Direct primary care and reference-based pricing: Is it a match made in heaven?

Nathan Houghton of PeakMed Direct Primary Care speaks during the track session titled “Direct Primary Care and Reference-Based Pricing: A Match Made in Heaven,” as moderator Omar Arif of ClaimDOC looks on.

“Direct primary care and reference based pricing can work really well together to create an alternative to self-funded plans,” said Omar Arif, SVP of Growth – ClaimDOC in Des Moines, Iowa, who moderated a panel of experts at the “Direct Primary Care and Reference Based Pricing: A Match Made in Heaven” session at Broker Expo in Atlanta.

The direct primary care (DPC) model is when the employer shifts their money from paying for services and instead moves that investment into a direct primary care relationship and reference-based pricing (RBP) helps make health care spending more consistent and predictable because reimbursement using a reference point, typically the Medicare fee schedule when calculating claim payments. This combination “can’t be beat from a cost perspective but also from a member experience perspective,” said Arif.