Central PA Medicine - Summer 2017 - 22

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Community, Health & Wellness

The Direct
Care Model
Taking Insurance Out
of the Picture!

irect Care is a model of healthcare that
is gaining traction in the United States.
This model takes insurance out of the
picture. This does several things. It allows
doctors and patients to focus on one another,
NOT the cost of medicine. It actually creates
value in healthcare. We charge an affordable,
monthly membership fee, which covers the cost
of all visits and most procedures. Most Direct
Care physicians cap at about 600 patients. For
patients, these things mean no copays and no
waiting to see the doctor.

In life, we use insurance for catastrophic events.
Car insurance is for a vehicle accident (not for gas
and tires), home insurance is for a house fire or
a flood (not for new paint and fixing windows).
Health insurance should be used the same way.
Health insurance should be for true emergencies,
like appendicitis or a heart attack (not for strep
throat and vaginitis).
Healthcare could be reasonably priced if health
insurance didn't have to pay for the more affordable
things (and the CEOs didn't have multimillion
dollar salaries).
That is what a Direct Care model does. It takes
insurance out of the equation. Direct Care practices
contract directly with labs, with radiology services,
with pathology so we negotiate a fair market price
for the patient's healthcare. All pricing should

22 Summer 2017 Central PA Medicine

By DEBORAH
HERCHELROATH, DO

be transparent. There are no secrets. We call this
wholesale pricing.
Value also comes from having a small staff.
Direct Care practices don't need lots of employees
because we don't have to do any pre-authorizations
or argue with insurance companies about billing.
Some practices are called micro-practices and
have no staff whatsoever, aside from the physician.
Patients can even use the EHR software to make
their own appointments.
By giving patients direct access to care, patients
are typically healthier. They can see their physician as much as they need to, and preventative
services are emphasized. Therefore, the insurance
companies save money because they have less sick
people to insure. In theory, they should be able
to lower their premiums.
Direct Care avoids stressing the system by
offering care through technology visits. We can
text and email patients. This is convenient for the
patient and the doctor. And because the doctor is
getting paid a monthly fee (and has a reasonable
amount of patients), he or she isn't overwhelmed
dealing with these types of visits.
We also decrease Emergency Room and Urgent
Care visits because our patients can access us
when they need us. This, too, has the potential
to save the system millions of dollars. It also saves
the patient the aggravation of an ER/UC visit.

Another value to the patient is that of the time
spent with the doctor. Because of a smaller patient
panel, visits are typically 30 to 60 minutes. This
gives the patient adequate time to address any
issues without feeling rushed.
Finally, rising deductibles have made insurance
unaffordable. Although this model does NOT
replace insurance, it gives the patient an affordable
way to obtain health care for most general issues
and preventative services.
The stress of the current model is driving
doctors out of practice. The Direct Care
model is a beacon to guide them back towards
medicine and the reasons they went into it to
begin with. It's like "old time" medicine where it
was just the physician and the patient. Nothing
between them but trust and the goal to make
the patient better.
Dr. Herchelroath oﬀers Direct Care gynecology, aesthetics, and wellness services including
bioidentical hormone pelleting. She feels strongly
about oﬀering our communities other options to
help with the healthcare issues facing this country.
Dr. Herchelroath would be happy to speak with
any physician considering Direct Care. She can
be reached at djmilstein@yahoo.com. Please visit
www.dpcfrontier.com and www.iamdirectcre.
com for more information.

http://www.dauphincms.org http://www.dpcfrontier.com http://www.iamdirectcre

Table of Contents for the Digital Edition of Central PA Medicine - Summer 2017