Direct primary care and the healthcare system

Launched in the early 2000s as an alternative healthcare delivery model, direct primary care was the preferred platform for only about 150 practices by 2005. Today, there are more than 1,200 such practices across the country as direct primary care continues to expand, transforming the healthcare system. Many patients and providers still wonder how the structure of direct primary care works.

Direct primary care (DPC) involves many unique elements for the provider and the patient. The structure is different from the traditional fee-for-service model of healthcare that depends on insurance reimbursement, involves larger patient panels, and restricts the amount of time the provider is able to spend with each patient.

How does direct primary care work for the patient?

A DPC patient pays a membership fee, typically on a monthly basis. The fee covers all basic services provided by the DPC practice and may also entitle them to discounts on other services such as prescriptions and lab tests.

Patients benefit from being able to access affordable routine, preventive healthcare as well as chronic care services. Although many DPC patients opt to carry high deductible insurance for hospitalizations and specialty care, the direct primary care membership structure enables them to avoid paying out of pocket for primary care services not considered preventive.

The DPC patient also enjoys more direct contact with the provider, even after hours, as communication is important to the structure of the practice. Generally, a visit with a DPC provider lasts two to three times longer than a visit with a traditional fee-for-service provider, enabling the patient to ask questions and share concerns in a more relaxed, supportive environment.

How does direct primary care work for the provider?

A DPC physician receives a set amount each month for each patient, rather than billing and waiting on reimbursement for each visit. This membership fee can range from $50 to $100 or more a month, depending on the practice’s level of service, the patient’s age, and whether the practice offers discounts for families. Revenue is predictable for the provider and is not dependent on the quantity of patient encounters.

Providers are able to spend more time with their patients, while in the office and via appropriate communication methods before and after the visit. The patient panel for a DPC practice is usually much lower than in a traditional practice, with many practices seeing 600-800 patients rather than several thousand.

DPC providers also enjoy a lower burnout rate than physicians in traditional fee-for-service model practices. Since the DPC practice does not accept insurance typically, there is significantly less stress in regard to billing and revenue. The provider who utilizes an electronic health record (EHR) solution designed specifically for DPC practices, such as Elation’s, has access to an efficient method of managing clinical records, membership recurring payments, and patient relationships.

Providers find that the DPC model gives them more time to address their patients’ needs, resulting in higher quality outcomes and in fewer bureaucratic headaches. They are not rushing through appointments or running from one appointment to the next and they are not concerned about coding, billing, and other insurance challenges. They are able, instead, to focus on practicing medicine for the benefit of their patients.

The impact of direct primary care on the healthcare system can be seen in the way that the model enables physicians to overcome the challenges of traditional payment models. The DPC healthcare delivery model:

• Moves providers off the volume treadmill that emphasizes revenue over outcomes
• Reduces the administrative burden that can take up to a third of a physician’s time
• Provides physicians with a population’s health to manage rather than a volume of patients to process for claim reimbursements
• Enables physicians to provide quality care and practice at the top of their license, utilizing the full extent of the education, training, and experience.