Direct primary care 101

Direct primary care (DPC) is an alternative to the traditional fee-for-service payment model of primary care. In DPC, physicians don’t bill insurance. Instead, they charge individuals or an employer’s health plan a monthly fee in exchange for providing immediate and unlimited access, longer appointment times, and intensive coordination of care. The fee is typically between $60 and $150 per patient per month. Employers may or may not choose to cost share this expense with their employees. Patients still require health insurance to cover services rendered outside of primary care (lab tests, medications, specialty visits, x-rays, hospitalizations, surgery, ER visits, and so on), but utilization of these services drops precipitously once direct primary care enters the picture.

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Why? The lack of immediate access patients have to fee-for-service primary care physicians makes it far more likely such patients will improperly overutilize emergency rooms and urgent care clinics resulting in more unnecessary and costly tests and procedures. What’s more, because of time constraints inherent in fee-for-service primary care, traditional primary care physicians often can’t adequately address issues that lie within their own area of expertise. As a result, they are more likely to refer their patients out for tests and to specialists who then run even more tests, many of which are often unnecessary. This leads to an increased likelihood of complications and additional out-of-pocket costs for individual patients and employers if the patient is covered in a self-insured health plan.