As the traditional health insurance framework becomes increasingly inaccessible, physicians and clinical leaders are being called to rethink both how care is delivered and how it is paid for. Insurance companies are covering fewer services, raising deductibles, and narrowing networks. Patients are now forced to make health decisions based not just on need—but on affordability, timing, and bureaucratic feasibility.

In this emerging landscape, sustainable health care delivery must move beyond short-term fee-for-service logic. What’s required is a hybrid model—one that aligns clinical precision with financial transparency and patient empowerment.

I have spent the last several years developing and refining such a model, rooted in functional medicine, but applicable across specialties that prioritize longitudinal care, proactive intervention, and human-centered design.

Structuring for outcomes: A systems-based clinical approach

This model is built on a comprehensive foundation of functional care, where the focus shifts from episodic illness management to systems optimization and prevention. Key pillars include:

Weight and metabolic optimization: Utilizing modern pharmacologic agents (e.g., GLP-1 agonists), lifestyle interventions, and peptide therapy to reset metabolism and reduce cardiometabolic risk.

Hormone regulation: Age-adjusted hormone replacement therapy (HRT) grounded in diagnostics and dynamic titration, supporting energy, mood, libido, and musculoskeletal preservation.

Peptide medicine: Targeted peptide protocols to aid in recovery, cognitive function, inflammation reduction, and tissue repair.

IV therapy: Micronutrient infusions tailored for bioavailability, especially for patients with gut or absorption issues.

Preventive diagnostics: Advanced biomarker testing to assess inflammatory states, mitochondrial function, cardiovascular markers, and early disease patterns before symptoms manifest.

Longevity interventions: Including senolytics, NAD+ support, and other molecular longevity strategies designed to extend healthspan.

Such interventions fall outside the scope of most insurance plans. Yet these services are precisely what patients increasingly demand—and what physicians must be equipped to offer.

Financial infrastructure as a pillar of care

Where most clinical systems isolate the financial experience as a billing function, this model integrates it into the care strategy itself. Finance is reframed not as an obstacle, but as a pathway to access and adherence.

Health savings accounts (HSAs)

One of the most effective instruments has been the integration of health savings accounts (HSAs). Patients are guided through the process of establishing HSAs, with education on their triple tax advantage:

• Pre-tax contributions
• Tax-free growth
• Tax-exempt withdrawals for qualified medical expenses

HSAs give patients greater control over how and when to allocate resources to their care. Clinicians should not underestimate the psychological agency this creates in the patient encounter.

Patient-centered payment flexibility

The model also incorporates deferred and installment-based payment structures. Through partnerships with third-party financing organizations, patients can begin treatment without prohibitive upfront costs, while selecting a weekly, monthly, or quarterly schedule that fits their financial landscape.

Those who opt for quarterly payments may be incentivized through adjusted pricing—an approach that rewards commitment, supports continuity, and enhances clinic stability without penalizing patients for choosing alternative schedules.

Subscription-style payment models

Adapting behavioral finance principles, the use of subscription-style payment models has proven transformative. These plans allow patients to pay for services predictably over time—just as they would a streaming service or wellness membership. Such structures encourage consistency, reduce dropout, and allow patients to focus on outcomes rather than costs.

This is especially well-suited for therapies that unfold over weeks or months, such as hormone optimization, metabolic reset programs, or regenerative treatments.

Communicating with empathy and transparency

Financial discomfort often causes patients to disengage from care. Clinicians must address this directly—not with sterile cost breakdowns, but with empathetic, transparent communication.

Key techniques include:

• Framing payments as investments in outcome-based care.
• Normalizing the use of tools like HSAs and financing platforms.
• Offering value-forward language that explains why certain interventions are necessary and time-sensitive.
• Documenting the financial plan within the patient’s chart to ensure consistency and trust across the care team.

This model acknowledges that financial stress is clinical stress. Addressing it reduces attrition, improves satisfaction, and enhances treatment adherence.

Designing for the future: Why direct-pay models are here to stay

The data is unequivocal: insurance coverage for proactive, preventive, and lifestyle-focused care is dwindling. From integrative oncology to HRT and metabolic optimization, patients are increasingly being told that the care they want—or need—is “elective.”

This shift opens the door for direct-pay models, which prioritize transparency, customization, and outcomes over bureaucratic approvals.

But this is not simply about bypassing insurance. It is about rethinking who owns the clinical decision-making process. By offering multiple avenues of access—HSAs, financing, subscriptions—physicians create a structure in which patients are not only paying participants but active partners in their own care.

The way forward

The path forward for health care does not lie in reactive, episodic reimbursement. It lies in designing care systems that integrate financial accessibility with clinical innovation, built around the realities of modern patients.

A well-structured payment model is not ancillary—it is essential. It is the bridge between a patient’s desire to pursue optimal health and their ability to do so without compromise.

As clinicians, we are responsible not only for what we treat—but for how we make care possible.

Jay K. Joshi is a family physician.