What Is Direct Primary Care?

Direct Primary Care (DPC) varies in several ways from the current third-party payment system, where providers contract with insurance companies to receive payment for primary care services. In DPC, patients pay a periodic membership fee (sort of like a gym membership) for access to primary care services. In other words, the consumer (patient) pays the provider directly, rather than the provider being paid for services by a third party. As you may know, to receive payment or reimbursement from an insurance company (for services that have likely already been provided or paid for), there are several very specific criteria are evaluated:

• How long did the provider talk to the patient directly?

• How long has it been since the patient’s last visit?

• Did the provider prescribe the most cost-efficient treatment or medication first?

• Did the provider code the visit correctly?

In DPC clinics, providers get to ditch the playbook insurance companies expect them to follow. DPC providers aren’t worried about how they are going to get paid, because those periodic membership fees provide stable income. Instead, DPC providers can focus on assisting each individual patient to optimize their unique health goals. These goals cannot be achieved in the amount of time a traditional office visit affords. Those time constraints barely even allow for pleasantries. Consider this: how many times have you felt like a provider rushed into the room, rushed you through your questions, didn’t ask for more detail about your concerns or medical/family history, left out potential treatment options (or just told you what to do), or maybe left the room quickly while you waited for another team member to come back and explain what in the world just happened? In the third-party payment model, how often did you feel like your provider genuinely listened to you? 

Since DPC providers aren’t focused on what the insurance companies demand (ie, how to get paid for what we do, day in and day out), they get to focus on truly knowing their patients (or members, if you’re already shifting your thought processes to the DPC way!). DPC conversations don’t go like this: I think you are depressed, and because of your insurance status or plan, you must start treatment with this medication first, and follow up in person in X weeks. Instead, they go more like this: Tell me more about how you’re feeling. Is it more like this or more like that? Have you felt like this before? Have you considered other explanations/diagnoses/actions? Have you ever tried anything that helped you feel better when you’ve felt this way before? (Sometimes, we can stop right there and do exactly what you already know works for you!)  

Here’s the bottom line: If an insurance company pays your primary care provider, your provider works for them, not you.

CRAZY story: Our members text us (not just call or schedule a visit to talk in person, but legit TEXT us) and say “Hey, remember when we talked about doing that one thing that one time? Can we do that now?” Enso’s providers can honestly and enthusiastically respond with, “YES! Let’s do it!”