What Is Direct Primary Care?
Charles Fazio
August 4, 2021
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In 2020, there was an estimated 31 million people living in America without health insurance coverage. Despite being uninsured, many of these individuals still want access to primary care physicians for ongoing health conditions or acute medical services.
When visiting primary care practices, the average cost for a patient without insurance coverage is $107. this cost varies depending on the clinical complexity, which determines the level of healthcare that is required. If a patient is uninsured and needs consistent primary care services, the bill can skyrocket quickly.
What is direct primary care?
Direct primary care is a new model that gives patients and physicians an alternative option to the standard billing structure, traditionally controlled by the individuals insurance company. Under the direct primary care model, patients are charged a recurring fee that covers a wide range of primary care services, depending on the structure this can include comprehensive care management, laboratory testing, care coordination, and other clinical specialties.
The direct primary care model seeks to eliminate uncertainty of billing for uninsured patients, and to free up administrative responsibilities of providers to focus on patient relationships with increased time, effort, and attention.
For people without insurance, this may sound like an excellent option to reduce medical expenses.
Is this primary care model right for you?
History of Direct Primary Care
The concept of direct primary care (DPC), patients paying their primary care providers directly for services that they receive, has been around long before insurance payments and regulations. The first insurance company was co-founded by Ben Franklin in1752, and before insurance was widely accepted, patient visits were directly with their doctor.
The resurgence of this payment model began in the late 1990s and early 2000s. During this period a handful of doctors came up with the idea to provide quality and personalized care with a monthly membership fee instead of the traditional insurance based model. One of the main goals of this shift in direction was to reduce uncertainty about medical expense for uninsured patients.
According to Elation Health, since the founding of modern day direct primary care, it has grown from humble beginnings to an estimated 6,500 provider base in 2015.
With the strong adaptation of patients searching for this kind of healthcare model, it seems that DPC is here to stay.
What Are The Benefits of Direct Primary Care?
According to GoodRx, patients benefit with substantial savings and have increased access and the ability to spend more time with their physician. Some of the other benefits include:
- More time with provider: One of the main selling points for DPC practices is the idea of delivering patients quality care, extended visits, and unlimited access to their provider. Typically DPC models have less patient load than a traditional primary care office, which results in increased knowledge of their patients health history and goals to form a better relationship and offer more personalized care.
- Convenience: Many DPC clinics offer same and next day appointments, and the option to video chat, call, text, or email directly with a provider. In traditional setups patients must schedule a visit to communicate with their provider.
- Straightforward pricing: Unlike insured patients who have clearly outlined copays for different types of visits, uninsured patients often go into a medical clinic without knowing how much it will cost for the services that they need. DPC aims to eliminate uncertainty by charging an upfront cost for a clearly outlined breadth of services.
Drawback of Direct Primary Care
One of the major drawbacks with this type of care is a false impression that it acts as an “insurance plan”, resulting in patients who rely only on DPC and do not get real insurance. If a patient has a healthcare condition that is outside of the scope of primary care services, they will not be covered under their membership fee for an outside visit.
This is an important consideration as primary care physicians are the main point of entry for individuals entering the healthcare system, and depending on the patients condition they may need more specialized care. Other medical specialists such as dermatologists, psychiatrists and other mental health care, cardiologists, chiropractors, physical therapists, and ophthalmologists will not be covered under this alternative payment model.
For patients that choose DPC in conjunction with high deductible health insurance coverage, the payment dues do not count towards your insurance deductible.
Direct Primary Care Services
Similar to a standard primary care clinic, DPC has a focus on preventative care, chronic disease management, patient education, and prescribing medications when applicable.
Some of the most common primary care services include:
- Annual physical examinations
- Treatment and management of chronic conditions
- Focus on patient education to increase quality of life
- Telehealth / Telemedicine / Virtual Visits
- Diagnostic testiing
- Referrals to other medical professionals
Although the services provided are identical to a traditional care model, uninsured patients who need consistent primary care services may find this option to suit their needs better while satisfying an affordable price point.
DPC vs. Concierge Care
Concierge care is not the same as DPC. Concierge usually caters to higher income populations and often accepts insurance providers and government programs in addition to perpetual membership fees. The annual fees for this type of care is often more expensive than DPC.
In contrast, DPC does not accept insurance or participate in any government healthcare programs.
How Much Does Direct Primary Care Cost?
The cost of DPC is fully dependent on the specific clinics monthly, quarterly, or annual membership fee. The average cost is around $100 per month, many providers will charge a different fee depending on the age bracket that the patient falls under. Patients who are younger usually require less consistent care than those who are older, thus the varying fee structure.
Depending on the health care providers, this affordable membership fee may cover typical primary care services such as preventative care, laboratory testing, consultations, telehealth, and acute care.
It is important to understand that urgent care, specialist referrals, and hospital care is not included in these monthly fees. Some providers have agreements for discount medications similar to what insured persons pay, but others must pay out of pocket.
Are you curious about urgent care? Please check out our article Primary Care vs Urgent Care.
Ironically, although this structure is popular for those who do not have insurance, it is still recommended that patients have some form of insurance for emergencies to avoid high cost medical bills. Enrolling in a high deductible health plan (HDHP) or health savings account (HSA) is a popular option for patient advocates of DPC.
Although a visit to the ER has extensive medical treatment options, this should only be used when it is an emergency situation.
Is Direct Primary Care Worth It?
It all comes down to the patients clinical complexity, age, stage of life, insurance status, and healthcare goals. No single solution will be perfect for every patient. If a patient has specific chronic conditions that require secondary care, they may be better off with a standard insurance provider plan.
If you require consistent primary care services and are uninsured, DPC may be an excellent choice to gain access to physicians while still being within budget.
Primary Care At South Pointe Healthcare
Depending on your specific healthcare needs, choosing the type of care that you receive is important whether it is primary care, urgent care, or emergency care.
South Pointe Healthcare provides integrated primary care solutions to our Colorado community. Located in Lafayette, CO, we combine primary care with chiropractic care, massage therapy, physical rehab, physical therapy, and mental health counseling to give all of our patients the best care possible – while keeping them under the same roof.
This unique model allows for our providers to work as a team with clear and consistent communication to treat all kinds of symptoms, from chronic issues to musculoskeletal pain and mental health issues such as anxiety and depression.
If you are looking for incredible healthcare, please give us a call today at (303) 665-8444 or checkout our online scheduling options.
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*The material contained in this blog post is for general information purposes only. You should not rely on the material or information in this article to make any diagnosis or healthcare decision. Any healthcare decision that you make should be brought up with and agreed upon in conjunction with your primary care provider. South Pointe Healthcare at Coal Creek LLC in no circumstances is liable to any party for damages that may occur directly or indirectly from information or material contained in this article.
