What Is Direct Primary Care & How Does it Work?

The healthcare system in the United States is complicated, broken, and leaves many Americans in a position where they either don’t make enough money to afford good health insurance, or they make too much to qualify for government subsidies or Medicaid.

Historically, healthcare has also been tied to employment, which leaves those unemployed or self-employed in a very tricky situation where they often need to choose between high healthcare costs or other necessities like rent, mortgage, car payments, and other bills that life brings. For a country that prides itself on innovation, diversity, and the idea that with hard work, anyone can succeed at making the “American Dream” come true, not being able to provide its citizens with affordable basic healthcare is an embarrassment. 

The good news is that with technological advances over the last decade, new healthcare options are starting to emerge. One option that is slowly gaining traction is the direct primary care (DPC) model. 

What is Direct Primary Care?

Direct Primary Care utilizes the subscription/membership platform that many have become familiar with over the past several years and applies it to the healthcare setting where primary care physicians charge their patients a monthly, quarterly, or annual subscription or membership fee, typically under $100 per month. The subscription grants patients access to their physician on a 24/7 basis through text, email, video, phone, and same-day visits, paving the way for more time with your doctor, deeper patient/physician relationships, and the elimination of co-pays and third-party billing. 

It is a la carte healthcare, which can be a huge benefit to so many people struggling with insurance companies and the long delays that insurance claims can cause, not to mention the skyrocketing prices in health insurance each year. 

What does a Direct Primary Care subscription include?

In addition to 24/7 access and extended doctor visits, the American Academy of Family Physicians, which supports DPC, explains that the membership also covers clinical, lab, consultative services, care coordination, and comprehensive care management. 

Ascent Internal Medicine, a DPC medical clinic in Bend, Oregon highlights the significant differences between DPC and the typical fee-for-service insurance companies including low overall costs, more time with patients, ability to have fewer patients, and minimal interruption in the patient’s schedule. They also provide a transparent breakdown of costs, which are significantly lower than obtaining these same services through insurance. 

DPC physicians can also refer patients to specialists and usually get them discounted rates for procedures like ultrasounds, X-rays, scans, etc. Depending on individual state laws, DPC doctors can also provide patients with common prescribed medications sold at wholesale prices right from the office saving you a trip to the pharmacy. 

To cover hospital stays and more complex medical care, the DPC community recommends obtaining a high-deductible insurance plan that will protect against emergencies that can’t be handled at a primary care physician office. 

Putting patients first

TV shows like Doc Martin, which feature a doctor who treats an entire town and creates personal relationships with everyone, depict an experience many dream of. To have a doctor who takes the time to get to know his patients, their families, and really listen to their medical history instead of feverishly typing on the computer the entire time to ensure he or she captures all the data the insurance companies require, whether it is relevant to the visit or not. 

One of the main goals of DPC is to bring the patient/doctor relationship back to the forefront by untangling the requirements and restraints insurance companies put on primary care physicians, freeing up time and resources to build a solid relationship with each member of their practice, and providing the quality healthcare we all deserve. 

Will Direct Patient Care become more mainstream?

DPC arrived on the healthcare scene in the early 2000s, and shortly after three doctors decided to try it out and go insurance-free, leading the way for other primary care physicians to follow suit. According to DPC Frontier, which has been reporting on the DPC model since the beginning, there are currently 1,377 physicians in 48 states, including Washington D.C., that are operating on the DPC model.  

DPC Frontier and the Direct Primary Care Coalition have been actively advocating for DPC at the government level, most recently with the Primary Care Enhancement Act, which aims to update the current tax codes to categorize DPC as medical expenses instead of a health insurance plan. This will enable its participants the ability to invest in Health Savings Accounts (HSA) that many people have become accustomed to by participating in their employer’s insurance plan. Participating in an HSA is currently not an option for DPC members.

As we move into a new year and a new White House administration, hopefully the continuing debate on healthcare in America will foster new innovative options for those who fall through the cracks of our current healthcare model, as well as those that want better primary care and that idyllic Doc Martin experience. 

Amy Isler, MSN, RN is a freelance healthcare writer who combines the worlds of nursing and journalism to educate consumers on important health topics.