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Direct Primary Care: Better Care at a Lower Cost



Direct Primary Care, or DPC for short, is a simple idea that solves an unnecessarily complex problem. The DPC model was developed from the belief that value in healthcare is in focusing on overall health and wellness without third-party payers inserting themselves between the patient and the physician.

DPC offers patients a transparent, specific set of agreed-upon primary care services in exchange for a periodic fee. You directly pay the doctor monthly (or quarterly/semiannually/annually), and the doctor will doctor you when you need doctoring.

HISTORY

While it may be a new idea to many, it is actually not a new concept. The DPC model emerged in the late 1990s and was an idea developed by a group of physicians in WA, WV, NC, NY, and MD.

Initially (and even now), the major challenge for the DPC movement has been regulatory. The DPC contract initially was misinterpreted by regulatory agencies as a type of insurance contract. Federal and state insurance commissioners argued that DPC contracts should be subject to regulatory and economic requirements. It has taken years to clarify that monthly DPC payments are NOT insurance premium payments. DPC monthly payments are simply payments in exchange for healthcare services. Several states now have explicit language in laws that state "DPC is NOT insurance" (Florida included)


GROWTH


DPC has gained popularity over the last several decades and has provided relief to a strained and inadequate healthcare system. By eliminating unnecessary elements and obstacles that interfere with the care between a patient and a doctor (i.e. insurance companies, stacks of paperwork, layers of administration within corporate hospital systems and pharmaceutical companies), healthcare is becoming simple again. That's DPC in a nutshell.

In 2018, there were approximately 900 DPC clinics in the US. As of today, there are almost 2000 DPC clinics in the US.


CRITICS

Not everyone supports DPC clinics. Some physicians criticize DPC doctors for abandoning traditional primary care during an epic primary care physician shortage. The counter-argument to this criticism is much more enlightening. In a recent 2020 survey of more than 20,000 physicians at 124 institutions across the US published in Mayo Clinic Proceedings, researchers found that one in five physicians say it is likely they will leave their current practice within two years due to burnout and about one in three doctors and other health professionals intend to reduce work hours in the next 12 months. Doctors are leaving a toxic healthcare system already. DPC doctors are attempting to stay in healthcare in a way that serves both the physician and the patient, and not the system.

Other critics feel like DPC providers "cherry pick" healthier patients and leave the sicker patients to a system that is already overwhelmed. This is not true. Logic would argue that “sicker” patients would require more time and attention from a physician. A system in which patients routinely are only given 10-15 minute appointment times is not a system that is set up to treat the sicker patient. The DPC system is designed to allow patients to have longer appointment times as well as more direct and personalized contact with the physician which allows time to fully explore complicated, complex medical concerns.



HOW DOES IT WORK?

A Direct Primary Care patient pays his/her physician directly in the form of a periodic payment (usually a flat monthly payment, but some clinics offer quarterly, semi-annual, annual payment options) in exchange for a defined set of primary care services. Third party payers are not billed for the same primary care services. In plain terms, a patient pays a flat monthly fee in exchange for his/her primary care services with no additional hidden fees.

This concept is often explained in similar language to a gym membership. Let’s use the gym membership metaphor to explain the difference between a DPC model and the traditional fee-for-service model.


Gym A is the DPC model. Mr. Z signs up for Gym A and pays $99 per month, no contract. He can cancel at any time, he just needs to give Gym A a thirty-day notice before canceling. There is a $100 enrollment fee that is non-refundable. For $99 a month, Mr. Z has unlimited access to the gym, the equipment, the fitness classes, and the sauna. He is able to use the gym towels and the gym locker room all without any additional fees.




Gym B is the traditional fee-for-service/insurance model. Ms. W signs up for Gym B and pays $199 per month, but there is a one-year contract. She is committed to paying $199 per month out of her paycheck for a minimum of 12 months. There is not an enrollment fee. For $199 a month, Ms. W has access to the gym but is required to pay $50 every time she uses the gym equipment or attends a fitness class or uses a gym towel or the locker room until she has paid an additional $500. Once she reaches that $500 limit, then she will only have to pay $25 every time she uses the gym equipment etc, until she reaches $1000. Once she reaches that amount, then she’ll have unlimited access to the gym and the equipment, etc.

In the Gym B metaphor, Ms. W is paying her monthly insurance premium but still has to pay a copay for every doctor’s visit until she meets her deductible. But even when she meets her deductible, she is still responsible for her portion of co-insurance until she reaches her out-of-pocket maximum.


Besides the cost benefit of DPC, there is another benefit. As a DPC patient, you form a relationship with a doctor who knows you well. Communication is clear and direct. Access to your healthcare team is not difficult. If you need an in-person visit, you can usually book one the very next day, sometimes same day for urgent issues. If an in-person visit is not possible, at a minimum a telephone call or a video call is standard. Your doctor is committed to you and your health and not the administrative work or the charting. Keeping costs low is a priority.


The DPC model is structured to prioritize the power of the relationship between a patient and his/her physician. This is healthcare like you've never experienced it. It's like having a doctor in the family.
 

NEED MORE?

For more answers to FAQs such as “Can I still have insurance if I sign up to be a DPC patient?” and “What are the actual services covered under my membership?” please visit our FAQ page on our website.

If you would like to schedule an in-person meet and greet with Dr. Cardona to talk about Direct Primary Care in more detail, please visit our scheduling page here or you can also call our office at (904) 551-4625.



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