KENNETT SQUARE—The longer the COVID-19 healthcare crisis persists, the more we see how fragile our country’s insurance-based system of primary care really is. Millions of people who have been sick, caring for the sick, worried, or simply seeking accurate medical information over the past months have been at a loss.
Disconnected from their primary care providers by quarantine restrictions or lack of insurance, many have been left to self-diagnose based on conflicting news reports, top stories from internet search engines, or social media rumors.
Even before the pandemic, many Americans had come to expect, if not fully accept, the stress of co-pays, endless insurance forms, and waiting for days or even weeks to see their primary-care physician. In many practices, the doctors have such a hectic schedule that they have only a few minutes with each patient—and patients often have to choose which one of their symptoms to address in those few minutes.
Gone, it seems, are the days of same-day appointments and of doctors who have time to listen, connect symptoms with underlying and interrelated causes, and discuss lifestyle changes to help treat symptoms and prevent future issues.
But patients aren’t the only ones who are increasingly disillusioned with our broken healthcare system. Dr. Ricky Haug, whose Core Family Practice on West Cypress Street has been providing direct primary care for patients since 2016, decided early on in his career that the traditional model, with its rapid-fire system of patient interaction, in no way aligned with his own convictions about holistic and proactive care.
Community-Based Direct Primary Care
When the hospital-based family practice in Jennersville where Haug had loved working for six years was sold, the new corporate mission was volume. The practice had served generations of patients, and though Haug cared deeply for his patients he was no longer able to treat them as whole people and give them the time they deserved—and the time and attention they needed in order to be able to make informed lifestyle choices and decisions affecting their health.
In his search for an alternative, Haug began to explore the possibilities of opening a direct primary care (DPC) practice. The more he learned, the more he realized that DPC encapsulates his vision for health and wellness and provides a viable model for transforming the healthcare system. “DPC is innovative—and it’s also common sense,” Haug says. With DPC, patients pay a monthly fee for which they receive unlimited access to primary care. Haug likens the model to a gym membership or a Netflix subscription. DPC cuts out insurance, which has become the cost-prohibitive and cost-inflating middleman in primary care. “I really believe in this model,” Haug says. “Our healthcare system is not working well for most.” Haug still recommends having some sort of insurance to cover hospitalizations, surgeries, tests, and specialist visits. “There are many plans that pair very nicely with DPC,” he says.
Haug, or Dr. Paul Yerkes, who joined the practice a year ago, are available around-the-clock to their patients via text, email, or phone in addition to regular office hours. Core Family’s patient access combines the latest cutting-edge technology, in the form of a secure patient portal as well as an app for texting and telehealth video visits, with perhaps the oldest model of medical care—Haug and Yerkes will also make house calls when necessary. “I’m an old-school town doc—like the Marcus Welby of Kennett Square,” Haug says. He grins.
Haug, who lives in West Chester with his family, loves the walkability and small-town feel of Kennett Square, a central location where his longtime patients from Oxford and even Maryland can still come to him as well. The holistic Core Family philosophy is about engaging with the community in other ways, too. “We love to support great nonprofits like KACS, The Garage, and other community initiatives in general, and particularly through these past difficult months,” he says. Core Family also hosts a summer intern through a Career Compass partnership with the Garage.
Healthier Individuals and Families
“Direct primary care gets people engaged and proactive about healthcare,” Haug says. “People who feel better are more productive—it’s better for everyone.” Accessibility, flexibility, and a relationship with a doctor who knows his patients and their medical history—not just as screens pulled up from a database but as people—are all key components of DPC. With no co-pays or insurance hassles, more relaxed visits, and more ways to access healthcare, patients are happier.
With no pressure to see a certain number of patients a day, no long lists of questions to check off that have no bearing on a patient’s long-term health, no need to bring a patient into the office for every little ailment, and a smaller “core family” of patients, doctors are happier too. Data gathered from one DPC conference found that primary care visits increased 115% in DPC practices, with a 20% reduction in overall hospital visits.
