Direct Primary Care (DPC): “Concierge Medicine for the Masses”

THOMAS FINN – February 11, 2014 11:14 AM

If you’re not yet fully familiar with the concept of Direct Primary Care (DPC), don’t worry about it. It’s coming soon to a theater near you.

DPC is an umbrella term used to describe primary health care delivery models that are based on direct financial relationships between patients and their docs. As the name indicates, DPC business models are limited to primary care. But what distinguishes them is that they trade off insurance-based coverage and its high cost of administration for a dirt simple subscription-based payment system –a monthly retainer or membership fee paid by the patient to the primary care physician or to an aggregator that, in turn, pays the physician. Yes, if you know the term “concierge medicine,” it too, is a DPC model, but concierge medicine has been positioned  as a primary care solution for the wealthy, where emerging DPC models are being billed as “concierge medicine for the masses.”  For example, while popular DPC subscription pricing varies according to the services covered, many are as inexpensive as $55-$65 per month –like joining a gym. And while the current administration is obviously not warm to solutions that just serve the rich, Obamacare expressly provides a place for DPC models when they are paired with high deductible policies that cover hospitalizations and visits to specialists. Of course, the fact that Obamacare explicitly allows it doesn’t mean that our lawmakers are conversant with what Section 1301 (a)(3) of the Affordable Care Act actually says, but (drum roll here) a growing and bi-partisan contingent in Congress are now talking about DPC in a reasonable context, suggesting that they actually “get it.”

As we know, physician practices continue to be acquired by acute care providers at record pace. According to an Accenture study, the number of independent physicians dropped from 57% in 2000 to 39% in 2012. Let’s face it, docs aren’t jumping ship because they see a bright future going at it alone. They clearly don’t. Accenture estimates that one in three remaining independent physicians –their ranks decline by 5% each year— will look to adopt a DPC model, and that the trend will only continue to grow by 100% annually over the next 3 years.

And it’s not just about the physician’s wallet. For consumers and employers, many believe that there is no better path to lower priced coverage than pairing a DPC model with a high deductible policy which, as said, Obamacare explicitly allows. Indeed, the stars are even aligning for the insurance companies. The Medical Loss Ratio requirements under Obamacare effectively capped their profits, forcing them to reduce their overhead just to stay even. Relative to current administration/overhead costs, DPC virtually eliminates them.


About Concierge Medicine Journal

Concierge Medicine Journal (CMJ) curates breaking concierge medicine news, and editorial opinion on a wide variety of topics relevant to the practice of Concierge Medicine.

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