What is DPC?
dpc: it’s kind of like netflix for healthcare.
One flat, monthly fee gives you easy access to the provider of your choice.
It’s cliché to compare a service or product to something like Netflix, but in this case, it really is an applicable analogy: Direct Primary Care is a monthly membership that allows you easier, more affordable, 24/7 access to your desired health provider or providers, including doctors and clinicians, all around the United States. Its existence is a solution to the problem of an overly complicated and inefficient insurance system in this country, and is a successful effort to reconnect patients to their healthcare providers directly, for more personal, wide-ranging, and attentive care.
frequently asked questions
Direct Primary Care is still a relatively new healthcare model, and it’s okay to have questions about its
many benefits and even occasional drawbacks. Here are the most common questions people like you
have asked us, along with information to help answer them. Wherever possible, we’ve used direct
quotes and citations from outside sources unaffiliated with doopl and who do not directly
benefit from the adoption of Direct Primary Care.
many benefits and even occasional drawbacks. Here are the most common questions people like you
have asked us, along with information to help answer them. Wherever possible, we’ve used direct
quotes and citations from outside sources unaffiliated with doopl and who do not directly
benefit from the adoption of Direct Primary Care.
What sort of services are usually covered by a Direct Primary Care membership?
According to GoodRx, “the monthly fee covers all – or most – typical primary services, [including] preventive care (routine screenings), laboratory tests (like blood tests or urinalysis), management of chronic conditions (medication checkups), acute-care visits (like for strep throat or the flu), and consultations.”
How is Direct Primary Care different from traditional insurance?
According to AAFP, direct primary care “is a practice and payment model where patients/consumers pay their physician or practice directly in the form of periodic payments…in exchange for access to a broad range of primary care and medical administrative services.” AAFP also says, “typically, these periodic payments provide patients enhanced services over traditional fee-for-service medicine. Such services may include real-time access via advanced communication technology to their personal physician, extended visits…home-based medical visits, and highly personalized, coordinated, and comprehensive care administration.”
According to GoodRx, key differences between Direct Primary Care and traditional insurance plans become quite visible when comparing a typical visit to your primary care physician’s office:
- “DPC providers can avoid preparing and filing insurance paperwork – this allows them to have more in-depth visits and spend more time with you.”
- “DPC practices also treat fewer people than those that accept insurance.”
- “Providers can take the time to get to know your health history in detail, and this creates opportunities for more personalized care.”
- “With a traditional health insurance plan, you have little knowledge of exactly what – and how much – your insurance will be billed. First, deductibles or copays are applied. Discounts are negotiated between the provider and your insurance company. Then you get an explanation of what you’re expected to pay for the visit. DPC eliminates that confusion: You’ll know the exact monthly cost of membership, as well as the flat fee (if any), for visits. This fee does not vary based on the services you receive.”
- “With DPC, you’ll have access to many perks, [including] same-day and next-day visits, appointments of 30 to 60 minutes, [and] access to your provider 24/7, [with] the option to call, email, text, or video chat with a provider.”
How does Direct Primary Care benefit employees?
According to AAFP, “patients…benefit from having a DPC practice because the contract fee covers the cost of many primary care services furnished in the DPC practice. This effectively removes any additional financial barriers the patient may encounter in accessing routine primary care, including preventive, wellness, and chronic care services.” AAFP also says, “the DPC model is structured to emphasize and prioritize the intrinsic power of the relationship between a patient and [their] family physician to improve health outcomes and lower overall health care costs. The DPC contract fee structure can enable physicians to spend more time with their patients, both in face-to-face visits, and through telephonic or electronic communications mediums should they choose, since they are not bound by insurance reimbursement restrictions.”
How does Direct Primary Care benefit employers and brokers?
Employees like choices when it comes to their healthcare, and offering employees a Direct Primary Care membership multiplies their options for primary care, simplifies costs for preventive services, and in many cases, eliminates copays and deductibles that would have been charged for comparable services under a traditional insurance plan.
Employees with Direct Primary Care memberships can visit their providers more often, for more reasons, and with less confusion or complication over payments. This encourages employees to seek treatment earlier in an illness, or when a concern first emerges, rather than waiting until they’re very sick to seek treatment from an urgent care or emergency room. This, in turn, removed a burden often absorbed by insurance premiums that are passed onto employers and employees.
When employees are healthy, they’re more productive. When employees seek treatment earlier, they typically miss less work and are back from sick leave sooner. Because they’re less likely to prolong treatment, they are less likely to spread an illness to others in the workplace. Direct Primary Care memberships help break a workplace cycle that’s plagued all of us in our careers.
How does Direct Primary Care benefit healthcare providers?
According to AAFP, “the DPC contract between a patient and [their] physician provides for regular, recurring monthly revenue to practices…this revenue model can stabilize practice finances, allowing the physician and office staff to focus on the needs of the patient and improving their health outcomes rather than coding and billing.”
If I have a Direct Primary Care membership, do I still need traditional insurance?
According to AAFP, “most patients, depending on affordability, still carry insurance for coverage of healthcare services that cannot be provided in the primary care practice setting, such as specialty care and hospitalizations. The model is especially well suited for those patients with high deductible [traditional insurance] plans where they might normally be paying out of pocket for any primary care services that are not considered preventive.”
What’s the catch? What are the downsides of Direct Primary Care?
Let’s be fair and transparent: DPC isn’t for everyone. According to GoodRx:
- “If you need additional testing, procedures, or medications, you’ll likely be responsible for the cost…that’s why you’ll need to pair your DPC membership with some sort of insurance plan. Many people using DPC also have a high-deductible health plan.”
- “You can use DPC providers if you have Medicare or Medicaid…but you have to sign an agreement stating that any and all services provided will not be billed to Medicare or Medicaid.”
- “The IRS categorizes DPC and its monthly membership fee as a ‘health plan,’ so the monthly cost is not eligible to go toward a deductible if you also carry high-deductible health insurance coverage.”
- “The monthly fee doesn’t include visits to (some) specialists, urgent care, or the hospital.”
Is Direct Primary Care worth it?
Wouldn’t it be weird if you got all the way to here and we said no? Of course it is. Here’s why GoodRx recommends it, in their own words:
- “People using DPC can typically text or call their provider(s) at any time, so this option may appeal to a range of people, especially families with small children, people who travel frequently, and older adults with limited mobility.”
- “DPC may be best for people who are generally healthy, or for people who need to see a primary care provider for routine visits or short-term health issues.”
- “It can help limit the costs of physicals and other routine healthcare visits.”
have a question we didn’t address here?
Reach out and ask — we’re happy to get back to you quickly with an answer.
