Ensuring that direct primary care providers deliver on their promises

DPC is a health care payment model where care is paid for with an affordable recurring, monthly fee rather than the traditional fee-for-service model.

Related: The beauty of DPC — with Clint Flanagan

In fact, doctors are also leaving traditional primary care for this new model, with 9% of family physicians operating a DPC practice in 2023, up from 3% in 2021.

The move from traditional fee-for-service primary care to DPC should be good for employers and their health plans.

Employers and DPC providers can embrace shared goals. That should generate significant cost savings and improve employee satisfaction with care.

The DPC model is expected to gain even further traction in the coming year because members can now leverage health savings accounts to pay the fees. Congress made that change by passing the Primary Care Enhancement Act as part of the One Big Beautiful Bill.

The change means that employers can now integrate DPC services in their health plans with HSA-eligible high-deductible health plans, or HDHPs.

Here are some benchmarks to help guide the assessment of a DPC provider and determine the depth and scope of capabilities needed to meet employee expectations:

1. Confirm a commitment to making DPC convenient for the employees.

This might seem obvious, but it's crucial.

For manufacturers with large concentrations of employees, it's much easier to settle on a few local DPC providers or even negotiate an on-site presence.

For a distributed workforce, it's important to tie into a large DPC network that has multiple, convenient locations.

For example, the Hutchinson Oil Company was able offer a plan for 21 locations in rural Oklahoma and Kansas while also saving $711,000 is health costs.

The key is to find a plan that aligns with the unique employee footprint and aligns employee demographics with the DPC model.

2. Ascertain that employees benefit from access to unlimited primary care.

Obviously, there will be widespread enthusiasm among members for the opportunity to use unlimited services, but the DPC model must be positioned to offer this level of service.

Note a recent industry study of DPC which showed that net promoter scores for DPC were well above 80.

Most patients cite the benefits of no deductibles and co-insurance — which often deter patients from seeking care to begin with — as well as reduced wait times for appointments and clear improvements in health outcomes.

Many employers choose DPC based on personal experience — like O'Neill's Pools and Hot Tubs.

If the company's leaders are believers, employees' job satisfaction also tends to improve.

One caveat is to confirm whether the DPC can address chronic diseases: Not all DPC providers are equipped to provide adequate comprehensive care for those conditions.

It's important to ask DPC providers what chronic diseases they have experience with and success with treating.

In some cases, the employer may want to add care-management programs for employees with diabetes, obese employees and other employees with chronic health problems. Offering the right care management programs to the right patients can deliver significant long-term benefits.

Equally important is the ability to measure those benefits.

3. Confirm what else is included.

The specific services covered by the membership fee can vary.

Some DPC practices may include lab tests, many prescriptions, or a broader scope of services, while others might focus more narrowly on primary care visits and vaccinations.

The extent to which DPC practices use technology, like telemedicine or online portals, can also differ.

Learn the specifics of the DPC payment model.

Some practices operate solely on a subscription model, while others might offer cash-pay options or a hybrid model combining both.

4. Validate capabilities for benchmarking and measuring success.

While the traditional insurance-driven market is full of solutions to analyze the cost-effectiveness of health care, DPC can be an information black hole.

DPCs do not typically file insurance claims, since there is a set monthly fee for care (averaging $50 to $100 per month), although there may be separate claims for services like emergency care.

What is often lacking are clear metrics for care outcomes.

Therefore, it's important for brokers and their clients to ascertain from DPC candidates how they measure things like health outcomes, provider performance and employee usage of the services.

This will likely mean that the health plan sponsors and providers will need to rely on patient records rather than claims for performance metrics.

Employee satisfaction surveys also help employers assess patient experience.

Delivering on The Promise of DPC

When a DPC meets the criteria as described above, these achievements reflect positively on brokers and deepen their value as trusted advisors.

This opportunity sparks both employer trust and employee satisfaction with the benefits plan.

While there is a consensus that DPC provides a more patient-centered and streamlined approach to primary care, it's important to research and compare individual practices to find one that best aligns with the specific needs and preferences of health plan members.

Carefully consider the guidelines cited earlier before making a decision.

Ben Newton is the CEO of Milliman Pluritem Health and a principal at Milliman. He co-founded Pluritem Health, a clinical data firm, with John Clark in 2021. The company was acquired by Milliman in August 2024. Milliman Pluritem offers the Milliman CareFlowIQ clinical data platform.