What is a DPC?
Direct Primary Care (DPC) is a direct agreement between the doctor and patient (or employer). It is not a health insurance or a health plan. Instead of relying on a fee-for-service reimbursement model, DPC uses a flat recurring fee for comprehensive care.
An increased use of this innovative health care delivery model could lead to better outcomes for treatment of patients with chronic diseases, and that could mean cutting the incidence and severity of disabilities, according to the 2017 John Locke Foundation Policy Report.
For the nation’s health care system to slow the growth of health care spending and better manage the prevalence of chronic disease and its association with disabilities, patients need better access to health care, writes report author Katherine Restrepo, Director of Health Care Policy at the John Locke Foundation. In turn, providers need the flexibility to spend more time with their patients. By analyzing data, Restrepo makes the case that Direct Primary Care has a good record of addressing these concerns.
DPC is a health care business model that removes insurance companies from basic primary care. Patients pay a monthly fee and, in exchange, they have unrestricted access to their physician and unlimited access to a defined package of services. In most cases, primary care physicians are available around the clock, whether that’s in person or by phone, text, or email.
Skip the wait of a Fee-For-Service Practice! Icon Medical DPC offers phone, text, email, and video call access direct to your doctor.
Reduce costs with the use of direct pricing for labs, imaging, and medicine.
Credit: Direct Primary Care, A Simple Health Care Model Designed to Help Patients With Chronic Disease and Disabilities, by Katherine Restrepo, Director of Health Care Policy, John Locke Foundation, March 22, 2017. https://www.johnlocke.org/wp-content/uploads/2017/03/DirectPrimaryCare.pdf
Why choose a DPC?
Uncoupling primary care from insurance is essential. No other system uses insurance for predictable, low-cost, and expected incidents. For example, car insurance is not used for oil changes, new tires, and replacement of brake rotors. This would lead to undue higher costs, lack of transparency, and poorer quality. Consider the absurdity of getting prior approval for a tank of gas out of network!
“It is very easy to be different, but very difficult to be better.”
A real example of cost savings is with the county government in Union County, North Carolina. It saved more than $1.2 million in medical and prescription drug claims under its first-year contract with its DPC solution. A few noteworthy details from the analysis for that 2018 include the following:
DPC participants spent twice as much time with their physician compared with the traditional Fee-For-Service clinics.
DPC participants cost Union County $313 less on a per-member, per-month basis than traditional consumer-driven options.
A total of 99% of DPC county participants reported both high satisfaction with provider access and a positive overall experience.
Credit: Busch F, Grzeskowiak D, Huth E. Direct primary care: evaluating a new model of delivery and financing. Accessed March 24, 2021. https://www.soa.org/globalassets/assets/files/resources/research-report/2020/direct-primary-care-eval-model.pdf
DPC Benefits for Patients
There can be considerable cost savings for patients, particularly if they have no insurance coverage or a High Deductible Health Plan (HDHP). The average deductible for a HDHP is now $2300, with the maximum at $7600 for an individual and $13, 800 for a family. This does not include the additional out-of-pocket expenses for co-insurance and noncovered expenses.
DPC offices cover more than 85% of most health care needs, with no deductible, no coinsurance costs, and no claims. This is advantageously done with upfront and inclusive pricing. Coupling a DPC plan with a HDHP saves on average 20% to 30%.
For patients without insurance, the savings from one urgent care or emergency room visit can almost cover the entire cost of one year with a DPC practice. Additional savings can come from access to wholesale pricing on labs, radiology, and some procedures.
The most significant benefit is the care received. Figure 2 is a wordle of the many testimonials of patients in the Integrated Family Care practice. This represents a diverse group of patients of all ages with coverage from Medicare, Medicaid, employer-based insurance, health sharing communities, and patients who are 100% cash pay.
Figure 2
Credit: Mechley AR. Direct Primary Care: A Successful Financial Model for the Clinical Practice of Lifestyle Medicine. Am J Lifestyle Med. 2021 Apr 15;15(5):557-562. doi: 10.1177/15598276211006624. PMID: 34646107; PMCID: PMC8504342. https://pmc.ncbi.nlm.nih.gov/articles/PMC8504342/