Your Guide to Direct Primary Care

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For primary care physicians seeking to focus more of their time on the patients they serve, a new avenue for healthcare has emerged. As of 2014, over 4,400 doctors have turned to direct primary care as their alternative healthcare model.

What exactly is direct primary care?

Direct primary care is exactly that– a direct path to care from doctor to patient, without third-party or fee-for-service billing. Some people believe that direct primary care restores the value of personalized medicine since it allows doctors to spend more time with patients and less time dealing with insurance billing codes, regulations, and government programs.

Direct primary care is a payment model that attempts to bring more accessibility and affordability to high-functioning healthcare. Patients pay a flat monthly, quarterly, or annual membership fee for access to a doctor for primary care needs and services. This periodic fee can sometimes be as low as $70 a month.

What services does direct primary care provide?

Direct primary care practices usually suggest that patients get a supplemental high-deductible policy plan to cover emergency care and services that fall outside of primary care. This plan would also cover specialists, which aren’t included in direct primary care. However, direct primary care can offer a variety of common primary care services, including:

• Annual physicals
• Lab services
• EKG testing
• Joint injections
• Laceration repairs
• Skin biopsies
• Care coordination and management

While some direct primary care practices may have retainer fees that cover a wide scope of primary care services, other practices offer limited services and collect fees at the time of visit to cover the services provided at that time.

Direct primary care vs. concierge care

Direct primary care often gets confused with concierge care, but the two models are not synonymous. Direct primary care is mentioned in the Affordable Care Act as an acceptable option for receiving medical care without insurance, while concierge care is not. Concierge care tends to cater to higher income populations and has higher fees than direct primary care. While membership fees cover an in-depth physical and screening in concierge care, direct primary care offers a wider range of services. Concierge care can also continue to bill insurance for covered services on top of the membership fee. Direct primary care delivers healthcare with no insurance billing at all.

Benefits of direct primary care

For patients, direct primary care may be a more affordable alternative to healthcare that offers lower, transparent rates that don’t change depending on service. Direct primary care may also allow patients to have more unrestricted access to physicians, as some plans allow patients to text or call their doctor at any time and as frequently as they want to. Patients may also get to spend more time with physicians during appointments.

For physicians, direct primary care offers a simplified revenue structure that reduces administrative costs since it is no longer necessary to have an administrative staff to work on billing. This also allows for longer interactions with patients, creating a stronger patient-physician relationship that benefits well-coordinated and communicated care.

Disadvantages of direct primary care

For patients, direct primary care doesn’t include all medical services like hospital stays or seeing specialists. In a direct primary care model, physicians’ focus on personalized care causes them to not be able to see as many patients, and in some cases, down to one-third or one-quarter of the number a traditional primary care doctor can see. This limits physician access for patients. Also, patients with medicare, medicaid or Affordable Care Act plans will have limited funds to spend on direct primary care.

Ready to start your journey with direct primary care? Find a direct primary care provider near me.



Kristen Luft is a digital marketer working on health-centered blog posts for Wellistic. When she's not writing, you can find her reading, snuggling her greyhound or chihuahua, or following the latest trends on Instagram.

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