Direct Primary Care: A Self-Funding Strategy for Cost Avoidance

by | Apr 2, 2024 | Uncategorized

Exploring cost management in self-funded health plans isn’t complete without considering Direct Primary Care. To truly appreciate what sets Direct Primary Care apart, we must first understand the more common fee-for-service model.

In the traditional model, nearly 70% of physicians are tied to hospital systems and corporate entities that bill each service to insurance companies. Unfortunately, this model requires providers to align revenue more closely to the volume and cost of services rather than patient outcomes.

Direct Primary Care shifts this paradigm. It’s a monthly membership, usually with an independent doctor or practice, covering a broad spectrum of patient care—from preventive to urgent care, chronic condition management, labs, and care coordination. This approach caters to about 85% of a typical patient’s healthcare needs and is a throwback to the original doctor-patient relationship.

Why does Kimmel Benefits + recommend that employers integrate Direct Primary Care into their self-funded plans? When evaluated through the lens of cost, quality, and employee satisfaction—the triple bottom line for most business decisions—Direct Primary Care stands out:

  • Cost Reduction: Direct Primary Care can significantly lower healthcare expenses by focusing on chronic condition management and minimizing unnecessary services. A notable Milliman study showcased a Direct Primary Care group experiencing 40% lower ER visits, 20% fewer hospital admissions, and a 20% overall decrease in healthcare costs compared to a non-DPC group over a two-year period.
  • Quality Improvement: Direct Primary Care practices typically serve fewer patients, about a third of traditional practices. When doctors aren’t rushed, they tend to avoid outsourcing services or quickly resorting to “quick fix” and more invasive options like surgery, medication, and imaging. Instead, DPC physicians prioritize lifestyle modifications and maintain regular communication with their patients to assess the necessity of further treatments.
  • Enhanced Customer Satisfaction: It’s hard not to mention our all-too-common experience of enduring a 45-minute wait to see a doctor for less than 10 minutes of face-time. In stark contrast, Direct Primary Care practices have minimal to no wait times followed by unrushed visits that truly focus on the patient. DPC simplifies and strengthens the patient-doctor bond by improving accessibility with same-day to next-day visits, as well as direct communications via text, video, and email. This level of personalized and accessible care has propelled the growth of DPC through positive word-of-mouth.

A Look at the Benefits of Direct Primary Care in Real Life. 

An employee, with Direct Primary Care as part of her health plan, dramatically turned her health around with the help of her DPC doctor. In partnership, they reversed her type 2 diabetes; she dropped 50 pounds and was able to cut down her meds from three to just one.

This Integrative Family Medicine of Asheville member shares, “Dr. Cox has been such a great advocate for helping me take responsibility for my health.  She is a wonderful coach and spends time listening and answering questions. She looks for solutions instead of just throwing medications at the problems. Yes, she prescribes meds, but hopefully, for the short term, until you get things under control with diet and exercise. I can’t thank her enough for the changes in my health!”

Direct Primary Care: A Win for Your Business & Employees

Direct Primary Care redefines healthcare, offering substantial benefits for patients and employers managing self-funded health plans. It’s a strategy that enhances care quality while managing costs, embodying a win-win for all involved in the healthcare ecosystem. It’s healthcare as it used to be: personal, comprehensive, and patient-centered, and, we believe, the model of the future for innovative businesses. 

There are a growing number of Direct Primary Care practices; let us help you choose one for your team!