In 2024, 63% of workers with employer-sponsored insurance in the United States were enrolled in self-insured plans, rising to 83% for employers with 1,000+ workers. In these plans, employers pay for the health care expenses incurred by their workers through third-party administrators (TPAs) in administrative services only contracts, rather than purchasing coverage directly from insurance companies.

The United States is facing a healthcare affordability crisis with inflation expected to drive costs up by 6.5 percent next year. While Americans worry about the rising costs of medical care, many of the underlying causes of higher prices are overlooked. Bad government policies, especially Medicare reimbursement policies, foster an environment of consolidation in the healthcare industry, leading to higher prices that hurt everyone. Medicare policies must be changed to bring down costs.

Last week on Here & Now, host Peter O’Dowd spoke to a primary care doctor about the new trend of membership care, a model that’s becoming more common across the country. Under this model, doctors ask patients to sign up for membership plans for direct primary care services.

The conversation sparked a debate online with members of the concierge medicine community. This is a follow-up conversation with Dr. Josh Umbehr, a direct care doctor at Atlas MD. He brings a different perspective on this model of care and tells O’Dowd why he believes this model is better for patients and how it avoids a doctor shortage.

After two years of lockdowns, panics, and gallons of hand sanitizer, we seem to be entering a post-COVID world. Governments are relaxing vaccine mandates and minimizing masks mandates, while markets are returning to normal. We’ve all learned more about the Greek alphabet then we did in high school. Bill Maher accurately assessed the pulse of the nation when he concluded, we’re “over COVID.”

At one time only available to the very rich, a model of what is now called “direct primary care” has been developed by Atlas MD in Wichita and is rapidly spreading across the country.

The administration hopes to make Medicare open to direct primary care. Under the arrangement, Medicare would pay a fixed monthly fee to a physician or physician group instead of the traditional fee-for-service payments. In return, the physicians would provide virtually all primary care. The fees would range from $90 to $120 a month, depending on the patient’s age and medical complexity.

Concierge doctors used to be available only to the rich. Today, “direct primary care” is far more affordable. Atlas MD in Wichita, for example, provides all primary care along with 24/7 phone and email access and generic drugs for less than what Medicaid pays. They help patients gain access to specialist care and diagnostic tests, with minimal waiting. The cost: $50 a month for a middle-aged adult and $10 a month for a child.

Dr. Umbehr and Dr. Segal discuss the potential of direct primary care, the origins of Dr. Umbehr’s interest in the space, and how direct primary care influences outcomes, insurance expenditures, and interactions with patients.

Health-care policy is often portrayed as a fight between government and insurance companies. But one of the most effective cost-saving measures is to cut out both and allow patients to deal directly with doctors.