The DPC model enables the physician to actively engage with each patient individually without the concern of lost revenues that would be faced under a traditional model, where revenue is based solely on the number of patients seen per day.

The opportunity to spend more time interacting with patients and providing ongoing, follow-up services is at the heart of the patient-centered care provided via the DPC model.

Many DPC physicians additionally expand their services to provide a larger array of non-face-to-face services, such as tele-visits or e-visits, in an effort to ensure primary care services can be accessed in a manner most convenient for patients and their families.

Although the DPC and Concierge models are often confused with each other, the terms are far from synonymous. The terms have become clouded due to physicians not properly making the distinction in how they classify their clinics to patients.

However, the two models have some clear differentiating factors that are important to understand.

Some of the most notable similarities are:

1. Decreased patient volume in both practice types from a traditional care model.
2. Both are based around a monthly subscription type of fee to access the service.
3. Both lead to more robust appointment times that can often result in an enhanced patient experience.

Notable differentiators:

1. The first word of the DPC acronym stands for Direct and this will be the one key factor to distinguish between Concierge and DPC. Concierge involves third-party payers (i.e. insurance companies) while DPC does not, meaning consumers (or their employers) pay physician entities directly eliminating the insurance ‘middle man’ by way of a monthly subscription or fee.
2. Concierge models typically result in two fees to the patient – the concierge medicine fee (the access fee for non-covered services) and the insurance premium (for actual medical visits). Additionally, Concierge has been associated with being ‘select’ or ‘elitist’, as it was created as a way to gain access to a system that would bypass the ‘woes’ of the current fee-for-service system allowing priority access to a select group of physicians and services without concern for increased cost to do so.
3. Direct Primary Care was created originally to serve the uninsured with the model recognized under ACA, as well as by many states as a non-insurance entity. Under the DPC model, consumers or their employers pay one monthly fee. The cost reductions under the DPC model are largely driven by the disappearance of the overhead associated with claims, coding, claim refiling, write-offs, billing staff and claims-centric Electronic Medical Record systems for the physician practices that are passed through to the patient that are still necessary under the Concierge model.

One of the primary myths surrounding Direct Primary Care is that it costs more than traditional care. However, this is a total fallacy.

Direct Primary Care models, when compared to traditional insurance driven models, cost the patients less when you add up the cost of insurance premiums, deductibles and co-pays.

Direct Primary Care continues to deliver a lower cost option for patients to have a better experience, even when you include the cost of a wraparound plan to cover emergency care and complex procedures.

There are many different types of DPC clinics. It is always recommended you research clinics you have access to, analyze their strengths and/or specialties, before selecting the best clinic for your needs.

If you anticipate using a particular insurance carrier for all or part of your care, it is recommended to discuss this ahead of any scheduled appointment to determine facility policies, including what services are covered by the DPC fee.

Some DPC practices choose to continue participating in a smaller number of insurance plan contracts. Those that do must make clear to patients what medical services and procedures are covered by particular carrier contracts. Many insurance carriers will not pay for services determined to be covered by the DPC contract.

The DPC model may not be right for everyone, but there are some distinct advantages. Those include:

1. Most generic prescriptions are offered at no cost to the patient.
2. Clinics work on a 30 minute schedule, so they only have 2-3 appointments per hour versus 10-12 per hour of the traditional provider setting.
3. Clinics are better able to stay on schedule and get patients in on time.
4. Physicians are able to spend more time with patients allowing them to get to know the patient better and provide a more customized level of care.
5. Decrease in patient volume per provider allows better availability for appointments, often same-day accessibility as opposed to the often month or more wait to get an appointment under the traditional care model.
6. Less overhead often results in less cost to the patient.
7. No need for precertifications or preauthorizations through an insurer for appointments.
8. Removal of concern regarding proper coding resulting in denial of claim issues.
9. More focus on the patient and the proper course of care for that patient than on what an insurance carrier might cover for that patient.

Rather than looking at eligibility, you should focus on suitability. The DPC model is often best suited to either a self-funded or partially self-funded employer, because they would have the funds on hand for the per-member, per-month fees associated with the DPC model of care.

Historically, only large employers could have sponsored clinics like these. JA is unique in that they have been successful at creating and implementing innovative, shared clinic models making the advantages of DPC clinics accessible to employers as small as 20 employees at an affordable cost.

What is best for one large employer is not the best option for the next. What is best for one small or mid-size employer is not the best for the next. The best way to determine if the DPC model is right for you would be to contact one of the experts at JA. It is important to have your employee benefits ‘big picture’ looked at to determine what solutions will have the most meaningful impact for you.

Our Advisors will take a deep dive into your company goals and current offerings to see what may be the best solution for you today, as well as how to best plan for what you may want in the future. Understanding your big picture and ensuring you have a clearly defined, actionable 3-5 year strategy will give you confidence in your employee benefit related decisions now and well into the future.