The pressure on U.S. healthcare costs is not letting up. PwC projects a 9% medical cost trend for the commercial group market in 2027, the highest in 17 years, according to its annual medical cost trend report. In the individual market, insurers are proposing a median rate increase of 15% for 2027, according to a Peterson-KFF Health System Tracker analysis.
Those numbers measure the cost of coverage. They do not measure the copays, the drive across town, the hours away from work or the follow-up tests that can trail a single scan, and they say little about what any of it does to the relationship between a patient and a physician.
Susan Baumgaertel, MD, an internal medicine physician in Seattle, sees that relationship from both sides. She spent about 25 years at The Polyclinic in Seattle before leaving in 2021 to launch her own independent practice, myMDadvocate, a telemedicine and healthcare navigation service.
Her three decades of experience as a physician and more recent experiences as a patient seeking care have significantly shaped how she thinks about the business of healthcare, she told Becker’s.
“We get caught up in the finance, the money side of things, follow the money, but we often lose sight of the human part,” Dr. Baumgaertel said. “And I think bringing those together is kind of my current quest.”
Part of that financial pressure shows up as administrative friction long before a patient sees a bill — especially prior authorization requirements, she said. Physicians and their staff spend an average of about 13 hours a week on prior authorization, according to the American Medical Association’s recent report, The “Private-Payer and Government Insurance Report 2026: Medicare, Medicaid, and More,” published Oct. 2. Four in 10 physicians said they devote staff exclusively to authorization.
Dr. Baumgaertel also pointed to what has changed in how patients relate to their physicians over time.
“Gone are the days, sadly, where you go in every year and you kind of have your checkup, and then the person actually knows you because they haven’t moved three times or they haven’t retired early,” Dr. Baumgaertel said.
Direct primary care, in which patients pay a flat monthly fee for access to a primary care physician rather than billing insurance visit by visit, is one model that has drawn attention as a way to restore that continuity. Under HR 1, patients enrolled in a high-deductible health plan can use health savings account funds for direct primary care arrangements that cost no more than $150 per month for an individual, starting Jan. 1, 2026.
Dr. Baumgaertel described where the model stands today.
“I still think of it as grassroots because DPC is not for all. It’s certainly not affordable by all, and it’s not everywhere,” she noted. DPC practices tend to be more affordable and less specialized than concierge services, with DPC fees averaging between $150 to $300 a month, according to the American Academic of Family Physicians. They typically offer preventive services and unlimited, direct access to their appointments and their physicians.
“DPC, you think of as a mom-and-pop store in the corner, right? It’s not a big organization. You cannot possibly compete with insurance agencies in terms of negotiating prices and all that,” Dr. Baumgaertel said.
“I’m always educating people about DPC, and there are plenty of DPC practices in any urban area nowadays. But it’s not for rural medicine,” she continued, noting that the model isn’t a blanket solution for primary care access.
On cost, she noted that people often see the membership fee and see the upfront payment as unaffordable — but contends that through traditional insurance models, patients often end up paying at least that much between premiums, copays and unexpected costs.
“Let’s say you’re going every six weeks for [a condition]. You’re paying your copay, and then you have to leave work and you have to drive and park,” she said. “And when you add up all the costs, you’re actually saving money with the DPC [physician].”
“If we can just educate people, there are always options, or there are more options than what people realize, and that access to care is not just dollar for dollar,” she continued. “It’s about redefining what it means to access care. And anytime we can make it more personalized, anytime we can make that human component front and center, is, I think, a win for humanity.”
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