Is Direct Primary Care Right for Your Organization?

Direct Primary Care (DPC) is an innovative health care strategy whereby patients enter into a financial arrangement with healthcare providers directly, cutting out the insurance provider.

Instead of paying a health insurance premium, the patient pays a monthly, quarterly, or annual fee to the primary care provider directly. This means no third-party billing from an insurance provider, but rather an arrangement will be set up between the patient and health provider.

In this arrangement, health care professionals are directly responsible for their patients, creating a trusting and personal relationship. That said patients will often still need to purchase another form of health insurance, as this coverage typically only provides for basic care. This basic care equates to laboratory testing and services, preventative clinical services, as well as consultations, and care management.

What Is the Difference Between DPC and Concierge?

Concierge clinics provide services for a fee directly from the patient. They work off of monthly fees in much the same way as DPC, however, the difference lies in the structure of the clinic. Concierge clinics are a part of a national network that may send bills to the patient’s insurance if need be. This is in stark contrast to DPC, which will remain staunchly independent of any such network.

While a concierge may be a part of a hospital or an insurance company, DPCs are not. DPCs work directly with the patient creating a complete sense of transparency.

How Much Is Direct Primary Care?

Monthly premiums can be set as low as $70 per month, though most services will sit closer to $100 or more.

These fees provide patients with unlimited access to the healthcare provider and their services. It is also common for these providers to charge an additional fee per visit. This can be based upon patient age, practice, and other factors such as individual plans or additional members on the same plan.

General monthly premiums will cover all of the typical primary care services. This coverage refers to preventive care and laboratory tests. Preventative care might mean a check-up or tests to ensure the overall health of the patient. The premiums may also include forms of comprehensive care, such as being treated for a cold, flu, or other illness.

Though the costs for DPC are significantly lower than those of traditional healthcare, the coverage does not extend beyond basic measures. For extended coverage, patients will need to consider additional wrap-around coverage.

What Are the Benefits of Direct Primary Care?

DPC allows a patient to work directly with their health provider removing the need for an insurance carrier. This opens up a relationship between the two parties, which allows for a stress-free experience. Patients will know exactly what they will be paying along with all fees, upfront.

Utilizing a DPC is advantageous in that it can reduce costs for your employees, and in turn, your business as well.

By removing confusing pricing models, you eliminate the stress and anxiety that is often attached to medical expenses. This in turn helps to build a level of trust between the patient and provider that would otherwise be lacking.

What are the Downsides of Direct Primary Care?

Due to the nature of DPCs, most patients will still be required to enroll in a separate health insurance plan. Many times patients will enroll in a plan that is either catastrophic or skeletal in nature, allowing for lower monthly payments, though this means they must maintain two separate forms of healthcare. While this can certainly save your employees money, it may not be beneficial for every situation. DPCs have the potential to complicate the process and will likely need to be considered on a case-by-case basis, as opposed to a one size fits all approach.

Another downside to using DPCs is that they are technically categorized as a health plan meaning that should you also be enrolled in a health insurance plan, the monthly fee will not count toward the overall deductible.

Is Direct Primary Care Right for You and Your Organization?

Consider your situation to determine whether or not DPCs are right for your organization and employees. Consider your employee pool and what the general needs may be. You may also consider the long-term financial outcomes of using a DPC.

These programs do typically give patients the opportunity to contact via text or call at any time. This may be beneficial for the elderly or perhaps families with children. Those with difficult working hours or who find themselves traveling often may also find these DPCs beneficial.

You may simply be attracted to the idea of having to deal with insurance companies as little as possible. In this case, purchasing an HDHP alongside a DPC would be a sufficient choice.

Take time to forge a long-term plan that will best benefit your employees and the organization as a whole.