Direct Primary Care

Direct Primary Care is not insurance. In fact, it takes insurance providers out of the process of paying for healthcare by setting up a financial arrangement directly between healthcare providers and patients. Patients who use Direct Primary Care don’t pay monthly health insurance premiums or co-pays. Instead, they pay their healthcare provider a monthly fee.

How does DPC work?

DPC is like a primary doctor subscription: For a low monthly fee, patients have 24/7 access to a physician via phone, text, or video at no extra cost. In-office visits, when needed, are available the same or next day at no extra cost. 

Most minor procedures are available at no extra cost, and any labs or medical devices are provided at cost (often 90% less than they would be through a typical clinic). The physician is able to spend more time with each patient and develop personalized care plans. Basic women’s health services are included. This option provides everything that a typical urgent care clinic would. 

Other advantages of DPC

Direct primary care doctors have created a lean and technologically advanced primary care office for the benefit of the patient and payer. The doctor cares for a smaller population of patients vs a traditional doctor and offers services that are traditionally reserved for an urgent care or specialist office without marking them up.

The result is enhanced primary care that can reduce specialist and ER visits while guiding patients to low-cost medications and procedures. Since the doctor is accessible by video teleconference, phone, or text, more consistent follow-up can lead to improved health outcomes and can reduce absenteeism, as employees communicate with their doctor without having to leave the workplace.

Does DPC cover all medical needs?

No, DPC does not cover everything. Most patients who use direct primary care are also enrolled in a High Deductible Health Plan (HDHP) or a Cost Sharing Community.

What is a High Deductible Health Plan (HDHP)?

Direct Primary Care providers do not offer services like surgeries, treat complex or catastrophic health issues like cancer, or handle emergencies like a heart attack.

Direct Primary Care also does not cover hospitalization charges from circumstances that may require stitches, a cast, or other treatment received in the emergency room or at an urgent care facility. Of course, those types of events are relatively rare in younger healthy people.

As the name suggests, people insured in a HDHP must pay a (relatively) high deductible before insurance covers the rest, but in a high-cost situation like emergency surgery, the insured can at least get treatment.

Why offer Direct Primary Care plan along with a high-deductible healthcare plan or a Cost Sharing Community?

Direct Primary Care provides employees with access to a doctor for basic health care, while a high-deductible plan or cost sharing community protects employees in the case of major illness or a catastrophic event.

Find out more:

• TexHealth Central Texas

TXHealth is a community-based nonprofit organization located in Austin, Texas, dedicated to making it possible for small businesses in central Texas to afford health benefits for their employees.

• Euphora

Euphora is a for-profit corporation that offers a month-to-month membership for Direct Primary Care service with no long-term contract.

• METSI Care

Metsi Care is a for-profit corporation that offers a month-to-month membership for Direct Primary Care service with no long-term contract.

• Virtuous Benefits

Virtuous Benefits is a for-profit corporation that offers customized health care plans built around the Direct Primary Care model.