“I can operate. Or you can go on a strict diet.”
“You’d better operate,” the patient replies.
Puzzled, the clinician asks, “Are you sure?”
To which the patient replies, “My insurance doesn’t cover a strict diet.”
This exchange and others like it have been used repeatedly over the years to satirize the bizarre influence of health insurance on medical decision-making.
Patients have been lulled into a costly daze—allowing reimbursement policies to govern their decisions in managing their health. Meanwhile, reliant on reimbursement revenue for survival, physicians must continuously reshape care delivery to mirror the ever-shifting values of payers.
This era of medicine is drawing quickly to a close. As consumers shoulder the growing burden of healthcare costs, America is waking up to the reality of an apparent oxymoron. With deductibles ballooning to thousands of dollars, most working-age Americans are now insured, self-pay patients.
For primary care physicians (PCPs) in particular, this new reality creates an extremely important fork in the road. As the payer system shifts to more cumbersome, value-based compensation models, a clinician could easily conclude that an independent practice is no longer sustainable. The overhead required to maximize reimbursements is simply too high for a small practice to bear.
On the other hand, PCPs searching for viable avenues to grow and sustain a thriving independent practice could recognize the enormous opportunity behind door number two.
Consumers hate the old, payer-driven model of primary care. Now that they are footing the bill, they will seek out and buy what they actually want from doctors who equip themselves to provide it.
The new consumer has three demands—all well within the reach of any PCP:
- Convenience. Patients are sick and tired of wasting time. Successful PCPs will shift resources from cumbersome billing and collections overhead to technology-enabled customer service.
- Transparency. Patients are sick and tired of blindly purchasing medical services only later to be shell-shocked by the staggering bill.
- Health. Patients are sick and tired of being sick and tired. More specifically, they are no longer content to submit to the delusion of health held tenuously together by an expensive fistful of pills.
The new consumer is searching for a practitioner trained and committed to treating the causes rather than the effects of their health conditions.
In other words, they are seeking providers trained in functional medicine—and doctors are responding. A growing legion of PCPs are now being joined by the likes of Cleveland Clinic Center for Functional Medicine in satisfying the exploding demand for this modern approach to managing health.
This market shift is not about shaming PCPs into practicing smarter, more sustainable medicine. Rather, it is a golden invitation for doctors to break their dependency on a relentless, volume-driven payer system and practice as they have wanted to all along.
For PCPs willing to seize the opportunity, functional medicine provides a repeatable, scalable structure for delivering this common sense–type of care to the new health consumer. In partnership with the Kalish Institute, The Institute for Functional Medicine recently unveiled the practice planning and optimization training that is necessary to capitalize on this opportunity. “My Practice Plan” is a 16-week, online cohort program that supports clinicians building a practice, growing their practice, or reinventing their business model. Practitioners will walk away with hours of business management education and a personalized business plan to implement in their practice.