Since the majority of us have been patients in America’s traditional healthcare system since we were born, we’ve become accustomed to its prevailing aspects: The waiting rooms. The efficient appointments. The billing to our health insurance. If you’re someone who has, luckily, only been in and out once a year for annual checkups, you may hardly think twice about this system. But if you’re a person who deals with a chronic health issue, wants to get down to the bottom of head-scratching symptoms, or simply wants to feel better than they already do, perhaps you’re wondering: is there a better way? That better way may just exist. Called direct primary care, several doctors are turning to this new form of healthcare that allows for longer appointments and, as the name suggests, more direct access to your doctor. As of 2018, according to Optimum Direct Care, approximately 20,000 of the 465,000 primary care physicians in the United States have switched to a direct care model. Some examples of direct primary care models you may have heard of include Parsley Health, Forward, Carbon Health, and more. Is there a catch? What are the differences between this form of care and customary primary care? What are the benefits? Are there any downsides? We talked over these questions and more with two doctors. Read on to find out if direct primary care is the right fit for you.
What is direct primary care?
Simply put, direct primary care is a new model for delivering healthcare that works “outside the current insurance model in which individuals pay a monthly fee for unlimited access to their physician or provider,” as Aaron N. Hartman, MD puts it. Think of it as a subscription-based approach to primary care in which you pay a monthly flat fee. “They get unlimited, unhurried visits with the same doctor with no hidden fees, whether for an annual wellness physical or acute sick visit,” says Direct Primary Care Provider and Vice President of Medical Affairs at Decent, Inc. Dr. Ben Aiken. “Same or next-day appointments and video calls are available, along with phone, texting, and email support for your health questions.” Dr. Aiken goes on to explain that in-office lab work, such as urinalysis or strep throat tests, is generally included at no cost, and all other lab tests are available at wholesale, transparent pricing. The doctor further coordinates and helps manage all care outside the clinic, including referrals to specialists, advanced imaging, and surgeries or procedures.
What makes direct primary care different than traditional primary care?
Our experts list several characteristics of direct primary care that differ from traditional primary care. The main aspects include:
A membership or subscription model that centers around a predictable monthly feeDirect primary care providers do not accept health insuranceOptions to meet in person or through text message or video chatLonger appointmentsFewer patients per doctor
“Traditional primary care works through a fee-for-service model that is driven by health insurance contracts and networks,” Dr. Aiken says. “The patients pay these fees in three ways: monthly insurance premiums, visit co-pays, and resulting bills for services rendered. For the service billing component, every appointment, treatment, and test ordered has a fee which is accounted for by a code. There is often more than one fee matching various diagnoses or treatments, and fees can vary depending on the facility, location, and type of provider, all of which is negotiated between the provider and the insurance carrier. In short, it is really complicated and confusing, and rarely is anyone able to know upfront what something is going to cost.” Dr. Aiken adds that the average face-to-face time between a doctor and patient is 8 to 10 minutes. Dr. Hartman says that meeting with a direct primary care provider can last between 30 to 45 minutes and beyond. “Longer appointments are the norm,” Dr. Aiken observes. “As a result, it allows for in-depth, root cause analysis of issues rather than just quickly treating symptoms.” Then there’s the fact that direct primary care providers do not accept health insurance. This is where the monthly fee comes in that’s in place of charging for every visit and service. “Without the administrative burden of navigating health insurance companies for payment, we keep our costs down and can see much fewer patients in a day,” Dr. Aiken says. “As such, we’re able to spend more time with each of our patients, if they need it.” Oftentimes, direct primary care offers a more functional, or alternative medicine, approach. “This is mainly because of the time piece,” Dr. Hartman notes. “In order to practice functional medicine and apply all the nuances of medical therapies around the world, keep up to date with data, and then apply it to the patients in front of you—you need time. And that’s the one major thing that insurance companies do not pay for. They pay for procedures, operations, imaging tests—but they do not pay for time. And that’s the biggest commodity that we actually need right now in healthcare.”
