As patients across the country become increasingly frustrated with their health insurance and their inability to access healthcare, thousands are turning to an increasingly popular and affordable alternative: subscription-based Direct Primary Care. Learn more about the pros and cons of Direct Primary Care!
Direct Primary Care Pros and Cons
In this blog, we’ll explore what DPC is, how it works, and learn about its advantages and disadvantages compared to using a traditional insurance-focused primary care practice.
You’ll also learn how many people can save thousands of dollars per year in healthcare costs by combining a DPC plan with a health sharing plan.
And finally, we’ll discuss the advantages for small business owners of offering DPC membership as a valued employee benefit.
First, let’s go over the basics.
The Problem
With conventional health insurance, primary care services are extremely costly and inefficient.
And patients are paying the price.
Even just going to your family doctor typically involves long waits for limited appointment times, high out-of-pocket costs like deductibles and copay and coinsurance requirements that are impossible to predict, and that run roughshod over household budgets.
All that to get an appointment where you may only get five or ten minutes of face-time with your doctor.
That’s not enough time to get to the bottom of any but the simplest of medical issues.
Direct primary care solves this problem by eliminating the middleman (health insurance companies and their added bureaucracy and costs), and forming a direct relationship between patients and their doctors. Without these costly insurance intermediaries. Read more about Direct Primary Care.
What is Direct Primary Care (DPC)?
Direct primary care, or DPC, is a model of healthcare where patients pay a flat monthly subscription or membership fee to a primary care physician or practice.
In return, members of the DPC plan get unlimited primary care services. That is, they receive as many appointments as necessary, whether in person or via telehealth.
This fee covers a wide range of services typically handled at the primary care level. Typically, these include:
- preventive care and screenings
- routine check-ups
- diagnostics
- care for minor aches and pains
- well baby visits
- basic pediatric care (at some practices)
- sick note verification/return to work clearances
- prescription management and updates
- Routine in–office procedures
- Management of chronic conditions such as diabetes, hypertension, and asthma.
- Minor procedures, such as laceration repairs and skin biopsies.
- Immunizations and vaccinations.
- Urgent care visits for acute illnesses or injuries.
- Virtual consultations via phone, email, or secure messaging platforms.
- Coordination and management of specialty referrals when necessary.c
- Well-child visits and pediatric care.
- Comprehensive health assessments and personalized care plans.
Direct primary care is exploding in popularity across the United States. Currently there are more than 1,600 DPC practices established in all 50 states.
What sets DPC Apart?
The key distinction of DPC is that it operates outside the realm of traditional health insurance. The insurance intermediary is eliminated at the primary care level. This reduces cost, improves efficiency, and provides for a direct and ongoing relationship between the patient and the primary care provider.
How Does Direct Primary Care Work?
DPC practices typically offer unlimited access to primary care services for a fixed fee. Here’s a breakdown of how direct primary care works:
- Membership Fee: Patients pay a monthly or annual membership fee to their chosen DPC provider. The fee structure varies depending on the practice, location, and the age of the patient.
- Comprehensive Primary Care: With the membership fee, patients gain access to a broad range of primary care services. This often includes preventive care, vaccinations, routine check-ups, minor procedures, urgent care visits, and consultations via phone, email, or virtual platforms.
- Direct Access to the Provider: DPC emphasizes the doctor-patient relationship. Patients have direct access to their primary care provider without the need for insurance claims or referrals. This allows for longer appointment times, personalized care, and enhanced communication.
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Benefits of Direct Primary Care Pros and Cons
Direct primary care offers a number of advantages both for patients and for physicians. Here are some of the key benefits of DPC.
DPC Advantages for Patients
- Personalized and Accessible Care. With DPC, patients have more time with their primary care provider, fostering a stronger doctor-patient relationship. Access to care is enhanced, with extended appointment times, minimal wait times, and convenient communication channels.
