Direct primary care is a business model that allows primary care physicians to offer their services directly to their patients—without an insurance company in the middle—in exchange for a monthly or annual fee. The membership fee allows the patient to access a variety of primary care, including consultations, exams, care coordination, and some lab services, without paying any additional fees at the time of service.
The direct primary care model accounts for a small fraction of the primary care provided in the U.S.—there are about 1,000 direct primary care practices providing care to about 500,000 patients—but it’s steadily growing, as virtually all of those practices have opened in the last decade.
Benefits of the Direct Primary Care Model
A direct primary care model allows physicians to spend more time with each patient: Roughly 30-60 minutes per visit, as opposed to 12-15 minutes per visit in a traditional clinic that relies on health insurance reimbursements.
Because they don’t deal with health insurance paperwork or bureaucracy, direct primary care facilities spend less time and money on administrative tasks. And patients get to pay one monthly fee and have all of their primary care covered, without having to worry about deductibles or separate copays for each procedure.
The elimination of out-of-pocket costs at the time of service means patients are less likely to avoid seeking care due to cost. Combined with the increased amount of time that physicians get to spend with each patient, a direct primary care model could be more conducive to thoroughly addressing patients’ primary care needs as soon as they arise. This can potentially prevent them from escalating into situations that require emergency or inpatient care.
Because doctors don’t need to worry about whether a patient’s insurer will cover telehealth services, most direct primary care memberships allow patients to access care via phone calls, email, or video chats, all of which can be more efficient and convenient than in-person consultations, depending on the situation.
Downsides of the Direct Primary Care Model
Physicians who utilize the direct primary care membership model typically have between 600 and 800 total patients, as opposed to more than 2,000 patients for physicians in a traditional primary care practice that gets paid by health insurers on a fee-for-service basis.
This is no doubt a benefit for the patients who receive care under the direct primary care model, but there are concerns that the direct primary care model could exacerbate primary care physician shortages in the traditional insurance-based clinic setting. (There is also an argument to be made that the growth of the direct primary care model could encourage more physicians to enter family practice, as they wouldn’t have to deal with the administrative headaches that often plague doctors in traditional practices).
It’s also important for direct primary care members to carefully understand what’s covered under their membership fees, and to maintain major medical coverage for scenarios that are outside the scope of the direct primary care program (but that would be financially ruinous without coverage). But reports indicate that there are some direct primary care practices where as many as half of the members are uninsured, relying fully on their direct primary care membership for their health coverage.
How Much Does Direct Primary Care Cost?
Direct primary care memberships generally cost in the range of $50 to $150 per month. These fees can be covered by the members themselves, but employers can also offer direct primary care membership to their employees, often in conjunction with a self-insured major medical health plan. Some employer-sponsored direct primary care memberships include onsite primary care facilities, allowing employees to seek care without having to travel anywhere, and with minimal disruption to their workday.
For services that are fully covered under the direct primary care arrangement, patients won’t pay anything else when they see the doctor. But it’s important to understand the details in terms of what’s covered under the membership and what isn’t.
Some direct primary care memberships cover a fairly limited scope of services, while others are more extensive. Services like lab work and imaging may have additional fees. And while some direct primary care memberships cover the cost of basic medications, most medications will require an additional fee. But the direct primary care membership can be structured so that there’s no markup on these fees, with the patient paying wholesale costs instead of retail costs.
If you’re planning to combine a direct primary care plan with a health coverage plan that isn’t compatible with the Affordable Care Act, be sure to read the fine print very carefully and fully understand what isn’t covered under your combined plans.
Direct Primary Care vs. Concierge Medicine
Direct primary care memberships differ from concierge medicine in several ways, although the two models are both based on the idea that patients (or, in some cases, their employers) pay a membership fee in order to have access to basic medical care. But while concierge practices tend to cater to higher-income clientele and often accept health insurance in addition to their concierge fees, direct primary care practices generally rely entirely on membership fees paid by patients.
Discover the growing direct primary care movement (DPC). Doctors & patients working together to improve care and reduce medical costs. What is DPC? It’s a practice and payment model where patients pay their physician or practice directly, typically a flat monthly or annual fee, under terms of a contract, in exchange for access to a broad range of primary care and medical administrative services.
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