Direct primary care practices are growing in the smallest towns as well as in big cities, and these practices are a democratizing force on healthcare, treating everyone including the very wealthy and undocumented immigrants. “You don’t need a Social Security Card to be seen,” Haug says. DPC is also a lifeline for the millions of people in the “very vulnerable” position of making too much to get subsidies but not enough to buy healthcare. “So many people are not getting the care they need, and it’s stressful,” Haug says. “They can’t afford $1,500 a month for a very high deductible.
But they’re happy to pay $70 a month for access to high-quality healthcare—and only $325 for a CAT scan if they need it.” The question of how much medications and services actually cost, Haug says, is a revelation in itself. Core Family Practice also provides services like an in-house lab and pharmacy to lower costs for patients.
Eventually, Haug and Yerkes hope to be able to add a female doctor to their team as well. “Recruiting doctors is hard,” Haug says. “It can be a difficult decision for a doctor to give up the salary, benefits, and bonuses of corporate health systems to join or start a DPC practice. It’s a risk, but the quality of life and job satisfaction are worth it. I’m so happy now. I have time with my patients, I’m able to practice medicine the way I think it should be practiced, and I also have time to be the dad and husband I want to be. That’s worth more to me and my family than any extra pay I might have received.”
A Health Policy that also Makes Good Business Sense
"Beyond inflated prices driven in large part by insurance companies, Haug says, patients are the ones who are suffering, and even dying, needlessly. It’s quite literally a matter of life and death."
“We’re so invested in a system that doesn’t support patients,” he says. “Our infant mortality rate is disgusting. We need to put a lot more effort into prenatal care. Hospitals are making a lot of money treating cancer and heart disease but we’re not, for example, going into poor communities to teach people how to eat right, exercise, and take care of themselves and their families to prevent these problems.”
Haug is helping to change the way our community thinks about healthcare, but he’s also passionate about doing what he can in Harrisburg and Washington, DC to lobby for the kind of systemic and legal changes that need to be made so that this kind of healthcare can be an option for everyone.
It needs to be possible, for example, for patients to pay for DPC using their HSAs. Although there are currently laws in many states that can make it confusing and difficult for patients to choose DPC, Haug is “cautiously optimistic” that will change soon. He’s seeing a swell of support across the country among primary care doctors and specialists, as well as among patients themselves who find themselves increasingly at risk without adequate insurance—or any insurance at all.
“We need a new model with partial universal healthcare so that people are protected and don’t go bankrupt as a result of a catastrophic medical emergency,” he says. “But it’s crazy to use insurance for things that are just part of life.” Haug likens it to car repairs. “If you need an oil change, you pay for an oil change and don’t bill insurance. If you need something more expensive, like a new transmission, you go to a mechanic you trust—and if the price isn’t fair you go somewhere else. We never ask the price of an MRI. If we did, we might be motivated to learn how to do home exercises so we maybe wouldn’t need the MRI. We need to negotiate cash prices for services in our area so that they’re fair and consistent.”
“To make a fundamental change in our healthcare system we need businesses on board too,” Haug says, and the DPC model makes sense for employers of all sizes. “Health insurance is such a big chunk of the budget for small businesses that they just can’t physically afford it, but DPC is a win-win for employers and employees.”
Haug loves to talk with individuals as well as with small business owners about the benefits of DPC and is very knowledgeable as well about the various options for DPC that are open to those who have traditional insurance.
“Only about four percent of doctors across the country are doing DPC or are in the process of converting their practices to DPC,” Haug says. “Ideally in this area we’ll see DPC practices in West Chester, Oxford, and other towns with different providers offering different areas of expertise to offer patients more choice. As early adapters, we’ll be part of the big changes I foresee in the healthcare system over the next decade.”
To find out more about Core Family Practice or to schedule a consultation over the phone, go to https://corefamilypractice.com