I shouldn't say they're 100% mutually exclusive, but they tend to be for most routine services. They're probably still going to file a catastrophic claim if they find cancer, etc...

>it seems like you can gain only so much by bypassing them.

You do, but self-insuring on it's own saves a big chunk, so what's left is really just the complicated paperwork. The only reason it exists is to complicate insurance dictated rate structures, so get rid of the complicated rate structures for the 80-90% most common visits by contracting a doctor directly and there just isn't the need to pay someone else to manage it anymore.

Then the real gain is paying the doctor based on a simplified negotiated rate, and in return he gets a whole company of regular patients, and can send just one summarized bill to the company for everyone he sees in a week. Not having to file any additional billing paperwork per patient is just a happy side-effect, for both the doctor, the patients, and the sponsoring company.

>And why would you want to eliminate medical records?

It's not to eliminate medical records, it's just a matter not being forced to do them in a certain way. I think most doctors would have loved to start by scanning paper charts at the end of the day, then let some data people convert that into something the computer understands.

But the way it's setup (and mandated), the database is the official record (not the attached notes) so it all has to be done personally by the doctor, or signed-off by the doctor if a nurse or mid-level or medtech enters anything. They basically make the doctors responsible for data entry QAQC, with their malpractice insurance at risk for a screw up.

Doctors are used to mostly freeform notes with a few fill-in-the-blanks and check boxes for orders or standardized info like heart rate, bp, etc. Most software tries to cram 99% of this into a mess of a structured relational database. These also have freeform typing boxes for notes, but getting paid depends on duplicating most of the note information across a huge range of screens and tables so that the billing software understands what was done, and understands it in such a way that is covered by the patient's provider.

They are probably a 6-digit number of ways to code for giving the patient aspirin, but half might not be covered, and the other half might range in price from free to thousands of dollars of copay. And this changes with every different insurance policy, and every different doctors office/hospital system, (depending on negotiated rates with insurance) so that even the most expert billing tech might not know the correct way to bill a particular patient the first time. And oh, if they need to change it later to get insurance to cover it, the doctor usually has to sign-off on it again as if he performed a different exam than was recorded the first time.

It's a lot easier to just scratch down on paper (or in a computer) "gave patient exam and aspirin, bill for a level 2 and rx" or something similar, and then your receptionist knows what to collect or bill. All of a sudden you don't need a staff of billing techs on the phone with insurance companies all day, or a software support contract that your billing depends on.

Now imagine getting all the doctors approaching retirement and working in small practices that switching is worth the expense and hassle.

So it's not being against medical records, but the freedom to do them as you see fit, while avoiding the hassle of compliance.

And one of the few remaining ways to do that is go for the market that can pay cash, which overlaps nicely with both the concierge market and self-insured employers. (and some niche co-op style wellness "clubs", but I'm not familiar)