- Cost Savings. DPC eliminates the need for co-pays, deductibles, and coinsurance commonly associated with traditional health insurance plans. The flat fee structure allows for predictable monthly or annual costs, making it easier to budget for primary care services.
- Focus on Preventive Care: DPC providers emphasize preventive care, including routine check-ups, screenings, and vaccinations. This proactive approach can lead to early detection and intervention, potentially preventing more serious health issues down the line.
- No Insurance Hassles. Since DPC operates independently of insurance, there are no insurance claims to file, pre-approvals to obtain, or referrals needed for specialist visits. This streamlines the administrative process and reduces the hassle associated with traditional insurance.
- Holistic and Patient-Centered Approach. DPC providers often take a holistic approach to healthcare, considering not only the physical but also the mental and emotional well-being of their patients. This can lead to more comprehensive and individualized care.
Benefits for DPC Physicians
Direct primary care practices often experience a massive reduction in overhead compared to traditional primary care settings.
Here are some reasons for the reduced overhead in DPC practices:
- No Insurance Billing. DPC practices do not need to deal with the complexities of insurance billing, reducing administrative costs associated with claims processing and staff dedicated to billing and coding.
- Streamlined Operations. DPC practices can operate with smaller staff sizes and lower administrative burdens since they focus primarily on direct patient care rather than managing insurance-related tasks.
- Lower Administrative Costs. By removing the need to navigate insurance networks and reimbursement systems, DPC practices don’t need to have multiple full-time staff doing nothing but insurance billing, documentation, and chasing down payments. By adopting a DPC model, rather than a traditional insurance-focused model, DPC practices can vastly reduce their admin headcount and office space overhead. This results in significantly reduced administrative expenses. As a result, DPC practices can focus more manpower and resources on direct patient care.
- Reduced Patient Loads on DPC Doctors. Thanks to the significantly lower overhead costs, DPC doctors can run a profitable practice with just a fraction of the patient load. While primary care doctors at traditional insurance-based practices typically have patient loads of 2,000 or more on the books, established direct primary care physicians typically carry between 500 and 800 patients. They also require fewer appointments per day to keep the doors open and pay a small army of billing and administration staff. Which means they can spend much longer with each patient.
- Extended Appointment Times. DPC doctors can allocate more time for each patient visit, allowing for comprehensive evaluations, in-depth discussions, and personalized care plans. This reduces the need for rushed appointments and allows for a higher quality of care.
- Enhanced Doctor-Patient Relationship. With a smaller patient panel, DPC doctors can establish stronger relationships with their patients, fostering trust, better communication, and a deeper understanding of individual healthcare needs.
- Focus on Preventive Care. DPC providers prioritize preventive care, which can lead to early intervention and potentially reduce the need for more extensive and time-consuming treatments in the future. And since there are no deductibles or copays to worry about, patients are unlikely to put off or forgo the care they need because they can’t afford it. This is a major problem for lower-wage workers and minority communities. This is a big benefit not just for patients but for their employers, too, as it eventually reduces the significant costs of presenteeism, absenteeism, increased medical insurance utilization (which drives up premiums), and turnover. As a result, DPC plans are enjoying increasing popularity as an employee benefit.
Patient Satisfaction with DPC Practices
Patient satisfaction is a crucial aspect of healthcare delivery, and DPC practices often excel in this area. Here are some reasons why patients are satisfied with DPC practices:
- Enhanced Access to Care. With DPC, patients have greater access to their primary care providers, including extended appointment times, same-day or next-day appointments, and convenient communication options. This accessibility contributes to higher patient satisfaction.
- Long-Term Doctor-Patient Relationships. DPC fosters long-term relationships between patients and their primary care providers. This continuity of care allows for better understanding of patient history, preferences, and personalized healthcare planning, leading to higher patient satisfaction.
