In a swiftly changing health care environment, an increasing number of patients and doctors are reconsidering their reliance on conventional insurance-based systems. During a recent episode of The Podcast by KevinMD, family physician Dr. Jay K. Joshi provided his perspectives on this transition and proposed a more individualized care framework rooted in financial openness, independence, and direct involvement.

Here’s a summary of the key points from Dr. Joshi’s conversation on “Why patients and doctors are moving away from insurance for personalized care.”

The Diminishing Trust in Health Insurance

Traditionally, health insurance providers have been seen as the arbiters of medical value—determining, often by themselves, which treatments and services merit coverage. This power imbalance has fostered a landscape filled with bureaucratic intricacies, unclear pricing, and mounting dissatisfaction among patients and health care providers alike.

Dr. Joshi notes that the COVID-19 pandemic acted as a turning point. It not only diminished the appeal of conventional health care spaces but also heightened consumer awareness and demand for more tailored, efficient, and transparent care.

“We are experiencing a significant transformation,” Dr. Joshi articulates, “moving from provider-payer relationships to individualized patient-physician collaborations.”

The Emergence of the Direct-Pay Model

Central to this movement is the direct-pay model—a care framework that entirely circumvents insurance companies. Drawing inspiration from fields such as functional medicine and preventive care, direct-pay structures often incorporate metabolic optimization, hormone therapy, and diagnostic assessments that are either not covered or only partially covered by standard insurance plans.

Dr. Joshi advocates for a care strategy that integrates financial planning into the clinical narrative, prompting physicians to:

– Inform patients about alternatives like Health Savings Accounts (HSAs)
– Provide flexible payment options through third-party services
– Introduce membership-style subscription models for ongoing care

By positioning health care expenses as long-term investments rather than unpredictable costs, this model empowers patients and strengthens the patient-physician bond.

Reconceptualizing Finance as Clinical Literacy

A primary message conveyed by Dr. Joshi is the importance of incorporating financial literacy into contemporary health care. Many doctors are trained to avoid discussing finances, often seeing money matters as outside their expertise. However, Dr. Joshi contends that evading discussions about affordability leaves patients exposed to an issue oncologists call “financial toxicity”—the economic strain that can follow otherwise successful treatments.

To address this, Dr. Joshi encourages providers to regard financial planning as integral to a holistic care approach. Whether assisting a patient in establishing a tax-advantaged HSA or offering interest-free monthly payments through platforms like PatientFi and Cherry, financial empowerment can enhance adherence, diminish stress, and cultivate trust.

“When pricing is made clear, patients feel valued,” Dr. Joshi observes. “It’s an extension of care—financial literacy intertwines with clinical care.”

From Payment Mechanics to Behavioral Familiarity

A novel idea put forward by Dr. Joshi is the application of behavioral economics to health care finance. He elaborates on how emulating familiar insurance payment patterns—such as regular, subscription-like fees—helps patients feel comfortable. Even in the absence of insurance, patients readily grasp structured models due to their resemblance to the regularity they associate with premiums or copays.

This structure enables patients to choose from bundled offerings or individual services, granting them financial flexibility tailored to their goals and situations. The method promotes mutual respect and shifts the focus from what insurance includes to what patients prioritize.

Is It Scalable?

Despite its various benefits, Dr. Joshi recognizes that the direct-pay model confronts challenges regarding scalability. Customizing financial plans for each patient can be time-intensive and challenging to standardize without compromising the personalized experience that renders it effective.

Nonetheless, he argues this need not be a disadvantage. “I don’t wish to scale at the expense of the human connection,” he asserts. Instead, he advocates for smaller, community-centered practices that are agile, compassionate, and responsive to local financial conditions.

A New Physician-Patient Relationship

At the core of this economic transformation is a cultural shift in how patients engage in their care. According to Dr. Joshi, the pandemic also expedited the impact of social media and digital resources on patient behavior. Today’s patients frequently consult online information and anticipate having their perspectives acknowledged and valued.

To stay relevant and impactful, physicians must be prepared to engage with patients where they are—not solely clinically, but also emotionally and intellectually.

A Call to Action for Physicians

For physicians eager to transition to this new framework, Dr. Joshi provides several actionable steps:

1. Initiate financial dialogues with trusted patients to foster comfort and assurance.
2. Familiarize yourself with financial tools such as HSAs, financing options, and tax-advantageous payment models.
3. Investigate hybrid care models that resonate with your patient demographics and practice objectives.
4. Regularly assess and modify your services to align with patient needs and local economic circumstances.

Final Thoughts

As Dr. Jay K. Joshi emphasizes in his conversation