"When you have health insurance, you are already paying twice. The first time you pay is when you pay your premiums, and the second time is when you pay anything in addition to those premiums, like co-pays, prescriptions, etc. Direct Primary Care is a way to decrease how much you shell out for the second payment, while providing high-quality, easily accessible primary care." - Rich Stamps, President & CEO
Definition: Direct Primary Care
The definition of direct primary care is a primary care practice that charges a periodic fee for services, does not bill any third parties, and any per-visit charges are less than the monthly equivalent of the periodic fee.
There is not a single direct primary care practice model; rather the model represents a broad array of practice arrangements that share a common set of characteristics. The defining characteristic of direct primary care practices is that they offer patients (a.k.a. your employees) the full range of comprehensive primary services, which include routine care, regular checkups, preventive care, and care coordination in exchange for a flat, recurring retainer fee that is billed to patients on a monthly basis.
Why Is Direct Primary Care Growing?
The direct primary care model is growing steadily due to economic and legal pressures on physicians. Many physicians say keeping up with the paperwork involved in value-based care, meaningful use of electronic health records (EHR) and other initiatives tied to the Affordable Care Act, leaves little time to actually practice medicine.
With direct primary care practices, many doctors see much lower operating costs than traditional primary care practices because there is no need to send claims to third-party payers. Thus, the retainer fee payment structure makes the operations simpler.
Furthermore, direct primary care can help improve the work-life balance of the physician. Paperwork often keeps doctors working long hours but direct primary care reduces the paperwork and helps physicians better balance their lives outside of work.
For patients (your employees), direct primary care provides a beneficial alternative for those seeking more personal, proactive, and/or intensive medical care. Because of the direct primary care contract, patients (your employees) gain more access to their doctor with greater ease. This means that they can get the care that they need.
Why Employers Should Care About Direct Primary Care
1. Insurance is not necessary for all health care.
2. Not all health care is expensive.
3. Employers can use Direct Primary Care to lower health care costs.
With the evolution of direct primary care and as year-over-year healthcare costs increase, employers are increasingly seeking out new mechanisms for controlling healthcare costs in the short and long term. In today’s new and unprecedented health care climate, it’s vital to know the latest health care models that could keep an employer’s costs down while increasing quality and coverage. Direct primary care is such a model, and smart employers are taking notice as they design employee benefits.
Direct primary care can save employers up to 40 percent on health care costs compared to the traditional insurance alternatives, yet stay in compliance with the Affordable Care Act. For self-insured companies, direct primary care can control downstream catastrophic costs by providing high-access, quality care upstream and can be inserted strategically as part of the total plan offering.
There are many other advantages direct primary care provides for employers: Immediate and unlimited employee access to personalized primary medical care, reduced time away from work (reduced absenteeism), personalized medical care and unhurried time with the doctor, reduced turnover costs, and reduction in claims processing.
It’s time insurance was used for what it was meant – catastrophic events. In time, employees will be making two health care decisions: 1) who they will use for routine primary are, and 2) who they will use for insurance. It’s already happening with employers and employees nationwide.
Is direct primary care right for your business?
Check out Total Access Medical's Corporate Health Programs.