- Focus on Patient-Centered Care. DPC practices prioritize patient-centered care, which involves active listening, shared decision-making, and a focus on individual patient needs and goals. This patient-centric approach contributes to improved satisfaction and overall healthcare experience.
DPC Provides Better Patient Outcomes
Direct primary care has been associated with improved patient outcomes. Here’s why DPC practices may contribute to better health outcomes:
- Enhanced Preventive Care. DPC providers emphasize preventive care, including regular check-ups, screenings, and vaccinations. This proactive approach can lead to early detection, timely interventions, and improved health outcomes.
- Continuity of Care. With DPC, patients have ongoing relationships with their primary care providers, enabling better coordination of care, management of chronic conditions, and early identification of potential health concerns.
- Holistic Approach. DPC practices often take a holistic view of healthcare, considering the physical, mental, and emotional well-being of patients. This comprehensive approach can address underlying factors impacting patient health and result in improved overall outcomes.
- More Healthcare Freedom. Because DPC doctors don’t need to worry about what insurance company bureaucrats think, they have much more freedom to talk to patients about alternative therapies and approaches.
Disadvantages of Direct Primary Care
While direct primary care covers a broad range of primary care services, it’s important to note the limitations of DPC. Here are some things that direct primary care typically does not cover:
- Specialist Care. DPC practices focus primarily on primary care services and may not cover specialized care provided by medical specialists or require additional fees for such services.
- Hospitalizations. Direct primary care does not cover hospitalizations or emergency room visits, as these are typically handled through separate health insurance plans.
- Major Surgeries. DPC practices are not designed to cover major surgeries or procedures requiring hospitalization or specialized surgical care.
Combining Direct Primary Care with Healthsharing Plans
Some individuals choose to combine direct primary care with health sharing plans to enhance their healthcare coverage.
Health share plans are a more affordable alternative to traditional health insurance approaches that can pick up where your DPC plan leaves off.
Your DPC plan handles all your routine primary care level care. The healthsharing plan typically will not cover that level of care. This avoids duplicating the cost of coverage of primary care.
Instead, your healthshare plan is free to focus on helping you pay the cost of specialist care. Hospitalizations, ER costs, surgeries, and ‘catastrophic medical bills.
Healthsharing typically does this at just a fraction of the cost of an unsubsidized traditional medical insurance policy available via Obamacare.
Here are advantages of this combined approach:
- Better Access to Routine Care. Direct primary care ensures easy access to primary care services, including extended appointment times, personalized care, and enhanced doctor-patient relationships.
- Shared Cost of Catastrophic Events. Healthsharing plans provide coverage for catastrophic events, offering financial protection in case of major medical expenses beyond the scope of primary care.
- Potential Cost Savings. By combining DPC with healthsharing plans, individuals can potentially save on premiums, deductibles, and out-of-pocket costs associated with traditional health insurance plans.
The DPC DIRECT Healthshare Plan
The DPC DIRECT Healthshare plan is a terrific medical cost sharing solution designed specifically for individuals and families who are members of a DPC plan.
With DPC DIRECT, your DPC membership still handles all your routine primary care needs, all included in your monthly DPC subscription. No deductibles, no co-pays, no coinsurance or surprise bills from your primary care doctor.
The DPC DIRECT health share plan layers on top of your DPC membership, in lieu of health insurance, and helps you pay for the things that your DPC membership doesn’t cover, such as specialist care, hospitalizations, ER costs, urgent care centers, and surgeries.
Like other health share organizations, DPC DIRECT costs just a fraction of what a traditional health insurance plan costs each month.
Pricing varies depending on your age and whether your DPC DIRECT plan covers just a single individual, you and your spouse, or your entire family. But individual plans start at just $170 per month.
Click here for more complete information about DPC DIRECT.
There are no limited open enrollment periods. And DPC DIRECT gives you much more freedom to choose your own doctor compared to typical HMOs and PPOs under the traditional health insurance model.
