What Is Direct Primary Care?'
Direct Primary Care (DPC) is a comprehensive primary care model that improves quality and availability by removing barriers frequently encountered in the fee-for-service (insurance-based) model. In the DPC model, the patient is central, and the clinic acts as a medical home where all of the patient’s care (both from the clinic and from outside providers/hospitals) are reviewed and managed. Our “bottom line” focuses on something called the Quadruple Aim (for more information, read THIS article), which focuses on three areas – physician availability, quality care of the patient, and lower overall costs – and then adds a fourth item, which is a focus on the provider avoiding burn-out from their own job.
Recent developments in the primary care model such as the Primary Care Medical Home (PCMH) or Comprehensive Primary Care Plus (CPC+), have been extraordinarily difficult, if not impossible, to initiate and maintain successfully in the traditional primary care model. Unfortunately most attempts to repair or fix areas of the fee for service model tend to fall apart, primarily because the end result is always the same – poor quality, limited time (if any) to complete tasks for patients, poor financial results, excessive burden on the care team, and burnout. At the end of the day, these developments, often called “advancements,” chase numbers and figures, shifting the focus off the patient and even the community, in order to justify sub-par care.
Virtue Medical defines Direct Primary Care as a practice where a patient has straightforward access, high quality care, and reasonable, affordable, and transparent costs for their membership, labs, imaging, medications, and more. Less red tape = more access. And for those who have commercial insurance, you can still use your insurance for any of the services outside the clinic, just as would be the case in most practices.
What is the difference between Direct Primary Care (DPC) and Concierge Medicine?
Concierge medicine, like Direct Primary Care (DPC), charges a membership fee of some type. Typically, a concierge medicine practice charges higher prices on a yearly or quarterly cycle, usually at or above $2000 per year. In addition to the membership cost, concierge practices often bill patient visits through insurance (or at a standard rate), and may charge for additional services (such as on-call costs, home visits, etc). Many charge on a tier structure (bronze, silver, gold, platinum, unicorn-ium packages, etc). Many variations exist, but patients are generally high-income earners.
DPC, like concierge medicine, charges a monthly membership, but at a much less expensive rate. Most services are provided at no additional cost, such as routine/general physical exams, urgent visits, virtual visits, and on-call services. DPC communities are able to make agreements with third parties (for labs and imaging) to provide discounts, as low as $5 for many labs (i.e. labs from a routine physical are $20). The DPC community has also partnered with other businesses that allow for many medications and supplies to be bought and sold at wholesale prices, which means your prescriptions may be cheaper than the copay from your insurance or better than the discounts through online services.
What are the Pros and Cons of Direct Primary Care?
- 24/7 access to your provider
- No hidden fees/gotcha fees (always upfront before you’re charged)
- Less insurance hurdles (prior authorizations, less “must do this before that”)
- MUCH less expensive labs, imaging, medications, and equipment
- LONG appointment times for scheduled visits in-office
- Membership covers for all Virtual Visits
- Phone calls, text messages, and emails handled without additional charge
- Urinalysis, pregnancy check (urine), strep swab, mono swab, and more in-office testing included in membership
- EKG’s free of additional charge for members
- Less likely to need to go to the ER
- Prolonged appointment times allow for more to be completed before you leave
- Shorter wait times for follow-ups or care in general
- Faster turn-around time on results
- Appointments can be scheduled when it’s convenient for you (scheduling URL given to members)
- No “person-to-person-to-person” transfers on the phone before getting an answer
- All forms (FMLA, handicap, short-term disability, work or school notes) covered by membership
- Better overall health outcomes at lower overall cost (less ER visits, less referrals out of office)
- Enhanced patient experience (better doctor-patient relationship)
- Many more!
- Still need to have some sort of insurance for specialty care, surgery, and emergencies
- Generally, we recommend a high-deductible or cost-sharing plan, but this is entirely up to you.
- Some specialists will provide a service with up-front pricing, which is usually at a discount.
- Not always cost-effective for people who don’t require a great deal of care
- For low-utilizers (rarely visit except a few times a year, rarely call/message), reach out and we will try to work with you.
- No Medicare coverage/billing (neither patient nor provider can bill Medicare for services)
- No Medicaid coverage/billing (neither patient nor provider can bill Medicaid for services)
- Some medications not covered (varies, but usually brand-name medications). GoodRx (C) and Blink (C) are always checked for price comparisons.
- Common childhood vaccinations not yet covered (currently investigating ways to obtain coverage without additional cost)