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Unbundle: A Key to Healthcare Decision Making

There are, of course, myriad factors and considerations when pursuing optimized health, achieving better healthcare, and containing healthcare costs. It’s a lot to take in, especially when you try to do it in one, big gulp.

The key is to unbundle.

Set everything else aside, for the moment, and consider three things first. But, consider them one at a time – by themselves – and in a particular order.

1) Be Honest with Yourself & Set Realistic Health Goals

First, be honest with yourself about your current health and set some realistic, achievable health goals. General goals are fine to begin with. Don’t get bogged down with specifics (just yet).

    • How well do you take care of yourself?
    • What chronic conditions are you managing?
    • What’s in your family history that causes you concern?
    • What age-related conditions might creep in?

Then…

    • What do you hope for your health in the future?
    • What do you want to be able to physically do or accomplish?
    • What do you want to feel like?
    • What do you want to look like?
    • What do you NOT want to worry about?

Fix these things in your mind. Write them down. Don’t move to the next thing too quickly.

2) Think Objectively and Define What You Want in a Primary Care Physician

Second – and separately – you are going to need a good primary care physician. We all do. Your health and chronic conditions may necessitate any number of specialists, but concentrate on primary care for the moment. Disregard the things that customarily keep us attached to a particular PCP (“takes” your insurance, has been your doctor for years, is located in convenient proximity to you…etc.) and think objectively.

    • What do you really want in a doctor-patient relationship?
    • What do you need from him?
    • How accessible is your doctor?
    • How long does it take to get an appointment?
    • How much face time do you actually have with your doctor during appointments?
    • Is your doctor proactively engaged in your health and well-being or does she simply medicate you when you’re sick?
    • Does your doctor suggest and encourage natural, holistic approaches to health maintenance? Does she offer nutrition and fitness advice – tailored for you specifically?
    • How about follow-up or ease of communication?
    • Does your doctor really know you or are you primarily a name on a chart? Does that matter to you?
    • What kind of doctor-patient relationship gives you the best chance for optimized health? Do you have that now?

When you have generally defined what you want – and deserve – in a primary care physician, move to number three.

3) Consider the Economics

Third, you have to consider the economics of it all. But, as with numbers one and two, think objectively. Set aside the inclination to make health and healthcare decisions from a place of fear. Oh, the fear is real enough. Most of us are more concerned about not being able to “afford” the healthcare we need than we are of being sick. And for good reason.

But does the way you pay for healthcare right now have to be? Might there be another way that makes more sense for you? Are you carrying too much health insurance? Do you really need the degree of comprehensive coverage you now have? (Remember, health insurance and healthcare are two different things. Healthcare can make and keep you well. Health insurance cannot. Learn more in Step #5 of our eGuide, 5 Steps to Better Healthcare at Lower Cost).

Have you considered some type of health savings account (HSA)? Have you looked into the possibility of paying for most of your healthcare out-of-pocket instead of a sole reliance on health insurance? Is it better for you to pay for insurance only, or to pay a subscription or membership fee to a direct primary care or concierge physician? How about one of the medical cost sharing plans available? Are you sure you are getting your money’s worth right now? Research and understand how the options work.

Now that you have considered and clarified these three things separately – that is, you’ve unbundled them from each other – start to put them back together. How can you best make them piece together to form your desired healthcare universe? Chances are you have some decisions to make. But remember this, you DO have options. You’re not locked into anything, necessarily.

Want to learn more? Read our latest eGuide

For detailed step-by-step encouragement and assistance, read our free eGuide, 5 Steps to Better Healthcare at Lower Cost and visit Healthscient.com for practical tips and important healthcare insights.

Healthscient eGuide, 5 Steps to Better Healthcare at Lower Cost

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View From the Other Side of the Examination Table

At Healthscient, we wholeheartedly encourage healthcare consumers like you to consider partnering with a primary care physician who proactively aligns with your health goals and offers a payment model that makes good, financial sense. After all, your health is your greatest asset and…well…money is a consequential issue.

Partnership is an important word. It suggests a cooperative arrangement between two or more parties. In this case, it suggests a cooperative arrangement between you and your doctor. Both doctors and patients want this kind of partnership – it’s the dream scenario. So why does your relationship with your doctor so often feel like something less?