Need help? Want to explore other healthsharing or health insurance solutions? Just click here to make an appointment with one of our highly-experienced Personal Benefits Managers.
Consultations are always free. There’s no stress or pressure. And you’ll learn about all your options and get a personalized recommendation and quote.
Download the DPC DIRECT brochure
DPC as an Employee Benefit
Employers can consider offering direct primary care as an employee benefit, providing additional value to their workforce.
This option can be particularly attractive for smaller companies with fewer than 50 employees. These smaller employers are not required to provide full-fledged employee group health insurance plans for employees.
By providing a DPC plan for your workers, and combining it with lower-cost healthsharing plans rather than high-premium traditional group insurance plans, you can provide workers with a meaningful health plan at a much lower monthly cost compared to using a traditional health insurance company.
Other advantages of offering DPC as an employee benefit include:
- Enhanced Employee Wellness. By offering DPC, employers prioritize employee health and well-being, leading to improved productivity, reduced absenteeism, and higher employee satisfaction.
- Cost Containment. Direct primary care can help manage healthcare costs for employers by providing predictable primary care costs and potentially reducing the need for more expensive healthcare services.
- Recruitment and Retention. Access to quality primary care through DPC can be an attractive benefit for employees, aiding in recruitment and retention efforts.
Direct Primary Care Pros and Cons Conclusion
While there are certainly advantages to the traditional insurance model, DPC is definitely an improvement over insurance-based practices at the primary care level.
Insurance is most cost-efficient when it comes to spreading the risk of unpredictable catastrophic, high-cost, low-frequency events. And both traditional insurance and healthsharing plans do this very well.
But primary care is the opposite of catastrophic, high-cost, low frequency events, insurance does not work well at this level. It’s like using car insurance to pay for oil changes. All it does is add a layer of bureaucracy and expense.
Many of our clients have found that adding a DPC plan can be a life-changing event. Often, just finding a DPC doctor who could spend an hour with them to get to the root of a medical problem can make a massive difference in your health and lifestyle.
Is DPC right for you? Can you save money by combining DPC with a healthsharing plan like DPC DIRECT?
Let’s talk about it!
Getting in touch with one of our Personal Benefits Managers is very easy. Just click here, and follow the prompts to make an appointment.
HSA For America is one of just a few health insurance brokers in the country that can talk to you about all your options – even the ones the insurance and medical industry don’t want you to know about. Like DPC plans, health sharing plans, and high-deductible health plans.
Depending on your circumstances, you could be saving hundreds per month in health care costs. So don’t let another month go by overpaying for healthcare. Click here, and make a free, no-obligation appointment for a consultation, recommendation, and quote.
Here are some additional blogs on th topic: Direct Primary Care: How to Use a DPC and Still Protect Yourself from Major Medical Expenses | Direct Primary Care – 2023 Patients’ Guide [DPC Explained] | How to Combine a DPC Membership with a Health Sharing Plan
Here are some additional pages related to this article: Complete Guide to Direct Primary Care (DPC) – HSA for America | HSA Secure
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Direct Primary Care Pros and Cons FAQs
What is direct primary care (DPC)?
Direct primary care is a model of healthcare where patients pay a flat fee to a primary care provider for comprehensive primary care services, without involving traditional insurance.
It removes the costly insurance intermediary between patient and physician and emphasizes a direct relationship between patients and doctors.
How is DPC different from traditional fee-for-service primary care?
In traditional fee-for-service primary care, providers bill insurance for each service rendered. This requires extensive documentation and paperwork and thousands of additional man-hours in a typical primary care doctors’ billing department.
This drives up costs, and pulls doctors out of direct patient care.
DPC, on the other hand, operates on a membership fee basis, providing unlimited primary care services without the need for insurance claims or copayments.
What services are typically included in a DPC membership?
DPC memberships often cover a wide range of primary care services, including preventive care, routine check-ups, chronic disease management, minor procedures, urgent care visits, and virtual consultations.
