Direct primary care (DPC) is a practice model that is quickly gaining popularity among primary care practitioners and patients across the country.
From 2017-2021, the number of active DPC clinicians per 100,000 people increased 159% in comparison to only a 6% increase overall in primary care providers per 100,000 people. Additionally, DPC memberships are seeing an average annual growth of 36%, reaching a total growth rate of 241% from 2017-2021.¹
There is good reason for this surge. Instead of using traditional insurance, patients pay their primary care physician a flat monthly or annual fee, under terms of a contract, in exchange for a broad range of primary care and medical administrative services that include office visits, lab tests, basic procedures, and more.² Under the DPC model, physicians can rely on a stable revenue stream without involving insurance companies or third-party payers. As result, they can provide a higher level of comprehensive and personalized primary care services to their patients.
DPC allows patients to have a direct relationship with their primary care physician and improved access to their needed services and treatment, all while potentially paying less out-of-pocket costs.
Other components of a DPC practice model:
Benefits to Physicians
- The DPC model allows primary care physicians to operate independently, without the administrative burden and restrictions imposed by insurance companies, enhancing job satisfaction and reducing physician burnout.
- The DPC model can foster a stronger doctor-patient relationship, as patients have more frequent and unhurried visits with their primary care physician, leading to better communication and trust.
- DPC doctors often have more flexibility in prescribing medications, as they are not bound by insurance formularies and can focus on choosing the most appropriate treatment for their patients.
- DPC can also reduce overall healthcare costs by minimizing unnecessary specialist referrals, emergency room visits, and hospitalizations through proactive and preventive care.
Benefits to Patients
- DPC focuses on preventive care and wellness, aiming to keep patients healthy and address health issues early on before they become more serious and costly.
- DPC doctors have smaller patient panels, which allows them to offer same-day or next-day appointments, extended office hours, and even virtual consultations, improving access to care.
- DPC can be particularly beneficial for individuals with chronic conditions who require ongoing and specialized care, as they can receive comprehensive primary care services from a single provider.
- DPC can lead to cost savings for patients, as they only pay a fixed monthly or annual fee instead of copays and deductibles for each office visit or service.
For small businesses and self-employed individuals who want to provide healthcare benefits to their employees without the complexity and high costs of traditional insurance plans, DPC can be a viable option.
It is important to note that DPC is not a substitute for health insurance, as it does not cover specialty care, hospitalizations, or emergencies. Patients are encouraged to have a catastrophic insurance plan to cover these situations.
The DPC model addresses many of the challenges present in today’s healthcare system, including high costs, barriers to quality ongoing care, physician burnout, and complex insurance administration and billing.
Some critics argue that DPC may lead to a two-tiered healthcare system, where those who can afford to pay for direct primary care receive better access and quality of care compared to those who rely on traditional insurance. Additionally, DPC may face regulatory challenges in some states,
as insurance laws and regulations are not always tailored to accommodate this model.
However, through various organizations, efforts are being made to create a more favorable environment for DPC practices.
Learn more at:
The California Direct Primary Care Coalition: www.calidpc.com
The Direct Primary Care Coalition: www.dpcare.org
Andie Tena is CAP’s Assistant Vice President of Practice Management Services. Questions or comments related to this column should be directed to ATena@CAPphysicians.com.
¹Shryock, Todd. “High cost of health care may be boosting direct primary care membership.” Medical Economics. April 8, 2022. https://www.medicaleconomics.com/view/high-cost-of-health-care-may-be-b…
²“Direct Primary Care.” American Academy of Family Physicians. https://www.aafp.org/about/policies/all/direct-primary-care.html