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Elements of Direct Primary Care
The defining element of DPC is an enduring and trusting
relationship between a patient and his or her primary care
provider. Empowering this relationship is the key to achieving
the quadruple aim of (1) superior health outcomes, (2) greater
access, (3) lower costs and (4) an enhanced experience for
both patient and provider. DPC fosters this relationship by
focusing on five key tenets:
① Service
② Patient
Choice
③ Eliminate
Fee-For-
Service
④ Advocacy
⑤ Stewardship
The hallmark of DPC is adequate time spent between patient
and provider, creating an enduring patient-provider
relationship. Supported by unfettered access to care, DPC
enables unhurried interactions and frequent discussions to
assess lifestyle choices and treatment decisions aimed at
long-term health and wellbeing. DPC practices have extended
hours, ready access to urgent care, and patient panel sizes
small enough to support this commitment to service.
Patients in DPC choose their own personal provider and
are active partners in their healthcare. Empowered by
accurate information at the point of care, patients are
fully involved in making their own medical and financial
choices. DPC patients have the right to transparent
pricing, access, and availability of all services provided.
DPC eliminates undesired fee-for-service(FFS) incentives
in primary care that distort healthcare decision-making
by rewarding volume over value. This undermines the
trust that supports the patient-provider relationship and
rewards expensive and inappropriate testing, referral,
and treatment. DPC replaces FFS with a simple flat
monthly fee that covers comprehensive primary care
services. In essence: value > volume
DPC providers are committed advocates for patients within
the healthcare system. They have time to make informed,
appropriate referrals and support patient needs when they
are outside of primary care. DPC providers accept the
responsibility to be available to patients serving as patient
guides. No matter where patients are in the system, DPC
clinicians provide them with information about the quality,
cost, and patient experience of care.
DPC providers believe that healthcare must provide
more value to the patient and the system. Healthcare
can, and must, be higher-performing, more patient-
responsive, less invasive, and less expensive than it is
today. The ultimate goal is health and wellbeing, not
simply the treatment of disease.
Future Plans
The great Hippocrates was credited with saying, "Healing
is a matter of time, but it is also sometimes a matter of
opportunity." Now is the opportunity for innovation in
the field of health care, particularly through the
application of more sound economic principles that focus
on re-establishing proper incentives. True progress in
American healthcare will be lead by patients and
providers – not insurance and government – and will
involve utilizing disruptive care delivery strategies such
as Direct Primary Care, which allows for more valuable
healing between patients and providers.
Anecdotal Evidence
 24/7 access to a provider
(phone, text, email, etc)
 Longer office visits (~45 min)
 No extra charge for in-office
testing (EKG, UA, spirometry,
glucose monitoring, etc)
 Urgent care visits & reduced
visits to the ER
 Minor in-office procedures
(sutures, joint injections,
biopsies, cryotherapy, etc)
 Often 90%+ savings on in-
house medications (often
cheaper than Wal-Mart)
 Discounts on testing (Imaging,
Labs, Pathology, etc)
Introduction
Direct Primary Care (DPC) is an
increasingly popular delivery model which
focuses on value-based care by offering
patients more comprehensive services for
a low monthly fee instead of billing
insurance.
Source: Direct Primary Care Coalition
Discussion Questions
The Typical DPC MembershipMarket Data on Direct Primary Care
Insurance-Based Model - VS - Direct Care Model‡
$1.00 $1.00
(US avg) - .35 Uncollected - .01
0.65 0.99
(US avg) -60% Overhead -18%
 $0.26 Remaining →
Uncollected Overhead OverheadRemaining Remaining
‡ Source: Forrest, Brian R. “DPC101: A Blueprint for a Thriving Practice.” Direct Primary Care Summit.2015.
Model Comparison
Case #1: While on family vacation
in a city two hours from their DPC
clinic, a little girl fell and hit her
chin while at the hotel pool and
needed stitches. The local
emergency room quoted them the
standard wait-time of three hours.
Rather than waiting, the parents
drove the two hours home in
order to get their girl’s stitches
done faster, for free. In the
process, the family saved
themselves a $1500-3000 ER visit,
which savings can now go towards
the cost of their family's
membership for years to come.
Case #2: A 30 year old uninsured
female was stuck paying
$140/month at a retail pharmacy
for her heartburn medication. Then
she learned that the same
medication was only $1.55/month
through a local DPC clinic. After
buying a DPC membership for
herself, her husband and two kids
for a total of $120/month, she now
has her medication - as well as
primary care for her whole family -
and is still saving $18/month.
Case #3: At 10pm on Thanksgiving
Day, a man is finishing cleaning his
family’s turkey and cuts himself
badly with the knife. After a quick
phone call, their DPC doc meets
them at the office, and after 30
minutes and 3 stitches, both doc &
patient are back at home. This
exchange easily saved the patient
a $1500 ER visit. Talk about access!
Source: AtlasMD
20-30 † 4-6 + =
† Estimate based on Medscape PhysicianCompensationReport 2015
146
756
4400
Growth of DPC
2005-2014
- VS -9-16
Qliance
DPC Data
2013-2014
Per 1,000
Qliance pts
Per
1,000 Non-
Qliance pts
Difference
(Qliance vs.
Other)
Patient
Savings per
year
ER Visits 81 94 -14% ($5)
Inpatient
(days)
100 250 -60% $417
Specialist
Visits
7,497 8,674 -14% $436
Advanced
Radiology
310 434 -29% $82
Primary
Care Visits
3,109 1,965 58% ($251)
min/visit
45
min/visit
1. Is DPC lawful under the Affordable Care Act?
 Yes. DPC is specifically cited in Section 10104 of the law
and patients avoid penalties when they have a DPC
membership plan paired with a qualified high-deductible
health plan.
2. Is DPC meant to replace insurance?
 Nope. Insurance is a necessary tool, but it’s being used
incorrectly in today’s healthcare industry. Car insurance
does not pay for routine expenses such as oil changes and
wiper blades - insurance as a service is used to mitigate
risk in the event of more expensive, unforeseeable
expenses such as hospitalizations, major surgeries, etc.
DPC helps these 3rd party payers rediscover their role as
true insurance by demonstrating that primary care is
fortunately not as expensive as previously believed.
3. If DPC Patient panels are smaller how will DPC address
access when there’s already a shortage of PCPs?
 DPC increases a patient’s access to their provider, and has
the added benefit of reducing burnout by significantly
improving the clinician’s experience. It is important to
note that the ACA exacerbated the access problem, while
not providing a tangible solution. Fortunately, as its
sphere of influence grows, DPC will make primary care
more attractive to MD & DO residents, PAs, and NPs.2005 2010 2014
Source: Heritage Foundation.Backgrounder2014;(2939):1–13
$679
Patient
Savings
per year
$679,000
Savings
per 1000
patients
19.6%
Patient
Savings
per year
Item DPC Insurance
%
Diff
CBC $3 $35 91
Chem Panel $5 $55 91
Lipid Panel $6 $65 91
TSH $5 $60 92
HgA1C $5 $55 91
PAP Smear $30 $75 60
PAP w/ HPV $75 $190 61
Zpak $2 $25 91
Lipitor $4 $15 73
Imitrex $8 $50 84
Pathology $40 $300+ 87
Breast Cancer
Chemo
$7
$600 for 2
wks
99
CT abd w/o $225 $892 75
Source: John Locke Foundation& AtlasMDSource: Qliance Medical ManagementInc.
Examples of DPC Savings
Restoring the Patient-Provider Relationship through
Direct Primary Care- VS -
Will Craghead, PA-S1