suggest that patients acquire a high-deductible wraparound policy to cover emergencies.”

In other words, DPC physicians provide a number of services for a fixed monthly fee but recommend a catastrophic health plan for bigger issues. In the same way, agents who sell high deductible health plans to cover big, unexpected expenses might recommend that their clients set up a DPC arrangement if they want increased access to a family physician.

What is Concierge Medicine?

While many people use the terms “direct primary care” and “concierge medicine” interchangeably, they’re not actually synonymous. As explained by Concierge Medicine Today, “Concierge Medicine is a form of membership in which doctors provide medical care to Patients generally providing 24/7 access, a cell phone number to connect directly with their physician, same-day appointments, visits that last as long as it takes to address their needs and varying other amenities.” In other words, compared with direct primary care, patients receive “enhanced access and personal attention.”

A Spectrum of Options for Consumers

Perhaps it would be helpful to think of the various options for primary care as a spectrum. At one end, consumers have the network discounts that come with a high deductible, HSA-compatible plan. At the other end is the 24-hour access they have under a concierge medicine arrangement.

The good news is that these options are not mutually exclusive. Consumers can purchase an HSA-qualified High Deductible Health Plan for catastrophic coverage and use the network discounts if they need specialty care. And they can pair the catastrophic coverage with a direct primary care or concierge medicine program for more comprehensive care in a primary setting.

What should brokers tell their clients?

Going forward, clients will look to their insurance advisors not only for advice on their health plans but for answers about filling the holes in their coverage:

• As deductibles continue to rise, they’ll want to know how to offset this risk.
• As formularies are modified, they’ll want to know what other affordable prescription options are out there.
• And as copays go away and networks continue to shrink, they’ll want to know how they can continue to access the primary care that their family needs.

Our advice is to get out in front of this trend, identify the challenges, and provide the solutions before your clients ask about them. In other words, be proactive rather than reactive. While clients will eventually realize that they need something in addition to their health insurance coverage, you as an advisor are in a much better position to recognize this need before your clients do. And it is your job to deliver the solutions when you hear about them.

At AHCP, we can help you with some of the insurance solutions that can help reduce your clients’ deductible risk, and when non-insurance solutions exist that can also be beneficial to your clients, we’ll do our best to put them on your radar.