What is Direct Specialty Care is a question that arises so often today.
A new era in the US healthcare market has arrived. For the last 20 years, we have witnessed a gradual increase in our family premiums and high deductible plans. To every medical office that you go you are greeted with the question : “what insurance plan do you have?”. Every year, our copayments have increased, and surprise bills became not a surprise to anyone anymore. No real transparency in medical service prices is available today.
Did patients receive more value for their money paid to insurance premiums?
Unfortunately, these changes were paired with a steep decrease in access to specialist physicians. In the US traditional system, patients wait for months to see a specialist. Then, when the time comes, they spend too little time with that physician. Unless you are admitted to the hospital, there is almost no urgent access to a specialist office. Moreover, seeing a specialist often translates into prohibitive costs for the patient.
Patients and physicians are ready for a change.
What is Direct Specialty Care?
Direct Specialty Care is an innovative healthcare model where physicians partner directly with their patients to provide specialty care services under a flat or periodic membership fee.
What is the difference between direct care and typical concierge models?
Direct Specialty Care physicians are not providing concierge services. Concierge practices offer patients access for an additional fee, but they also receive a copayment and bill patient’s insurance. Direct Specialty care practices do not bill your insurance. You can still use your insurance for laboratory and imaging centers in your network.
What is the purpose of Direct Specialty Care?
Direct Specialty Care practices aim to remove the traditionally based billing system, removing the burden of documenting extensively, coding, billing, accreditation, and contracting with insurance companies. In this way, specialists can offer INDIVIDUALIZED MEDICAL CARE.Physicians can develop healthy relationships with their patients, primary care physicians, and direct collaborations with other specialists.
Specialists have the opportunity to provide excellent quality of care, transparency, and affordable pricing at fair market value for their specialty.
Why patients should embrace a direct specialty model?
The patients need to be proactive about their health care choices. As they shop for other services online, they can do it for their medical care. They need to compare what they receive and find out about the costs of their medical care BEFORE engaging. Ultimately they pay for these services, not the insurance nor their employer.
Where do you find direct specialty care practices?
Here are a few websites that can offer you some insight into direct specialty care options:
Green Imaging (Xrays, CTs, MRI, Echo studies)
Rheumatologist Oncall is one of the pioneers in the direct specialty care market. We strive to offer patients access, transparency, and affordable medical care by a top expert rheumatologist.
About the Author
Diana Girnita, MD, PhD is an US board certified internal medicine and rheumatology. She completed a PhD in immunology, postdoctoral fellowship at Harvard University, immunology fellowship at University of Pittsburgh and rheumatology fellowship at University of Cincinnati. She is the founder & CEO of Rheumatologist OnCall, a telemedicine company that serves multiple states in the US. Dr. Girnita is a graduate of the Nutrition Science course from Stanford University. Dr. Girnita was recognized many times with “Top Doctor” award (2017-2020) and is often invited speaker of the US National Arthritis Foundation. Read more