Health care spending has been accelerating at an exponential rate, with chronic disease being the primary cost driver. A total of 90% of the $3.5 trillion spent on US health care costs is attributed to chronic disease management and treatment. Evidence suggests that nearly 80% of chronic conditions could be avoided through the adoption of healthy lifestyle recommendations. Any attempt at reforming the current health care system should be focused on three key areas: Improving health outcomes, lowering costs, and providing a better patient experience. This is where Direct Primary Care (DPC) comes in. DPC has been shown to significantly decrease the overall cost of a population’s health care while improving the quality of each person’s well-being.
What is DPC?
DPC is a proactive investment in primary care that seeks to provide transparency and deliver essential services at a lower cost. In DPC, a transparent contract is created between the provider and patient with a known upfront inclusive cost for a specific set of care needs. This cost typically covers all visits, in-person and virtual, well and preventive care, and acute and chronic disease care.
Tenets of the DPC model include the following:
- a direct agreement between the doctor and patient or employer;
- a flat recurring fee for comprehensive care; any per-visit fee is less than the recurring monthly equivalent flat fee, all of which is not billed to a third party; and
- clear language that the model is not health insurance or a health plan, as defined by the Affordable Care Act and state laws.
The DPC model is relatively new but has seen exponential growth in the past 5 years, with currently more than 1,400 practices in the United States. With this growth, the next phase of the DPC economy will enable employers to add this service as a covered benefit to employees.
DPC: Benefits for Employers
The DPC model has become appealing to employers for a variety of reasons, particularly regarding cost and access to quality care. As employers continue to see premium increases of 10%+ annually, they have been forced to put more of the cost burden onto the plan members, resulting in high deductibles and out-of-pocket maximums. A way to offset this cost burden on the employees is to offer the DPC memberships as an add-on to the traditional health plan. A DPC membership can provide many of the routine and chronic condition management services at no cost to employees through this membership. In addition, many regions are experiencing shortages in primary care providers, causing issues with access to healthcare. Many individuals are having to wait months to see providers, causing delays in checkups, screenings, and preventative testing. Most DPC clinics have same-day access to care for their members, resulting in immediate care, tests, and services when needed.
DPC: Benefits for the Employees
The same qualities of DPC that appeal to employers will appeal to employees as well: Lower out-of-pocket costs and better access to care. Whether paid for by their employer or not, a fixed monthly membership fee to gain access to preventative, chronic, and acute care takes the uncertainties of cost out of the equation. In addition to access to a primary care physician, most DPC clinics can perform blood draws, run lab tests, dispense medications, and perform minor procedures all within their clinic at minimal to no cost to the member. Whereas, under a traditional health plan, all of these types of services come with additional out-of-pocket costs either through the deductible or copays. The average patient-to-physician encounter under the DPC model is significantly longer as well, allowing the patient to have a more thorough exam and build personal relationships with their DPC physician. This longer exam time, coupled with little to no wait time to gain access to your DPC physician, results in high patient satisfaction and improved adherence.
Conclusion
DPC has shown efficacy in 3 key areas of managing health insurance benefits: Improving health outcomes, lowering costs, and providing a better patient experience. Removing the access and cost barriers to primary care services promotes access to needed medical services while developing long-term physician relationships. This leads to appropriate, high-quality, customized care for the patient. This unique approach to health care challenges the normal constructs of health insurance while providing employees & their dependents access to low-cost, highly personalized care. Whether fully insured or self-funded, small or large, employers all over the country are looking at DPC as a potential benefit enhancement to their overall health insurance offering.
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