Direct primary care (DPC) is another response to the skyrocketing costs of traditional health insurance. Driven by their commitment to patient care, DPC providers have envisioned a fresh model that prioritizes patient-doctor interactions over insurance paperwork. Instead of accepting insurance, these doctors ask patients to pay a flat-rate, monthly fee (this fee averages about $100, depending on the location). In exchange, patients have unlimited access to primary care.
DPC is more popular than ever
DPC providers can spend much more time with their patients with no insurance paperwork to worry about, and appointments can be an hour long. Patients can see a doctor whenever they need and can also have consultations by text or over the phone. This arrangement makes it easy to get checkups, vaccines, blood tests, and other simple, routine care—and it has become increasingly popular since 2009.
The Direct Primary Care Coalition states, “Today, about 1,600 DPC practices in 48 states provide peerless access to great primary care to over 300,000 American patients.” As insurance costs continue to rise, it seems likely that the DPC model will continue to grow.
HealthShare members that are interested in DPC might wonder how a DPC program might affect their HealthShare membership. This depends on a couple factors.
Does the HealthShare membership support direct primary care?
Does the HealthShare’s policies encourage the utilization of direct primary care? A few HealthShares do. Several companies are trying to improve their plan options by offering more support for preventive care. To achieve this, they may allow cost sharing for DPC membership fees. If the HealthShare’s member guidelines mention DPC, what follows in the next heading likely won’t apply.
Does the HealthShare membership include preventive care?
Does the plan allow cost sharing for preventive care? Most HealthShares offer at least one program that only shares costs for major medical bills, such as hospital visits. In this case, adding a DPC membership for preventive care can be highly beneficial. But if the membership already includes sharing for certain preventive services, the individual may already be sufficiently served by their HealthShare membership alone. Nonetheless, some HealthShares, like Zion HealthShare and Sedera, incentivize members by offering exclusive rates or different membership options specifically designed to complement direct primary care. For example, Zion HealthShare memberships usually include some preventive care services and telemedicine, but members can access a lower membership rate without these features if they enroll in a DPC practice.
Need more information? Just ask.
With the HealthShare industry growing and evolving, new options are frequently being added to plans and memberships. If a company’s guidelines do not clearly address DPC membership, prospective members should reach out and ask for clarification. They might be pleasantly surprised by what they find.
