Quality of care is difficult to measure when hospital systems try to control the entirety of your care. Once they trap you in their net, they're relentless with reaching out to you to secure your next specialty appointment, then refer back to your PCP....it's a repetitive cycle. They don't allow you any time to research and choose someone you're comfortable with. On top of this are ghost networks and/or providing lists with zero information. It takes persistence and diligence to get what you want. The system is broken.
QC for me is (random order)
- A doctor who will take the time to listen
- Did their homework (looked at your history prior to your visit)
- Credibility: others speak well of him/her and had great results
- Lays out all of your options w/ pro's/con's
- is willing to change course based on new evidence
Thank you so much for this comment! Can you tell me more about these ghost networks? I love your suggestions and can't disagree with anything you've listed!
This literally should be a handout every single person graduating high school receives. It is a simple but profound guide to how people need to think when engaging in healthcare!
That means a lot Nick. Thank you so much for your kind words. I absolutely think it doesn't have to be complex, it's about just giving yourself permission to expect good care.
I opted not to get a traditional policy this year (my provider past 4 years quit private policies in CA) and went with a heath sharing org so I’d have some backstop for a major expense (knock on wood haven’t needed this year). I am supposedly getting cash pay discounts at primary care office but I have to trust them since I can’t look up their “normal” pricing and I’m sure that figure is a moving target anyway depending on the insurance contract. Same with dental. I may go back to traditional policy in ‘25 for a mix of reasons but it’s soooo frustrating. When I looked at policies for ‘24 I was faced with about $700/mo prem, $6000 deductible for bronze AND none of them allowed HSA unless I went gold level for around $1000/mo prem. I own a small biz and can’t justify the cost of offering to staff so there’s no savings going that route. Our model in the US is so FUBAR it’s maddening (and in LA at least, it’s harder to get into good specialists due to demand and I hear fewer total docs around here thx to cost of living, insurance etc). Good times :-(
Ugh! I wish your awful experience was unique but it just isn't! I personally have opted out of insurance and am also using a health share (I use CrowdHealth). I've been much happier. Have you tried going to a Direct Primary Care doctor for basic stuff? I think that's a game changer for a lot of ppl. I'd be happy to ask around for one in your area if you are interested! Hang in there!
I go to a GP who works for One Medical near me. So far their cash pay rates are reasonable in the grand scheme for basic checkup. They don’t control lab bills so I don’t know if I get any kind of break (Quest direct bill).
I DO believe you need to explore options and be as informed as you know how to be before saying yes to a Dr.'s recommendation for surgery, or other treatment, yet, I'm not sure I understand. If we are the customer (the payer) and not an insurance company, there would be MANY us who could not afford and operation in a hospital and a possible post-op stay for several days or weeks! So I'm not sure what you are proposing.
I LOVE this question and I agree it's the hardest of the 3 suggestions in the article by far! While it is true that sometimes it is not possible to escape the traditional insurance model, there are many times that it is possible and actually leads to better outcomes! For example many employers are beginning to explore 'direct contracts' with hospitals and surgical centers (where the employer pays a "fixed/bundled" fee for a procedure) and it is now increasingly common to have the option to pay cash for procedures, primary care doctor subscriptions (also called direct primary care) or even cash pay PT or mental health providers. My daughter needed PT recently and although the cash pay PT was about $150 cash/session, we were able to get her better with 2 visits instead of 10 recommended by the traditional PT practice that took insurance that is incentivized to bill insurance + collect my $50 copay. The 10 session PT course would have cost thousands in the end since we hadn't met our deductible + time and headache! I always recommend considering if cash pay or direct contracting through the employer is an option.
Quality of care is difficult to measure when hospital systems try to control the entirety of your care. Once they trap you in their net, they're relentless with reaching out to you to secure your next specialty appointment, then refer back to your PCP....it's a repetitive cycle. They don't allow you any time to research and choose someone you're comfortable with. On top of this are ghost networks and/or providing lists with zero information. It takes persistence and diligence to get what you want. The system is broken.
