Most of us are used to healthcare working one way: find a doctor who accepts your insurance, schedule an appointment, show your insurance card and hope the bill makes sense later.
But direct primary care offers a very different model.
In this episode of the Bill of Health Podcast, presented by Core 360 Benefits Group, I’m joined by Melinda Lacy, MSN, APRN, FNP-BC, of Direct Family Healthcare in Harrisonville, Missouri, to talk about how direct primary care works and why more patients and employers are paying attention to it.
Direct primary care uses a membership model rather than traditional fee-for-service billing. Patients pay a predictable monthly fee for access to primary care, often with longer appointments, easier communication and more help navigating the cost of labs, imaging and other services.
Melinda also shares real examples of how price transparency and cash-pay options can make a significant difference. In one case, a patient facing roughly $2,600–$2,700 for two MRIs was able to get them for about $1,400 by using a different imaging option.
The goal isn’t to replace every part of the healthcare system. It’s to give patients another way to access primary care, understand their options and make decisions that fit both their health and their finances.
In This Episode of Bill of Health:
Melinda and I discuss:
- What direct primary care is and how it differs from traditional fee-for-service medicine
- Why smaller patient panels can mean more time and access for patients
- How cash-pay pricing can lower the cost of labs, imaging and other healthcare services
- Why you may be paying more through insurance than you would by asking for the cash price
- How direct primary care can benefit employers and their employees
- Why having a financial safety net for catastrophic medical expenses still matters
How Direct Primary Care Works
Direct primary care is built around a membership relationship between the patient and the healthcare provider. Rather than billing insurance for each primary care visit, patients generally pay a recurring membership fee.
That model can give providers more time with patients and make same-day or next-day appointments, phone calls, texts and other communication easier to provide.
Melinda’s current practice, Direct Family Healthcare, is based in Harrisonville, Missouri.
Price Transparency Can Change the Equation
One of the major advantages Melinda sees is the ability to help patients compare options before receiving care.
A doctor may recommend the right test or procedure, but that does not necessarily mean the first location offered is the most affordable place to have it done. Independent imaging centers, cash-pay arrangements and other options can sometimes reduce the cost substantially without sacrificing the quality of care.
Sometimes the most useful question a patient can ask is simply:
What is the cash price?
Direct Primary Care for Employers
Employers are also beginning to work directly with primary care practices.
Giving employees easier access to routine and preventive care can help people address health problems earlier, spend less time waiting for appointments and potentially avoid more expensive care later.
For smaller employers especially, direct primary care can become another component of a broader employee health benefit strategy.
Jargon Jar: What Is Prior Authorization?
Prior authorization is the process in which an insurance company requires approval before it will cover certain medications, tests, imaging or treatments.
That can mean a provider has to submit information and wait for the insurer to approve the service before the patient receives it.
Because direct primary care operates outside traditional insurance billing for primary care, many of those insurance-related administrative hurdles do not apply to the services provided directly through the practice.
About Melinda Lacy
Melinda Lacy, MSN, APRN, FNP-BC, is a family nurse practitioner at Direct Family Healthcare in Harrisonville, Missouri. Her experience includes pediatrics, intensive care, case management, family practice and women’s health.
Direct Family Healthcare
directfamilyhealthcare.com
Email: contact@directfamilyhealthcare.com
Phone: 816-793-0071
105C W. Wall St., Harrisonville, MO 64701
Learn More
To learn more about individual health insurance options, Medicare planning and healthcare consumer strategies—or to schedule a consultation—visit:
www.core360benefitsgroup.com
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Disclaimer
This podcast is provided for educational purposes only and should not be considered legal, tax, investment or insurance advice. Individual circumstances vary, and listeners should consult qualified professionals regarding their specific healthcare and financial situations. Opinions expressed by the host and guests do not necessarily reflect the views of any insurance carrier or affiliated organization.
Chapters
00:00 How Healthcare Is Becoming a Subscription
01:13 Welcome to Bill of Health
02:54 Meet Melinda Lacy
04:07 What Is Direct Primary Care?
05:05 How Direct Primary Care Works Differently
06:22 Why DPC Providers See Fewer Patients
07:30 How DPC Helps Patients Navigate Costs
08:52 When Imaging Costs Thousands
09:12 Saving More Than $1,000 on Two MRIs
11:28 Lower Costs Without Sacrificing Quality
13:24 Stop Automatically Feeding Your Deductible
14:36 How Direct Primary Care Can Help Employers
17:23 The Future of Direct Primary Care
19:53 How to Contact Melinda Lacy
20:21 Jargon Jar: What Is Prior Authorization?
22:28 Five for Fighting With Melinda Lacy
23:28 The Biggest Benefit of Direct Primary Care
24:29 Why Catastrophic Protection Still Matters
25:27 Final Thoughts and How to Learn More
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