Premiums, co-pays, co-insurance, deductibles, out of pocket maximums, non-covered services…who really is in charge of your healthcare decisions? Is a provider in-network, out-of-network? Does a patient have control over which lab or radiology provider to choose? Does the patient know whether those providers are in network or out of network?

Do your patients know the same procedures done in an office, a surgery center, and hospital place of service affect the way your insurance processes your claim? It affects whether or not a patient will have to pay a deductible or a co-pay. The government wants patients to be involved with health care decisions and be “consumers.” Imagine going to the grocery store and having 5 brands of bread with the same ingredients, but the prices are not on the shelves. The consumer will not know the final price until they check out. It becomes awkward for the consumer to leave to get another brand – when they still will not know which brand is the best value.

The definition of value according to is “relative worth, merit, or importance.” Most consumers would agree health care has a very large value in our society. The Centers for Medicare and Medicaid Services (CMS) state the United States spent 17.8% of the gross domestic product in the health care industry in 2015. That figure represents the relative worth to our country. In terms of importance we want to ensure quality care. The dilemma for years has been how does a patient/consumer quantify – or put a price on their care?

How does our society start shifting from a model based on quantity of visits, procedures, test, etc. to a model focused on the patient? What if each provider had a team to care for a set of patients? What if the patients were able to contact their provider at any time to get assistance over the phone, streaming video, or house calls? What if we simplified the payments to providers so a patient would know how much it costs and how much their labs or x-rays at another place will cost?

There is a movement toward a Direct Primary Care model allowing family physicians and providers to treat their patient at a substantial savings to both the patient and provider (reduced administrative costs). The model additionally allows providers to spend adequate time with their patients potentially saving unnecessary tests. While the Direct Primary Care model is focused on family practice the design could also be used in specialties that have many procedures that are not covered by health insurance such as cosmetic dermatology or certain physical therapy treatments. Follow FinanSynergy as this topic is explored at a deeper level.