Learn more about the direct primary care healthcare model and see if it’s right for you.

Direct primary care allows for patients to have access to their primary doctor through an affordable membership that can be paid monthly, or annually. This removes the necessity of insurance companies and other non-medical establishments, while enhancing the personal relationship between patient and physician (1).

Benefits of Direct Primary Care:

1. Better health outcomes for the patient

Today’s healthcare system consists of long wait times and short visit times. Direct primary care allows for a more personalized connection between provider and patient due to the longer and more frequent sessions (2). The health outcomes are significantly better as patients have unrestricted access to their physician which allows for more comprehensive care. 

2. More affordable healthcare

DPC runs on a system of an overall flat rate. This consists of a set membership or subscription price paid directly to physicians by the patient. By using this system, third parties and fee-for-service systems are eliminated. Furthermore, third parties such as insurance do not interfere with the care patients receive which lowers overall cost.

3. Simplified administrative structure

Patients are charged on a monthly, quarterly, or annual basis. Included with this fee are laboratory services and comprehensive care management. DPC is not a concierge practice since most clinics will not accept any form of insurance, and rely solely based on patient fees (5).

Typical Wait Times for Health Services:

In 2017, a survey-study by Merritt Hawkins concluded that the average wait time to see a primary care doctor was, typically, 24.1 days. Mid-sized metro markets have even longer wait times than large metro markets (4). According to Healthline (3), these wait times are getting longer every year. Factors include: 1) a physician shortage, 2) more people acquiring health insurance, and 3) the introduction of electronic medical records. “Rheumatic diseases represent the second-greatest cause of disability and have the fourth-greatest impact on overall world population health in terms of both death and disability” (8). This means those affected must, first, wait from the onset of their symptoms, to, then, be able to see a primary doctor for their referral, and finally, be seen by a rheumatologist.

DPC offices give the patient an enhanced access to healthcare services with patient panels usually a third of the size of typical patient panels in a hospital. With DPC, patients spend a shorter time waiting in an office and more time interacting with their primary care provider. This ultimately improves patient-provider relationships and results in positive health outcomes (6).

DPC and Insurance:

A recurring issue is that insurances may often deny a claim for reimbursement, or most of the cost. The patient must go through a process which can sometimes be time-consuming and tedious. Factors that come into play regarding the percentage of reimbursement for these services are: 1) type of coverage, 2) out-of-network deductible limit, and 3) particular benefits included (1).

Since DPC models do not accept insurance and other third-party payers, there is no burden on the physician to complete meticulous insurance paperwork. The patient will be able to go to their provider at their own convenience since the physician is readily available. With the elimination of insurance policies, physicians can prevent the risk of serious illnesses, reduce healthcare spending, and improve their and their staff’s quality of life in the workplace (6).

Is DPC a Right Fit for You?:

Direct primary care combines elements of traditional care with modern features, offering a complementary or alternative approach to traditional health care plans. This model provides comprehensive patient care, leading to improved health outcomes at a lower cost. If this approach resonates with you, direct primary care could be a suitable fit for your healthcare needs. There are no fee-for-service third party fees included, so you have more control over your healthcare journey.

References

1. Norris L. Tips for when your medical insurance won’t pay. Verywell Health. May 22, 2023. Accessed July 21, 2023. https://www.verywellhealth.com/health-insurance-company-wont-pay-3231743.
2. Electronic Health Records. CMS.gov. Accessed July 21, 2023. https://www.cms.gov/Medicare/E-Health/EHealthRecords.
3. Mills D. Doctor appointments: Longer Wait Times. Healthline. April 19, 2017. Accessed July 21, 2023. https://www.healthline.com/health-news/why-you-have-to-wait-longer-to-get-a-doctors-appointment.
4. 2017 survey of Physician Appointment Wait Times. Merritt Hawkins. Accessed July 21, 2023. https://www.merritthawkins.com/news-and-insights/thought-leadership/survey/survey-of-physician-appointment-wait-times/.
5. Direct Primary Care. AAFP. November 15, 2019. Accessed July 21, 2023. https://www.aafp.org/family-physician/practice-and-career/delivery-payment-models/direct-primary-care.html.
6. Brekke G, Saint Onge J, Kimminau K, Ellis S. Direct primary care: Family physician perceptions of a growing model. Population Medicine. 2021;3(August):1-8. doi:10.18332/popmed/140087
7. Tsai CH, Eghdam A, Davoody N, Wright G, Flowerday S, Koch S. Effects of electronic health record implementation and barriers to adoption and use: A scoping review and qualitative analysis of the content. Life. 2020;10(12):327. doi:10.3390/life10120327
8. Widdifield J, Bernatsky S, Thorne JC, et al. Wait times to rheumatology care for patients with rheumatic diseases: A data linkage study of primary care electronic medical records and Administrative Data. CMAJ Open. 2016;4(2). doi:10.9778/cmajo.20150116