Direct primary care practices offer a membership-based approach to routine and preventive care that can dramatically reduce health care costs for individuals, families and businesses.
At the core of a direct primary care facility is a medical practice dedicated to providing routine, everyday care, essential for the well-being and ongoing maintenance of a patient’s health. This is where patients go for check-ups, vaccinations, sprained ankles, or frequent headaches.
Direct primary care providers know their patients. They have talked with their patients in detail, gotten to know them, treated past conditions and know what recurring problems are experienced. If a patient has a chronic illness, like arthritis or diabetes, their primary care provider is already a partner in management every step of the way. And, in the unlikely event of a life-threatening accident or disease, the provider serves as the patient’s advocate, coordinating care across multiple providers, facilities, and prescriptions.
How does it work?
Direct primary care practices serve as a patient’s “primary care medical home” (D-PCMH) where they go for all routine primary, preventive and chronic care management types of care. Patients pay one low monthly fee-sometimes as low as $49-directly to their direct primary care facility for all of their everyday health needs. Like a health club membership, this fee gives patients unrestricted access for visits and care, so patients can use the services as much or as little as they want. Many direct primary care practices are open seven days per week and offer same-day or next-day appointments. At many clinics, physicians are on call 24/7.
There is none of the paperwork and expense required today by insurance reimbursement – no procedure or billing approval, deductibles or co-payments. With a lower business overhead and dramatically less paperwork, primary care providers are no longer forced to squeeze in an unmanageable number of patients and can instead take the time necessary with each patient to deliver high-quality, personalized care.
Accidents and the unexpected do happen, so the typical patient in a direct primary care practice keeps an insurance plan to cover emergencies and serious illnesses. Because this insurance doesn’t need to cover routine care, many patients choose a less comprehensive plan with a higher deductible and lower premium.
With insurance-paid primary care, where each and every part of your medical care is billed to a third party payer, reimbursement costs consume more than 40 cents of each dollar. Eliminating insurance from primary care makes that 40 cents available for actual health care – more time with each patient, more extensive office hours, more on-site services and diagnostics, and more patient-provider support technology.
The combined cost of the primary care provider monthly fee and a lower-premium insurance plan is significantly lower than paying for soup-to-nuts health insurance that covers even basic primary care needs. This is important when more than three-quarters of America’s uninsured are working families. The annual income from a full-time, minimum wage job is only a few hundred dollars more than the cost of an average family insurance plan. With direct primary care, supported by a low-premium “wrap-around” insurance plan that covers everything primary care facilities do not, cost to families can drop by as much as 50%, saving hundreds or even thousands annually.
Even with a combination of direct primary care membership and lower-cost “wrap-around” insurance policies, employers opting for this combined option have routinely saved 20 to 35 percent on comprehensive health care benefits over what they currently spend, while employees’ payments (including premium cost-sharing, deductibles, co-payments and co-insurance) drop significantly. Downstream savings from unnecessary diagnostics and specialist, hospital and/or emergency room care add to these savings. In states where workers compensation insurance premiums are based on claims history, employers may be able to significantly reduce their costs as direct primary care practices do not file insurance claims, even though they do complete any legally required paperwork. Many employers also appreciate the impact that high accessibility direct primary care practices have on lowering absenteeism and improving patient health.
By eliminating unnecessary insurance costs, we also eliminate the need for primary care providers to flood their practices with thousands of patients that require reams of paperwork. A smaller patient pool allows primary care providers to spend more time with each patient. Instead of being rushed through a 5- or 10-minute appointment on what feels like a conveyer belt, patients are allocated what each needs – even if it is an hour or more – to discuss health details with doctors or nurse practitioners. There is time to actually treat, not just get an overview then refer to an expensive outside specialist. Most Americans have never experienced this level of care. For patients with chronic illnesses such as diabetes or high blood pressure, the unrestricted access to a primary care physician can have dramatic – often life-changing – positive effects on the individual’s health. As a result, doctor visits are no longer restricted by bank accounts and patients are seeing their providers whenever necessary to manage their health issues and improve their quality of life.
Reinvigorating Primary Care
By eliminating insurance burdens from direct primary care practices, physicians, nurse practitioners and physician assistants have more time to do what they were trained to do – practice medicine. This allows direct primary care practices to serve as a patient’s “medical home.” They develop deep, personal relationships with their patients and have ample time to diagnose and treat underlying problems. Providers can get off the treadmill of seeing 25 to 35 patients a day (national average for insurance-based practices), providing a balanced life-style. Physicians act based on what is in their patients’ best interests rather than those of the insurance company. Direct primary care can stave the exodus from primary care that has been occurring over the past decade:
Many former primary care physicians who discover this model actually return to primary care.
- Many former primary care physicians who discover this model actually return to primary care.
- Medical students are once again selecting primary care as their career of choice.
- Primary care physicians discover that with this model they no longer need to retire early to escape the stress of insurance-based primary care.
Why is it better? The Direct Primary Care Difference