5/25/2020 by Share Your Story

The Need for Healthcare Price Transparency

Kate Pecora (virtually) travels across America and speaks with Siobhan Benham about healthcare price transparency and Direct Primary Care.


This week, Kate talks to Siobhan Benham about new ways to combat healthcare price transparency, namely, direct patient care. Here’s Kate….


One of the biggest complaints about the United States healthcare system is the lack of healthcare price transparency. You might walk in the door and realize you owe a $50 co-pay, and then a few weeks later, the total bill winds up as an unpleasant surprise in your mailbox. That bill may feature a price that seems to come out of nowhere. This billing process can be frustrating to patients and providers, as pricing is relative to insurance coverage, discounts, deductibles, and all the middlemen in-between. The only guarantee is that you won’t know the exact cost of your service until after it’s been provided.

DIRECT PRIMARY CARE

When I first talked to Siobhan Benham, I was looking to learn more about a new model I’d heard wind of: Direct Primary Care. Siobhan would push back and say that this model is in fact, not new at all, and has had a rise in popularity since the 90s, particularly in rural areas.

Siobhan is a Registered Nurse Practitioner at her independent practice, Hearthside Family Health, in New Hampshire. Unlike the traditional primary care model, Siobhan operates with greater flexibility, personalization, and importantly, price transparency with her patients.

Direct Primary Care (DPC), as Siobhan puts it, is “when the patients pay the provider directly by taking out insurance middlemen and realigning incentives.” While DPC varies at individual practices, Siobhan’s model is based on a monthly subscription service with the option of additional, fully transparent pricing for specialized testing or prescription medications.

HOW DOES DPC FIX HEALTHCARE PRICE TRANSPARENCY?

If you’ve ever worried that getting the flu and then ear infection in the same month might break budget, the DPC model provides the solution. Siobhan’s patients have unrestricted access to her medical advice and appointment time with a clinician. This relationship between patient and provider is mutually beneficial, offering unfettered access for the patient, and more time practicing medicine, rather than charting, for the provider.

Siobhan BenhamAs healthcare systems have more hands in the pot, too often, the burden falls on the provider to treat medicine as a quota system. In her previous work, Siobhan practiced at a traditional hospital. She became frustrated with the amount of time spent compiling insurance paperwork and the limited ability to host meaningful conversations with patients.

 

KEEPING THE FOCUS ON PATIENTS

While her practice serves many uninsured individuals, Siobhan also works with patients who are otherwise insured, but still unable to justify potential out-of-pocket costs, or simply enjoy this more intimate relationship.

In the years I’ve spoken with clinicians, I have yet to find another provider more patient-centric than Siobhan. Listening to her enthusiasm about the benefits of a small, tight-knit practice helped me reevaluate the benefits of primary care. Certain chronic diseases, mostly attributed to lifestyle, could be prevented through the lens of primary care. However, as Siobhan correctly noted, access to healthcare via an insurance card, doesn’t always mean that its accessible.

MORE THAN JUST SUSTAINABLE – PREFERABLE

Because of the transparency the DPC practices like Siobhan’s provide, those with ongoing or future chronic health conditions can feel comfortable walking through her door without sticker shock on their way back out. That kind of healthcare price transparency and openness creates trust.

When the Coronavirus crisis impacted access to care, Siobhan’s patients, feeling a sense of belonging and benefit from her practice, stepped up to help others. “We had enough personal protective equipment,” said Siobhan, ” so we could do doorstep assessments. That was in part because (it was amazing, I have to say) how many of our patients reached out to us to say,’I have some masks. Do you need gloves?’ Knowing we are healthcare workers, they were so worried about protecting us, which was just wonderful.” That sounds like community.

To listen to my full interview with Siobhan and to learn more about Direct Primary Care, benefits to nurse practitioners in New Hampshire, and how Siobhan has continued to provide care during COVID-19, check out this week’s Patients Rising Podcast.


Kate PecoraKate Pecora is a graduate of the University of Massachusetts Amherst where she studied Healthcare Policy and Political Science. She is an advocate for rare diseases, primarily in the neuromuscular space. Kate is diagnosed with Spinal Muscular Atrophy Type III. She is currently traveling across the country (sometimes virtually) in search of the most compelling stories of patient access, affordability, and quality. Ultimately this will become a book that will educate students on the importance of patient perspective. Instagram Facebook Twitter


From the editor:

there are many ways that healthcare costs are opaque. Here are a few of our best articles on healthcare price transparency:

Jordan and the Case of the Copay Accumulator

The Diverse Cost of Diabetes Care

You can also hear from some of our members talk about this on the Patients Rising Instagram [ @patientsrising ].


Spread the Word:

You'll receive updates about new resources, patient stories and insights, advocacy work, and alerts about patient-support events.
The latest about patient advocacy

Join our Email List

Get notified about new stories and resources to empower patients and caregivers.