DPC (Direct Primary Care)

Direct Primary Care is a practice model where the patient (or employer) pays the physician a flat monthly membership fee — typically $50 to $150 per patient per month — for unlimited primary care access. No copays, no coinsurance, no insurance billing for the primary care visits themselves. The physician isn't in-network with anyone; the financial relationship is direct.

The economics work because the physician's overhead drops. A traditional primary care practice spends 30 to 40 percent of its revenue on billing, coding, prior authorization, and insurance-related administration. A DPC practice with 400 to 600 patients (versus 2,000+ in a traditional practice) can offer 30-minute visits, same-day or next-day appointments, direct texting and email access, and negotiated cash rates for labs, imaging, and generic drugs — often at 80 to 90 percent below insurance-billed prices. Employers pairing DPC with an HDHP and a wraparound plan for hospital care can build a comprehensive benefit that costs 20 to 40 percent less than a traditional PPO, with better primary care access. The model pairs particularly well with self-funded plans where the DPC fee is a fixed budget line and the savings hit the claims budget.

The takeaway: for employers frustrated with primary care access and rising costs, DPC is worth a serious look. The pilot is small — even one DPC practice near the worksite can validate the model.