Disruptive Primary Care
Direct Care was never polite. It was a rebuild.
Direct sounds soft.
Membership. Access. No middleman. A nicer word for a nicer clinic.
That’s half the story — and the half that undersells the work.
Direct Primary Care is Disruptive Primary Care.
It doesn’t ask the old system for a friendlier prior auth. It doesn’t beg for a better “allowed amount.” It builds a parallel stack where patients can finally win on price and time.
Meds go wholesale instead of pharmacy-benefit theater. Labs get a cash price you can read instead of a mystery allowed amount. Visits run on a flat monthly membership instead of copay and deductible roulette. Procedures are often free at the clinic — the line most people refuse to believe until they see the receipt. Paperwork and gatekeeper roles designed to limit care don’t get optimized. They get deleted.
Most people think you can’t make healthcare five or ten percent cheaper. Meanwhile premiums and unit costs climb five to ten percent a year, and everyone treats that as weather.
The Direct Care reality is uglier for the status quo and better for patients: on a regular basis, ordinary care can drop fifty, seventy-five, even ninety percent when you stop paying for the maze.
We’ve eliminated copays. We’ve made procedures free. We’ve taken out layers of authority whose job was to slow the visit down.
That’s not a feature list. That’s a different product.
Disruption isn’t a complaint. It’s the product.
You start with a small system that works — membership, posted prices, a doctor who answers — then you eat the bloated market from below. Costco for care. Not Costco cosplay with a loyalty card for your blood pressure meds.
We’re coming for anything unaffordable that we can rebuild: wholesale meds, wholesale labs, transparent procedures, care without the decoder ring.
If patients could design healthcare from the ground up, it would look a lot like this. Flat monthly for a lot of care. Transparent add-ons for the rest. Real insurance for the wreck — not for the oil change.
I am not anti-insurance. Keep a policy for the hospital.
I am anti pretending the maze is medicine.
We’re not waiting for permission to make unaffordable things affordable.
Call it Direct Primary Care if you want the polite name. Call it Disruptive Primary Care if you want the accurate one.
We’re disrupting every marketplace we can — and we’re just getting started.
Price Transparency Is a Search Bar
Price transparency is not a slogan. It is a search bar.
Turquoise Health’s patient tool is one of them. You look up shoppable care near you and compare prices rooted in hospital price-transparency data — including cash prices where hospitals posted them. Not every provider or procedure is listed yet. Cash shows up when the hospital published it. Confirm before you book. The habit matters more than the logo: publish the price, let patients compare, stop treating the "allowed amount" as if it were a price.
A walkthrough circulating from @themdnewsletter put the gap in one procedure: colonoscopy estimates ranging from about one thousand one hundred sixty-two dollars to about twenty-three thousand eight hundred seventy-three dollars across roughly one hundred results. Same word on the order. Different doors. That is why a search bar beats a mystery EOB.
Direct care already lives there. Membership. Wholesale meds. Cash labs. Procedures free at the clinic when we can. The price is on the door. Tools like Turquoise are public proof the black box was always optional.
This is the first post in a weekly scout for price-transparency tools worth knowing. More will follow for social and the blog. Keep a policy for the wreck. Shop the oil change with your eyes open.
Source: turquoise.health/patients
Stop Adding. Start Subtracting
David Epstein has been talking about a bias most of us never name. When something is broken, people reach for more. More parts. More rules. More layers. Researchers call it subtractive neglect. We overlook the fix that removes something.
Healthcare is that experiment at national scale. A visit gets a prior auth. A prior auth gets an appeal. An appeal gets a portal. A portal gets a middleman. Nobody asks whether the claim should have been there at all.
I am not shocked. The system was built to add. Direct care is the subtractive move. Flat monthly fee. No claim. No network. No permission slip before you see your doctor. Keep a policy for the wreck. Primary care is not a wreck. We take care of patients for a flat monthly fee. The number on the door is the number you pay.
You do not need another layer on the Lego tower. You need the one brick taken out.
Source clip: www.instagram.com/reel/DcJna25mwIl/
One Hundred Fifty Dollars Keeps the HSA Open
Congress did not invent Direct Primary Care. It finally stopped punishing people for buying it with an HSA.
Under the new rules, a qualifying DPC membership stays compatible with HSA contributions if the fee stays at or under one hundred fifty dollars a month for one person, or three hundred for more than one. Go over that line and you can still pay the fee from the account. You just cannot keep feeding the account while you are enrolled. Most adult DPC memberships already sit between fifty and one hundred fifty. The ceiling is not a price. It is a permission slip.
Source: www.irs.gov/pub/irs-drop/n-26-05.pdf
I am not shocked. For years the tax code treated a flat primary-care fee like "other coverage," as if texting your doctor was a policy. Patients chose between the membership and the savings account. That was a paperwork tax on common sense.
I am not anti-insurance. Keep a policy for the wreck. I am anti a rule that made the cheap, monthly door the expensive one. We take care of patients for a flat monthly fee. No claim. No network. The number on the door is the number you pay, and now the HSA can help pay it.
One hundred fifty is a line. Stay under it and the savings account keeps working.
Forty-Six Minutes on Shrugging Off Insurance
Josh Umbehr sat down with Center for Modern Health’s Healthcare Builders podcast for about forty-six minutes on a line we keep repeating: shrug off insurance for most care, keep it for the wreck, and let Direct Primary Care rebuild the doctor–patient relationship.
That is not a stunt. It is the model. Flat monthly fee. No claim. No network. A doctor who answers. Catastrophic coverage for the day you need the hospital. Primary care should not ride the premium.
If you want the long version in his voice, the episode is up.