Key takeaways:
In direct primary care (DPC) models, patients pay a monthly or annual membership fee in exchange for smaller panel sizes and increased access to their healthcare provider (HCP).
DPC models bypass insurance billing, which decreases administrative burden for HCPs and complexity for patients.
Unlike concierge practices, DPC practices focus on affordability and reducing costs and overhead, while increasing access to care.
Direct primary care (DPC) is a practice and payment model in which patients pay a healthcare provider (HCP) directly for a specific set of primary care services. Under a DPC arrangement, the patient typically pays either a monthly or annual fee, and the HCP does not bill services through insurance payers.
DPC models have distinct advantages and disadvantages for both HCPs and patients. Let’s discuss what DPC models look like and the expectations for HCPs and patients.
How does the direct primary care model work?
In essence, the DPC model involves a fee that buys a patient access to certain healthcare offerings, like a membership. This model has gained popularity among patients and providers since the early 2000s.
The fees for DPC membership, which are paid directly to the HCP by the patient, either monthly or annually, vary from $25 to $85 a month or more.
DPC practices tend to have smaller patient panel sizes compared to traditional practices — generally, about 600 to 800 patients versus at least 2,000 patients. These smaller panel sizes allow HCPs to provide more personalized care and spend more time with each patient.
Benefits of direct primary care
Both HCPs and patients see many benefits under the DPC model. Patients appreciate the simplicity, avoiding complex insurance issues like copays and coverage determinations, and the feeling that they are building a higher-quality relationship with their HCP.
Other patient benefits associated with DPC include:
Increased access to their HCP: DPC providers are typically available 24 hours a day by phone, text message, email, or in person. Same-day visits are often available.
Increased time and attention from HCPs: Because practice panel sizes are smaller, HCPs can spend more time with each patient, allowing for visits that don’t feel rushed, and address issues more thoroughly.
Price transparency: Patients know up front what their fees will be, either for the month or annually.
Discounts on ancillary services: This can mean discounts on on-site generic medications, labs, imaging procedures, and more.
Providers also see great benefits from DPC models. HCPs practicing under the DPC model enjoy a return to the type of medicine they envisioned when they began their healthcare careers — caring for patients unencumbered by the myriad of administrative burdens that define today’s healthcare landscape.
HCPs in DPC practices appreciate the following:
Ability to spend more time with patients: Because they’re not dependent on hitting a certain number of insurance reimbursements, HCPs can spend as much time as they feel they need with each patient, knowing it won’t impact their revenue.
Decreased administrative burden: In DPC practices, insurance paperwork burdens are eliminated.
Greater clinical autonomy: HCPs can practice in a way that makes sense to them, rather than according to the dictates of a health insurance plan.
Greater work-life balance: Smaller panel sizes and less administrative burdens translate to freedom from taking work home that can’t be completed during regular clinic hours.
Less practice overhead: DPC practices typically require less staff, since billing and administrative tasks are simplified.
Disadvantages of direct primary care
Nothing is perfect. Even with the DPC model, there are some disadvantages to be found. These include:
The growth of DPC practices could potentially worsen the primary care provider shortage, according to critics of the model. If HPCs are treating fewer patients in smaller panel practices, even more HCPs will be needed to provide care.
Some DPC practices offer a limited range of services, requiring patients to seek outside care for problems beyond primary care basics.
DPC practices do not usually provide prescription medications, necessitating the need for other insurance coverage. (Remember, GoodRx offers free coupons to offset medication costs regardless of insurance or DPC membership.)
Patients will find that even though their monthly fee gives them access to primary care, they’ll still need insurance for unforeseen events like surgery or a major accident or illness. But the arrangement still seems to work out for many patients who carry a high-deductible health plan.
How does direct primary care work with insurance plans?
Pairing DPC with an insurance plan is necessary for many patients. While a DPC practice only accepts payment directly from patients and doesn’t bill insurance, patients can use their health insurance at specialists, pharmacies, and for other health-related expenses. Patients may still choose to contribute to a health savings account for health-related expenses.
DPC works outside of insurance plans, and payments made to HCPs are not eligible for insurance plan deductibles.
What’s the difference between direct primary care and concierge medicine?
DPC and concierge medicine are sometimes used as interchangeable terms; however, there are some differences between these practice models. Concierge practices may accept insurance in addition to monthly membership fees, while DPCs do not bill insurance at all. And fees are often higher in a concierge practice because of a focus on providing “premium” services, like lab panels and screening evaluations. Members of concierge practices tend to be more affluent, while the affordable pricing of DPC allows greater access across even vulnerable populations.
The focus of a DPC practice is to avoid insurance and keep overhead and costs low. Concierge practices focus on value-added services beyond what insurance would normally cover.
The bottom line
Why trust our experts?
The DPC model provides an attractive alternative to traditional practices for both patients and HCPs. HCPs can cut out cumbersome administrative tasks and focus on providing quality healthcare, while building relationships with their patients. And patients enjoy the level of access and affordability associated with DPC plans. The few disadvantages of DPC seem to be worth the effort and can be easily overcome for patients willing to carry a high-deductible health plan for catastrophic coverage events.
