Top Questions Local Employers Ask About Direct Primary Care (And the Answers)

In today’s complex healthcare landscape, employers are constantly searching for innovative solutions that can provide quality care for their employees while keeping costs manageable. Direct Primary Care (DPC) has emerged as a compelling alternative to traditional employer-sponsored healthcare models, but many business owners still have questions about how it works and whether it’s right for their company.

Many business owners are curious about DPC but aren’t quite sure how it differs from conventional insurance-based primary care. This article compiles the most common questions employers typically have about Direct Primary Care and provides straightforward answers to help you understand if DPC might be the right fit for your business.

What Exactly Is Direct Primary Care?

Think of Direct Primary Care as a subscription to healthcare. Instead of the traditional fee-for-service model where patients (or their insurance) pay for each visit, test, or procedure, DPC operates on a membership model with a flat monthly fee. This fee covers virtually all primary care services with no copays, deductibles, or surprise bills.

For employers, this means paying a set monthly fee per employee for comprehensive primary care access. Your employees can then visit their DPC physician as often as needed without worrying about additional costs for routine care.

How Does DPC Differ From Traditional Primary Care?

The traditional primary care model typically involves:

• Insurance premiums, copays, and deductibles
• Brief 7-15 minute appointments (that have to be in person so doctor gets paid by insurance….opportunity costs to employer and workers)
• Crowded waiting rooms
• Limited access to physicians
• Complex billing processes
• Reactive rather than preventive focus

In contrast, Direct Primary Care offers:

• A transparent monthly fee with no additional costs for primary care services
• Extended 30-60 minute appointments
• Same or next-day appointments with minimal waiting
• 24/7 access to your physician via phone, email, or text
• No insurance paperwork or billing complexity
• Focus on preventive care and wellness

The fundamental difference is that traditional primary care operates within the insurance system, while DPC removes the insurance middleman from the primary care relationship, creating a direct financial and care relationship between patient and physician.

Will This Actually Save My Company Money?

This is perhaps the most frequent question employers ask, and understandably so. Healthcare costs are a significant concern for businesses of all sizes.

The short answer is: Yes, for most companies, implementing a DPC model alongside a complementary health plan can result in substantial savings. Here’s why:

1. Predictable costs: You’ll know exactly what your primary care costs will be each month, making budgeting simpler.
2. Reduced downstream costs: When employees have easy access to primary care, they’re less likely to end up in expensive emergency rooms or urgent care facilities for non-emergency issues. Studies have shown that strong primary care relationships can help reduce hospitalizations and emergency department visits, leading to overall healthcare savings.
3. Decreased specialist referrals: DPC physicians typically spend more time with patients and can handle many issues that might otherwise be referred to specialists.
4. Lower absenteeism and higher productivity: When employees can quickly address health concerns and receive preventive care, they miss fewer workdays and are more productive when present.
5. Compatibility with high-deductible health plans: Many employers pair DPC with a high-deductible health plan for catastrophic coverage, resulting in overall premium savings.

Research suggests that many employers experience significant healthcare cost reductions after implementing a DPC model with a complementary health plan. These savings typically come from reduced emergency room visits, (reduced UC visits, labs at cost not what hospitals charge, reduced claims…) fewer specialist referrals, and decreased employee absenteeism – all natural outcomes of having better access to primary care.

Don’t My Employees Still Need Regular Health Insurance?

Yes, but with an important distinction. DPC covers comprehensive primary care services—which represent the majority of most people’s healthcare needs—but it doesn’t cover catastrophic events, hospitalizations, or specialized care.

Most employers who offer DPC pair it with a high-deductible health plan (HDHP) or a wrap-around policy (ie level funded plan, self funded plan) that covers major medical events. Because your employees’ day-to-day healthcare needs are largely covered through the DPC membership, you can often opt for a less expensive health insurance plan with higher deductibles.

Research suggests that employers who implement DPC often report positive experiences. While individual results vary, many businesses find that the combination of DPC plus catastrophic coverage can result in lower total costs than traditional comprehensive health insurance while providing better access to care.