QC for me is (random order)
- A doctor who will take the time to listen
- Did their homework (looked at your history prior to your visit)
- Credibility: others speak well of him/her and had great results
- Lays out all of your options w/ pro's/con's
- is willing to change course based on new evidence
Thank you so much for this comment! Can you tell me more about these ghost networks? I love your suggestions and can't disagree with anything you've listed!
This piece has a pretty good explanation:
https://www.opb.org/article/2024/09/22/up-against-a-ghost-network-for-mental-health-care-here-s-what-you-can-do/
Hey! Thanks for sharing. Off to read now!
I would define quality as the right care, at the right time, delivered with loving compassion.
Right care encompasses both appropriateness of care and cost
Right time means not too early or too late
Love is the most powerful force in the universe
Beautiful answer, Gregg! I couldn't have said it better myself!
This literally should be a handout every single person graduating high school receives. It is a simple but profound guide to how people need to think when engaging in healthcare!
That means a lot Nick. Thank you so much for your kind words. I absolutely think it doesn't have to be complex, it's about just giving yourself permission to expect good care.
I opted not to get a traditional policy this year (my provider past 4 years quit private policies in CA) and went with a heath sharing org so I’d have some backstop for a major expense (knock on wood haven’t needed this year). I am supposedly getting cash pay discounts at primary care office but I have to trust them since I can’t look up their “normal” pricing and I’m sure that figure is a moving target anyway depending on the insurance contract. Same with dental. I may go back to traditional policy in ‘25 for a mix of reasons but it’s soooo frustrating. When I looked at policies for ‘24 I was faced with about $700/mo prem, $6000 deductible for bronze AND none of them allowed HSA unless I went gold level for around $1000/mo prem. I own a small biz and can’t justify the cost of offering to staff so there’s no savings going that route. Our model in the US is so FUBAR it’s maddening (and in LA at least, it’s harder to get into good specialists due to demand and I hear fewer total docs around here thx to cost of living, insurance etc). Good times :-(
Ugh! I wish your awful experience was unique but it just isn't! I personally have opted out of insurance and am also using a health share (I use CrowdHealth). I've been much happier. Have you tried going to a Direct Primary Care doctor for basic stuff? I think that's a game changer for a lot of ppl. I'd be happy to ask around for one in your area if you are interested! Hang in there!
I go to a GP who works for One Medical near me. So far their cash pay rates are reasonable in the grand scheme for basic checkup. They don’t control lab bills so I don’t know if I get any kind of break (Quest direct bill).
Interesting. I haven't personally used One Medical, but I'm glad that it's working well. Cash pay rates are the only way to go in my book!
I DO believe you need to explore options and be as informed as you know how to be before saying yes to a Dr.'s recommendation for surgery, or other treatment, yet, I'm not sure I understand. If we are the customer (the payer) and not an insurance company, there would be MANY us who could not afford and operation in a hospital and a possible post-op stay for several days or weeks! So I'm not sure what you are proposing.
I LOVE this question and I agree it's the hardest of the 3 suggestions in the article by far! While it is true that sometimes it is not possible to escape the traditional insurance model, there are many times that it is possible and actually leads to better outcomes! For example many employers are beginning to explore 'direct contracts' with hospitals and surgical centers (where the employer pays a "fixed/bundled" fee for a procedure) and it is now increasingly common to have the option to pay cash for procedures, primary care doctor subscriptions (also called direct primary care) or even cash pay PT or mental health providers. My daughter needed PT recently and although the cash pay PT was about $150 cash/session, we were able to get her better with 2 visits instead of 10 recommended by the traditional PT practice that took insurance that is incentivized to bill insurance + collect my $50 copay. The 10 session PT course would have cost thousands in the end since we hadn't met our deductible + time and headache! I always recommend considering if cash pay or direct contracting through the employer is an option.