Do direct primary care doctors take insurance?
As mentioned, direct primary care doctors don’t accept health insurance. Dr. Aiken says that by relying on a monthly fee system instead of insurance, direct primary care physicians can reduce overhead, have more time during appointments, and build closer relationships with patients.
Should a person keep their health insurance?
The answer is yes—you need to keep your health insurance even if you switch to a direct primary care provider. “We encourage all patients to have health insurance for the unexpected,” Dr. Aiken says. “Specialty care, surgeries, and hospitalizations are very expensive without health insurance. Patients should think of direct primary care as a complement to their health insurance and not a replacement.”
What are the benefits of direct primary care?
In their own opinions, both of our experts say that there are myriad benefits to having a direct primary care provider. They include:
Unlimited visits via text message, phone, video, or in personMoney savings since there’s a monthly flat fee and a doctor can guide their patients to the most appropriate care at the lowest costThe ability to plan ahead for medical expenses with no hidden feesMore access to a doctor, since they commit to fewer patients than a traditional primary care provider wouldLonger appointments
What can people expect to pay for direct primary care?
So, now you’re probably wondering: what’s the bottom line? Dr. Hartman says that the cost for direct primary care can vary “from locality to locality and what’s being provided,” and, according to Dr. Aiken, the fees can vary according to the patient’s age as well. “You can range anywhere from as low to $60 a month to as high as $140 to $260 a month,” Dr. Hartman says. “It all depends on what is provided. Some places will include basic labs available to the patients, while others will not. The monthly fee is determined by what traditional primary care services are provided within their model.” Dr. Hartman advises, “Always look at what you’re getting for the cost. It’s not just the dollar amount—it’s what comes with that.”
Which services are not offered?
“Direct primary care is a strong foundation, but it isn’t a replacement for all care,” Dr. Aiken points out. “Specialty care, surgeries, and hospitalizations are outside of what direct primary care practices offer and can be very expensive without health insurance.”
Is direct primary care worth it?
Although direct primary care has many upsides, there are a few downsides to be aware of as well. Since direct primary care is a relatively new form of healthcare, it may be difficult for you to find such a doctor in your region, especially if you live in a rural area. Direct primary care physicians take on fewer patients, which means there could be a waiting list. Also, some experts say that vulnerable populations may not be able to access direct primary care as easily. Dr. Aiken sings the praises of direct primary care, saying that it “reclaims the age-old value of a trusting doctor-patient relationship. Such a relationship was the foundation of care during our grandparents’ and great-grandparents’ time, where the family doctor could be called upon whenever there was a medical question, including even coming to the house. With the addition of modern medicine and technology, direct primary care is well-positioned to provide an authentic, meaningful experience that those who came before us would be proud of.” Dr. Hartman calls it “a superior overall way to get primary care at a better value to patients and frees up the physicians to practice medicine the way they ideally want to practice it.” The bottom line? Switching to direct primary care is a highly individualized decision. But it does make more sense for some people than others. For instance, if you’re someone who’s in excellent health and rarely contacts their doctor, money spent on a monthly fee may not be the best fit for you. But if you’re someone who prefers to stick to a strict budget with no surprises, you may enjoy the monthly fee model. Also, if you want to uncover the root cause of a health issue or work to understand some mystery symptoms, this could be a good approach for you. If you’d like to take a deeper dive into your health and build a close relationship with your doctor in the process, then yes—direct primary care could be worth it for you. Next up, discover a preventive health checklist for each decade of your life.
Sources
Optimum Direct Care: “Direct Primary Care Statistics”Population Medicine: “Direct primary care: Family physician perceptions of a growing model”Aaron N. Hartman, MD, an integrative and functional medicine doctor in Midlothian, Virginia.Dr. Ben Aiken, Direct Primary Care Provider and Vice President of Medical Affairs at Decent, Inc.
