The Doctor Is In: Affordable Care Act, Part 3
(KPLR) – Dr. Sonny Saggar, with STL Urgent Cares, stopped by to finish his discussion on health care reform.
Dr. Saggar’s first segment focused on the basics of the Affordable Care Act. Then, in his second installment he discussed the money and Missouri.
In this final conversation regarding the Affordable Care Act, Dr. Saggar talked about how to get ready for the changes and addressed several burning questions.
Aren’t doctors supposed to be working for the patient?
In ancient China, the ideal doctor was the one who was able to teach a healthy lifestyle in order to prevent diseases. Doctors got paid when they were successful (in keeping their patrons healthy), not when the patients got sick (which was considered a sign of failure).
So why is it that in our ‘modern’ health care system, we do the exact opposite? When someone is sick, he suffers both physically and financially, and his employer suffers by lost productivity in the workplace. So it’s completely backwards to think that the healthcare provider actually benefits financially from that illness.
Wouldn’t it make sense if we turned that around? Shouldn’t we change that model so that physicians can more easily work to keep people healthy rather than gain from their illness?
Our health care system would in all likelihood work much better if everyone was aligned to do better with the same outcome and the same goal, to keep our patients healthy in the first place.
How can we get the physician (or nurse practitioner) back to working for the patient?
There is actually a new system that fits this model. It’s growing in popularity all across America, and it was popular even before the ACA was introduced and passed.
You might even argue that it’s more pertinent now, with the ACA mandates focused so much on preventative care.
It’s called Direct Primary Care, and it involves the physician receiving a flat monthly fee, either without any extra payments from an insurance company, or actually directly from the insurance company.
Almost all of the complications and hassles of healthcare payments and insurance are removed. By eliminating copays and deductibles and by providing unlimited visits, Direct Primary Care transforms the patient-physician relationship to that of a trusted healthcare advisor.
Many employers see this model as a real solution to lost productivity due to employee illness. There’s a lot of evidence that this really works.
By keeping employees healthy, this up-front preventive care avoids a lot of what we call ‘downstream encounters’. These are expensive tests such as MRIs and CT scans as well as treatments including hospitalization.
By removing obstacles to care such as copays, deductibles, limited office hours and locations, people will be more able and willing to see their primary care provider.
By connecting up-front, they address concerns before they become serious problems.
Insurance or Medicaid administrator?
Some insurance companies have seen the wisdom and benefit of this model and are offering it as an option when you select your primary care provider.
Fewer downstream expenses benefit the health and financial well-being of everyone involved; the patient, the employer, and even the insurer.
Interestingly, this free-market solution is good for state Medicaid administrators as well.
Some are finding that including a DPC provider produces the same benefits for Medicaid. So by doing so, the state taxpayers also win by saving money as well. This is a solution that`s actually good for everybody.
What is this brave new world of healthcare?
There’s now a lot of focus on preventative health care, rather than curative. Keep them healthy, don’t just wait and fix them when they’re broken.
We can do better.
We should be standing and running for prevention, and not just scrambling for the cure.
More and more people are demanding better access to affordable preventative healthcare, not just expensive and often unnecessary tests that follow the typical 7-minute physician appointment.
Instead, physicians should be spending 30 minutes with the patient, really working out the situation and then finding that they often don’t have to order a special test or refer to a certain specialist.
Sometimes it’s just a matter of having the time to sit down and truly connect with the patient.
You can’t do that in a 7-minute visit.
How can people make such changes happen?
Employers can ask their insurance companyand state legislators can discuss it with the various Medicaid administrators.
Everyone should be asking how can they all get more DPC providers in contract in this kind of model.
When the insurers and administrators see the interest, and when they realize that this actually benefits them too, they will not just listen, they’ll act, because they’ll quickly realize that it’s in their interest to act.
For more information, visit DirectYourCare.com, which is a St. Louis home-grown company.
St. Louis Urgent Cares presently has 4 locations in St. Louis, and all 4 are active participants in Direct Medical Care: Downtown Urgent Care, Eureka Urgent Care and Creve Coeur Urgent Care, and North City Urgent Care.