TAMPA, Fla. — As patients grow frustrated with the traditional health insurance model, some doctors say it has burned them out, too.
Physicians in the Tampa Bay area are turning to what many call membership medicine, including direct primary care models that charge patients a monthly or annual fee for access to primary care services. Doctors who have made the switch say the model allows them to spend more time treating patients and less time dealing with insurance companies.
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At Xcelsior Health in South Tampa, founder Dr. Ryan Adami operates out of an unassuming home rather than a traditional medical office.
“We're an example of a membership model, and we are different from concierge and more the price, and then the fact that we're cutting out third parties to go direct with patients or their employers,” Adami said.
Adami said eliminating third parties can reduce costs and give patients more control over how they pay for care.
“It makes zero sense that you're almost penalized for having insurance and going through it, and paying more out of pocket than if you were to just pay cash ahead of time,” Adami said.
He said the model has also changed the way he practices medicine.
“And then how we take care of them. To me, that is the biggest thing that I really didn’t understand until doing it. How I take care of you as a patient is not dictated by the insurance,” Adami said.
Adami said Xcelsior Health memberships start at $55 a month.
This year, some direct primary care patients have a new way to pay. Under the One Big Beautiful Bill Act, some direct primary care memberships can be paid for using tax-free health savings account dollars.
Adami said he does not want to return to the traditional insurance model.
“How happy are you switching?” Paluska asked.
“I’m much happier, much happier. I don't know if I would have stayed with it honestly, and I think a lot of doctors, you probably would have lost a lot of doctors to practicing medicine at all if there wasn't that membership model or direct primary care,” Adami said.
Katherine Drabiak, a professor at the University of South Florida College of Public Health, said the administrative side of medicine can frustrate physicians.
“I think part of this has to do with a lot of what goes into being a physician is the business of medicine, or the paperwork behind it, or dealing with insurance companies, or dealing with government-funded programs,” Drabiak said.
Drabiak’s courses include discussions about the realities students may face when they become doctors, including the business decisions involved in practicing medicine.
“Do you tell your students you're going to come up against a lot of red tape with insurance?” Paluska asked.
“I think they know it think they know it. Yeah,” Drabiak said with a laugh.
“What do they say?” Paluska asked.
“They know it. So part of what I talk with with my students is navigating some of the risk of these business decisions and what they're able to do and what they're not able to do,” Drabiak said.
Drabiak said patient frustration over medical bills is one reason models outside traditional insurance have emerged.
“I think that's been one of the big frustrations among consumers and patients is feeling like why am I being billed for this amount? Where did this amount come from? Why is this so expensive? And so I think this is probably one of the areas why this model emerged. But as for what would the greatest model look like, I don't have the answer to that, so we'll have to we'll have to wait and see in the future,” Drabiak said.
Membership medicine also comes with trade-offs. Membership fees do not go toward a patient's insurance deductible, and not everyone can afford an additional monthly expense.
“The pro is they're able to get more access to that primary care physician and get those monthly visits to manage potentially some of those chronic health conditions that they might have, but it's an extra expense,” Drabiak said.
Dr. Marai Roque of Our Personal MD has also moved away from practicing under the traditional insurance model.
“I spent some time practicing with insurance medicine. Yeah, insurance medicine,” Roque said.
“How was that?” Paluska asked.
“It was exhausting. I mean, if we want to talk about burnout, it's not just not the kind of practice, the kind of medicine that I signed up for,” Roque said.
Roque said dealing with insurance companies took time away from other aspects of practicing medicine.
"What is it that you have to jump through with insurance that causes burnout?” Paluska said.
“When you work with insurances, you spend a lot of time on administrative burden. You spend time meeting their criterias, fighting their denials, or asking them for authorization. Because of that, you need to hire more staff,” Roque said.
She believes more doctors will consider making a similar shift.
“I think every year we're seeing more doctors shift into this type of medicine because we feel like we're actually able to care for patients, and patients feel the difference. So I do think that this is going to become more and more of the standard, and hopefully the healthcare system adjusts to that kind of care,” Roque said.
Adami stressed that membership-based primary care does not eliminate the need for
insurance to cover potentially expensive medical emergencies and illnesses.
“So we're trying to change the system, where at least primary care has the time to spend with their patients, and it's affordable, and then use health insurance or wraparound policies that will cover things like emergency room, a cancer diagnosis, hospitalization. Those are huge, hugely expensive items that you really need that insurance to cover,” Adami said.
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