There is, of course, a myriad of reasons and contributing factors as to why. But consider these few from a typical primary care physician’s side of the table:

    • They often carry hundreds of thousands of dollars of medical school debt into their 40’s or 50’s.
    • They have to manage a patient load of between 2000-3000 clients to simply make their economics work.
    • That means they have to see between 20 and 30 patients a day in about 10 minute increments.
    • It takes about 13 minutes per patient to simply complete the insurance billing and administrative paperwork. That costs real money.
    • 30 percent of appointments are no-shows (on average).
    • On top of it all, as high as 50 percent of patients with at least one chronic illness do not adhere to prescribed treatment plans.

Clearly, we patients are to blame for some of these reasons. We have to own our part of the problem and commit to doing better. But the fact remains that a typical primary care physician is trapped and ensnared by a broken system. It’s why there is record burnout among these doctors. It’s also why so many of them (in steadily growing numbers it seems) are opting for a different kind of model. Many are moving to Direct Primary Care or Concierge medicine.

And we think you should consider moving with them.

 
For a little more on the topic (albeit transparently biased), we highly recommend reading this article. Also, to help kick start your journey, download our infographic: 5 Steps to Better Healthcare at Lower Cost.
 


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Direct Primary Care – The Moment I Finally Made the Switch

I like my doctor. I really do.

We’ve been together for over a decade now. Oh sure, I only see him once or twice a year unless I get sick. And, sure, it’s pretty tough to schedule a timely appointment. I understand I’m not the only patient he has and that he can’t really afford to spend too much time with me during those infrequent visits. I don’t really mind that he continues to call me Robert – though no one else on the planet does.

I guess I don’t really mind that it’s never actually him who calls me back with an answer to a question I’ve phoned in. I will say, however, that asking subsequent follow-up questions through an intermediary is less than ideal – no offense to capable, well-intended staff. But, I really do like him and I think he is a good doctor.

Nothing is perfect, right?

As I turned the corner and headed north of 50 years old, I began to feel like I wanted a little more from this relationship. (I’ll resist the temptation to say, “It’s not him…it’s me.”) As I looked toward retirement, I realized that my health is my most important asset. I had begun to feel more and more like a number to his practice – like just a customer.

To be clear, I wasn’t mistreated in any way but I didn’t feel like I was all that “visible” either. I was feeling like I wanted more of a partner – someone a bit more engaged in my ongoing health instead of just a provider. I was already kind of feeling this way.

And then something happened.

 
I had my annual physical just two months before (it lasted a quality 13 minutes.) My blood pressure was running a little high (as it has been since high school – I’ve always been on the top end of normal) so we decided to add a little medication to my daily regimen. The doctor sent me a letter a couple weeks later re-capping the things we talked about and giving me the results of my lab work.

Two months later, I began receiving those annoying automated calls reminding me of an upcoming appointment and warning me that I’d be charged if I didn’t show up. I didn’t remember making the appointment (not to mention why) but I showed up.

I went super early in the morning for lab work before a mid-afternoon appointment. I was told my lab results should be ready by the time I saw the doctor (a fairy tale) but mainly I went early so I could eat.

When I checked in for my appointment, the conversation started like this:

Receptionist: Do you have your medication list?

Me: Don’t you still have it in your records? We just did this 60 days ago.

Then I asked the receptionist if she could tell me why I was there.

She couldn’t.

 
After spending a good bit of time in the waiting room, I was “taken back” about 30 minutes after my appointment time. My weight was measured on the way in to the examination room, as per normal. I hate that part. The nurse took my temperature and blood pressure, as per normal.

She then said to me, “What brings you in today?” And I said, “Funny, I was going to ask you the same question.” Perplexed, she looked at the papers in her hand and said, “‘Nurse Requested’ is checked, but I didn’t request it. Hang on. I’ll be right back.”

She returned and basically hemmed and hawed. No substantial answer.

Fifteen minutes later, my doctor arrives. “Hello, Robert.” I could tell by the way his eyes averted mine that he couldn’t tell me why I was there either. I assume the nurse had gone out to ask him. The next three minutes were spent with him essentially reading the report from my physical – reading aloud the letter he had sent me two months ago. I kid you not. He then told me that my lab results from that morning weren’t ready yet (big surprise) and that he’d send me another letter.

To be fair, I believe he was embarrassed. I believe that he was thinking, “Geez, what am I doing here?” Doctor burnout, by the way, is rising at an alarming rate.

No one could tell me why I was there.

On my way out, the checkout person says, “OK, let’s schedule your next appointment.”

“Thank you”, I said, “but no.”

My very next spoken words were, “Siri, show me Direct Primary Care doctors in Atlanta.”
 


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