The exact services offered may vary by practice.
For example, some DPC practices offer more pediatric services than others. Some may include lab services, while others stick to more basic services.
Is direct primary care affordable?
Direct primary care offers cost savings for many individuals. It is designed to be affordable for everyday Americans.
While membership fees are an additional expense, they often eliminate the need for copayments, deductibles, and other out-of-pocket costs associated with traditional insurance plans.
For these reasons, DPC plans are typically more affordable for people who need to see a primary doctor regularly.
Can I use my health insurance alongside DPC?
DPC memberships are designed to be standalone arrangements and are not intended to replace insurance coverage.
However, DPC can complement high-deductible health plans or healthsharing plans, providing primary care services while insurance covers specialized care or catastrophic events.
Do DPC practices accept patients with pre-existing conditions?
Yes, most DPC practices accept patients with pre-existing conditions.
DPC providers focus on comprehensive primary care, including the management of chronic conditions, and aim to provide accessible care to individuals with various health needs.
How do I find a DPC practice near me?
Click here for a map of 1600 DPC plan locations, managed by the Direct Primary Care Coalition.
How do DPC practices handle prescription medications?
DPC providers can often dispense generic medications directly to patients at wholesale prices, reducing the cost of prescriptions.
They may also provide guidance on medication choices, monitor usage, and assist with prescription refills.
Are there any limitations to the services provided by DPC practices?
While DPC covers a wide range of primary care services, it typically does not include specialized care provided by medical specialists or cover hospitalizations, major surgeries, or emergency room visits.
To help you pay for hospitalizations, ER visits, specialist care, labs, and other medical costs, you should consider a high-deductible health plan coupled with a health savings account (HDHP/HSA), or a healthsharing plan.
DPC plans also don’t include prescription drug costs. So you should also consider a healthplan with prescription drug coverage or a drug discount plan, such as HSA Advantage Rx, which is free for all HSA For America clients.
Are DPC practices suitable for families and children?
Yes, DPC practices often cater to individuals of all ages, including families and children.
They provide comprehensive primary care services for pediatric populations, including well-child visits, immunizations, and management of common childhood illnesses.
If you or your children see your primary care doctor frequently, or if you’ve been avoiding or delaying doctor visits because of costs, you should consider a DPC plan.
Can I continue seeing my current specialist while being part of a DPC practice?
Yes, DPC providers can coordinate and manage referrals to specialists when necessary.
However, the costs associated with specialized care are typically separate and may be covered by insurance or require additional out-of-pocket payments.
How do DPC practices handle emergencies or after-hours care?
ADPC practices focus on providing accessible and comprehensive care during regular office hours.
For emergencies or after-hours care, patients are advised to seek appropriate care through urgent care centers, emergency rooms, or by calling emergency services.
Is DPC suitable for individuals without ongoing health concerns?
Yes, DPC is suitable for individuals without ongoing health concerns as it offers preventive care, routine check-ups, and wellness services.
DPC providers can work with patients to establish personalized health goals and provide guidance for maintaining overall well-being.
Are DPC services available remotely or virtually?
Nearly all DPC practices offer remote or virtual services, such as telemedicine consultations, secure messaging platforms, or phone consultations.
These options enhance accessibility and allow patients to connect with their providers conveniently.
It’s also much easier to handle routine services like medication updates and refills that don’t require an in-person appointment.
Are DPC practices suitable for individuals with high healthcare needs?
DPC plans are great for people with high healthcare needs, especially those requiring ongoing management of chronic conditions.
The accessibility, personalized care, and extended appointment times in DPC can be beneficial for individuals requiring frequent care and attention.
They can also save patients a good deal of money compared to having to meet traditional insurance deductibles and manage copays and coinsurance costs.
Wiley is President of HSA for America. He believes that consumers should have choice and price transparency, so they can make the best healthcare decisions for their needs. Read more about Wiley on his Bio page.