About Direct Primary Care

Direct Primary Care offers a solution to what frustrates patients and providers alike in the traditional primary care model. In the traditional (aka “Fee For Service”) model, a provider is paid by a patient’s insurer by filing a claim for every service provided. Insurance company reimbursements traditionally undervalue primary care services, such that for a primary care provider (PCP) to earn enough to pay staff and overhead costs, a PCP must fill their schedules with 20+ patients per day, which limits time with patients and compromises the quality of the care provided.  Additionally, providers must document a huge amount of information to justify each claim submitted, most of which contributes little to the care provided, and may actually reduce quality.  Meanwhile, cost of health care insurance continues to climb, while insured individuals accept a greater share of cost with increasing deductibles. In a Direct Primary Care arrangement, a patient contracts directly with a provider via an agreement to pay a low monthly fee. For that monthly membership fee, an individual receives unobstructed access (typically same day or next day) to their provider for the full scope of their primary care needs, including the highest quality evidence-based chronic disease management (high blood pressure, diabetes, obesity, etc.), management of acute issues (injuries, illness, etc.), and preventative care (including skin biopsies, gynecologic care, etc.).  All such care is provided in return for the monthly membership fee, meaning no claims will be submitted to insurance for any services provided as part of this agreement.  The shift of paradigm is significant.  Instead of medical decisions being based on insurance reimbursement or the need to create a “billable visit”, decisions can now be made solely based on what is best clinically for the patient.  Patients and providers can now connect by text, email, phone, or video based solely on what is most convenient and appropriate to the clinical scenario, and without concerns about what cost may be incurred or if/how much a provider will be reimbursed.

Higher Quality Care

Additionally, as a consequence of low insurance reimbursements and a PCP’s need to fill their schedules with 20+ patients per day, primary care providers have traditionally targeted a practice patient population (aka panel size) of 2500 patients or more, further amplifying clerical burden and compromising meaningful provider-patient relationships. In the DPC model, a PCP typically targets 400-500 patients, allowing the time needed to truly and comprehensively address the clinical needs of the patient.

Discounted Medications

Direct Primary Care practices often offer additional perks such as discounted medications, lower rates on ancillary services, and streamlined specialty referrals.  In-clinic pharmacy at near wholesale medication pricing provides tremendous advantages in both convenience and cost.  As an independent entity, a DPC practice has the opportunity to form agreements with select ancillary services such as laboratory and radiology at significant cost and pass those savings on to members. Similarly, agreements can be made with specialists based on quality, access, and patient experience rather than just network affiliation, which dramatically affects the care experience.

Pricing

Individual

(Age 10-45)

$60/mo

Individual

(Age 45-65)

$80/mo

Individual

(Age 65+)

$95/mo

Child Add-On

(Age <18 child of enrolled adult)

$30/mo