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Primary care with a purpose: cutting hidden costs with Dephi Amid a multitude of shifting policies and a dictionary’s worth of jargon, even savvy patients can get lost in the maze of health care costs. Slight technicalities and discrepancies in facility fees can result in a $1,000 bill. It isn’t uncommon to hear of someone going to get what they believe is a preventative colonoscopy, only to discover it’s been billed as a diagnostic colonoscopy with a co-insurance bill of hundreds or even thousands of dollars more. Many consumers don’t realize how varied — and avoidable — these costs can be. When more than 40% of Americans say they can’t cover a $1,000 emergency expense with cash or savings, according to a U.S. News and World Report survey, those unanticipated costs can become catastrophic. “One thing I wish more people knew about is that the leading cause of bankruptcy in America is health care,” says Andy Vailas, president of Delphi Enhanced Primary Care. “When people are on a high-deductible health plan, which a lot of small, fully insured groups are, these individuals are essentially self-insuring.” COMPARING THE COST OF HEALTH CARE Figuring out the true cost of care is challenging when the same services can be billed differently depending on where you go, what your insurance plan is and how the payments are structured. In a 2024 review of data from the Centers for Medicare & Medicaid Services of 37 procedure codes, services performed at ambulatory surgical centers (ASCs) resulted in approximately 35 percent savings in total cost compared with hospital outpatient departments (HOPDs). Medicare numbers show how costs can be nearly halved by going to an ASC instead of an HOPD: A rotator cuff repair would be $889 compared to $1,574, or a hernia repair $626 compared to $1,184. “There’s very little force preventing this price abuse. We should say, as policymakers, what can we do to prevent this abuse?” says Nick Vailas, founder and CEO of Bedford Ambulatory Surgical Center (BASC). “First and foremost, absolute transparency is so important. Before services are rendered, patients need to be informed as to what it’s going to cost. On the other end, patients need to be motivated to ask, ‘what is the cost of the care?’” Nick Vailas compares it to car shopping. No one would buy a car without comparing prices. If they could purchase a car for one-fifth or even half the cost of another location, the higher-priced dealership would fold. But in the present health care system, finding the cost of services takes a lot of effort. QUALITY PRIMARY CARE CHARTS A PATH TO SAVINGS This lack of transparency and price predictability is what Delphi aims to address through its patientcentered model. At Delphi, members pay a monthly fee that goes toward keeping the physicians’ patient load far lower than the national average. This ensures not only that patients get care as soon as they need it, but they also have a doctor who acts as a health care navigator. “Even I need an advocate when I’m sick,” Nick Vailas says. “It is a great comfort for $120 a month; you get not only a physician that you can call your own, there’s a team of people that will help you navigate the health care system, from people who will make appointments for you to specialists who bring the greatest value to the marketplace.” While hospital-affiliated primary care offices may prioritize in-network referrals, Delphi’s doctors focus on finding qualified specialists who offer the best value— regardless of affiliation. “Having a primary care provider who’s independent, who steers away from these high-cost centers is tremendously valuable from an individual standpoint,” Andy Vailas says. WHEN PRIMARY CARE ISN’T ACCESSIBLE, PRICES RISE A primary care provider is supposed to be the one coordinating patient care, but when patients can’t get an appointment for days or weeks, they instead go to urgent care or the emergency room, where they aren’t getting familiar support and are also paying more outof-pocket costs. “We see it all the time,” says Andy Vailas. “There’s no co-pay or a minimal co-pay to come to a primary care office versus going to an urgent care, where you’re paying a facility fee and a doctor’s fee, and those costs add up, and we see specialist fees for like a $75 to $250 co-pay.” To try and mitigate this, some employers have added additional “benefits” to meet care coordination needs that aren’t being met by the traditional health care system. “Employers, or even insurance companies, like to offer advocacy services, navigational platforms and all that, when in reality, you should just rely on your primary care to handle the issues that you’re dealing with,” Andy Vailas says. “We’re paying a lot extra, and obviously people are starting to feel that. When in reality, if you had a primary care doctor that you can see regularly, or just least communicate with, and have a team like ours to help you with that system, you don’t need all those bells and whistles.” SAVINGS MULTIPLY WITH SUPPORT When patients get care for concerns before they escalate, there are cost savings. When patients know how their health insurance works, they can maximize its benefits. And when patients have a provider who has the time to find the best care for the best price, both the consumer and insurance carrier see the benefits. “There’s plenty of literature to support what I am saying: that concierge medicine saves an employer a lot of money, pays for itself many times over,’ says Nick Vailas. “And the beauty of it and the humanity of it is people are going to get care when they need it.” When patients can seek out cost information before getting care, and they have the support of primary care practices like Delphi to make the process more transparent, the competitiveness of the whole health care marketplace improves. Price transparency can reduce overall health care spending and improve outcomes. “Access and affordability are our mission,” Andy Vailas says. To explore how Delphi’s model is helping patients and employers reduce costs and improve care, visit delphihc.com. 20 Washington Place, Bedford NH 03110 (603) 255–5579 https://delphihc.com/