What Exactly Is Covered Under the DPC Monthly Fee?

The specific services covered vary slightly by DPC practice, but a comprehensive DPC membership typically includes:

• Unlimited office visits with no copays
• Annual comprehensive physical exams
• Same-day or next-day appointments
• Preventive care and chronic disease management
• Acute care for illnesses and injuries
• Basic procedures (joint injections, skin biopsies, suturing, etc.)
• Basic lab work performed in-office
• 24/7 access to a physician for urgent issues
• Telemedicine consultations
• Coordination of care with specialists when needed

Additional services like advanced labs, imaging, or medications are often available at significantly discounted rates negotiated by the DPC practice.

How Does This Benefit My Employees?

From an employee perspective, DPC offers numerous advantages:

1. No financial barriers to care: With no copays or deductibles for primary care services, employees don’t delay seeking care due to cost concerns.
2. Better access: Same or next-day appointments and direct communication with their physician mean employees can address health issues promptly.
3. More personalized care: Longer appointments allow physicians to truly understand each patient’s health status and concerns.
4. Convenience: Reduced waiting times, easy scheduling, and telemedicine options make healthcare less disruptive to work and personal life.
5. Improved health outcomes: The focus on preventive care and chronic disease management leads to better overall health.

Many employers report that offering DPC has become a valuable recruitment and retention tool in a competitive job market.

How Do I Implement DPC for My Business?

Implementing DPC is typically straightforward:

1. Choose a DPC provider: Look for an established DPC practice in your area with experience working with employers. Schedule consultations with potential providers to discuss how their model would work for your specific business.
2. Determine your funding approach: You can fully fund the DPC membership for employees, share costs, or offer it as a voluntary benefit with preferred group rates.
3. Evaluate your current health insurance: Work with your benefits advisor to select a complementary health plan that provides catastrophic coverage while avoiding duplication of primary care benefits.
4. Communicate the benefit: Clearly explain to employees how the DPC model works and its advantages. Many DPC providers offer information sessions for employees.
5. Enroll employees: The DPC provider will typically handle the enrollment process and ensure a smooth transition for your employees.

What Size Business Is DPC Right For?

DPC can work for businesses of all sizes, from small operations with just a few employees to large corporations with hundreds of staff members. The model is particularly attractive for:

• Self-insured employers looking to control healthcare costs
• Small businesses that struggle to afford traditional group health insurance
• Companies with high healthcare utilization
• Businesses focused on employee wellness and preventive health
• Organizations looking for innovative benefits to attract and retain talent

The flexibility of the DPC model allows it to be tailored to various business sizes and needs.

Will My Employees Have to Change Doctors?

This depends on your implementation approach. Some employers transition their entire workforce to a DPC model, while others offer it as an optional benefit alongside traditional insurance.

If your employees join a DPC practice, they will be establishing a new primary care relationship. However, many quickly find that the enhanced access and personalized care more than compensate for any initial adjustment period.

Quality DPC practices typically schedule comprehensive initial visits with all new patients to understand their health history, concerns, and goals, ensuring a smooth transition.

The Bottom Line: Is DPC Right for My Business?

Direct Primary Care represents a fundamental shift in how we think about and deliver healthcare. By removing the insurance middleman from the primary care relationship, DPC creates a model that can provide better care at a lower cost—a rare win-win in healthcare.

For employers tired of annual premium increases with diminishing benefits, DPC offers a refreshing alternative. It’s not just about cost savings (though those are real and significant); it’s about providing your employees with healthcare that actually works for them.

If you’re interested in learning more about how Direct Primary Care could work for your business, consider reaching out to a reputable DPC provider in your area. Many DPC practices have experience helping local employers implement successful DPC programs and would be happy to discuss your specific needs and circumstances.

Healthcare doesn’t have to be complicated or unpredictably expensive. With Direct Primary Care, we’re getting back to what matters most: the relationship between patients and their doctors, focused on health rather than billing codes.

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Gold Direct Care is a leading Direct Primary Care practice serving the North Shore Massachusetts area. Contact Gold Direct Care today to learn more about bringing DPC to your business.