Rising premiums and deductibles mean health insurance increasingly costs more but covers less, leaving Montanans paying some of the highest healthcare costs in the country.
This week, the legislature advanced Senate Bill 101, a bipartisan bill that could make Montana a national leader supporting a growing trend of doctors opting out of insurance entirely to help give patients more choice and lower the cost of health care.
Some readers may have heard of direct primary care (DPC), a direct care model where patients bypass insurance to pay doctors directly. DPC is a membership providing unlimited access to comprehensive primary care services for $70 per month on average.
Authorized in 2017 by former Insurance Commissioner Matt Rosendale, at least eight DPC clinics have opened in Montana — everywhere from Polson to Billings. DPC has proven a transparent, affordable option of quality primary care for thousands of Montana patients struggling under higher and higher medical costs.
A price comparison shows the incredible cost savings in DPC. My local hospital in Helena, St. Peter’s, charges $103.66 for a standard lipid panel. Pacific Source, a common insurance plan for Montana’s individual market, pays the hospital $98.48 for the service. Blue Cross, another common insurer, pays the hospital $22.13 for the same service. However, a DPC clinic in Whitefish that doesn’t accept insurance says a lipid panel costs their patients “$7.50, no more, no less.”
By eliminating the middlemen and bureaucracy involved in billing insurance, providers can save patients money and focus on their health. Many DPC doctors take pride in their ability to respond to texts from a concerned parent on a Sunday or make an occasional house call like “old-time family doctors.”
The decreased bureaucracy of DPC also has another benefit: lowering the overhead and administrative costs of providing patient care. The streamlined business model with stable revenue means providers can more easily operate in rural areas among vulnerable geographic populations. DPC could be the key to addressing disparities in health care access in underserved areas of Montana facing severe shortages of primary care.
Despite the growing popularity of DPC and clear benefits to patients and doctors, government roadblocks prevent the widespread adoption of direct care. Montana is one of the few states that has not authorized DPC in state law, creating uncertainty for patients and employers who want to offer DPC as a benefit to employees.
If approved, SB 101 would be the nation’s most expansive authorization of DPC to date, specifically allowing direct care arrangements with any health provider, not just primary care. This would allow maximum freedom for medical entrepreneurs of all sorts — dentists, mental health providers, even some specialists — to innovate and grow the market of affordable options in Montana.
Many people I’ve talked to believe the future of health care in the United States is gloomy, anticipating rising costs, poorer care and more government takeovers. But the doctors and patients pioneering DPC give reason for optimism.
Innovations like DPC show how the health care market is adapting to the needs of patients, bypassing our broken system and building a better doctor-patient relationship.
Kendall Cotton is the president and CEO of the Helena-based Frontier Institute. His column appears every other Sunday on the Missoulian's Opinion page.