Direct Primary Care (DPC) is capturing the attention of medical practices, employers and employees around the country, and we predict that the model will proliferate as stakeholders continue to seek valued-based payment models over traditional fee-for-service models.
Understanding the DPC Model
At its core, the DPC model is a healthcare arrangement that fosters a direct relationship between patients and primary care providers. Instead of relying on insurance for routine medical services, an employer or employee in a DPC arrangement makes a fixed monthly payment to a medical practice in order to have access to both face-to-face and remote primary care health services. There is usually no extra copay or deductible for patients to meet, so they are incentivized to seek care at the physician’s office, rather than go to a hospital’s emergency department. Additionally, patients are more likely to see their physician for an acute or chronic health issue, thereby avoiding unnecessary complications and hospitalizations caused by treatment delay.
DPCs typically operates outside of a traditional insurance plan, though DPC membership may be paired with a major medical plan.
Legal Matters
More than 30 states have adopted some form of DPC regulation. These regulations define how a DPC model may be developed without invoking state insurance regulations. This permits DPC models to operate outside the often onerous regulatory structure of the state department of insurance.
Establishing a Relationship
A DPC arrangement may be directly between a primary care provider and its patients, or through a self-insured employer plan and the provider to cover the employer’s workers. These arrangements involve a contractual relationship that defines the scope of primary care services, satisfies the various state regulatory requirements governing DPCs, and sets forth the monthly fee structure.
If you are a self-insured employer or a primary care provider, and are considering a DPC arrangement, Frier Levitt attorneys are happy to speak with you about your options.
Co-Managing Partner
