September 8, 2022

Have you ever wondered why your out-of-pocket costs for a visit to the emergency room are much greater than for an appointment with a primary care physician (PCP)? Have you noticed a difference in the quality of care and attention you receive?

Most health plan members are accustomed to understanding which providers are in-network and out-of-network based on a logo on their medical insurance ID card. But the marketplace is changing, with some plans offering alternatives to traditional provider networks. It’s important to understand which providers are covered with your plan to get the most from your health care benefits. But perhaps even more vital is the access and relationship you have with your provider – particularly your PCP. Nova’s latest podcast episode, “A PCP with DPC,” discusses the importance of a PCP and, how a direct primary care (DPC) model of health care can benefit both the patient and employer group.

Nathan Houghton, a business development analyst with PeakMed LifeCenters in Colorado, joins this episode of “Under the Coverage,” to share how his perspective has evolved through his experiences with the health care system. PeakMed is a DPC practice, which uses a payment model where patients pay and access their physician directly as an alternative to fee-for-service insurance.

After spending eight years in the Navy, Houghton entered the private sector and had his first experience with employer-sponsored health care. He recalled he was shocked at the expense of premiums and enrolled in a high-deductible health plan because he was generally healthy, and it was the lowest monthly cost.

“But you know how it goes – you’re healthy until you’re not,” Houghton said. “You don’t need to utilize the plan until you do.”

Between deductibles and being unsure of where to best access care, he spent more than $10,000 on services. As an accountant at the time, he then decided to educate himself on the health care system. One of his biggest lessons was realizing the importance of having a PCP.

“My insight to those that are viewing their health insurance card as health care, please don't,” he said. “Health care is where you have a relationship with the primary care doctor and just know that there’s ways to develop that relationship that doesn’t involve that card.”

With the DPC model, while the DPC physician is your first point of access to health care, the doctor or practice does not completely replace your health insurance.

“Our direct primary care physician will let you know when it’s time to tap into your health insurance,” Houghton said, explaining part of the physician’s job is to guide you to the appropriate level of care when needed.

However, by utilizing DPC, both the patient and ultimately the employer sponsor of a group health plan save money by minimizing higher cost services at emergency rooms or urgent cares and by establishing a relationship and wellness baseline through access to quality care from the PCP.

Tune into our newest episode to hear more about how patients benefit from having a strong relationship with their PCP, as well as how a DPC model works.

 

How to Listen

New episodes are added regularly and are available on SoundCloud, Stitcher, Spotify, Apple Podcasts, Google Podcasts, Amazon Music and TuneIn. You can also listen via digital assistants like Alexa, Google and Cortana. Just ask Alexa to, “play the Under the Coverage podcast on Apple Podcasts” (or wherever you get your podcasts).

Under the Coverage features people who spend their working days focused on health benefits and health care, sharing their insider tips on information they wish every health care consumer knew. Have an idea for a future episode or a question you’d like answered? Find Under the Coverage on Twitter @UndrTheCoverage or email podcast@novahealthcare.com.