January 2024

For employers with self-insured health plans exploring innovative solutions, Direct Primary Care (DPC) is a health care model that aims to simplify and improve access to primary care services by establishing a direct relationship between patients and health care providers.

It’s safe to say we all would like to gain more control of health care costs and have access to a better health care delivery system. For employers with self-funded health plans exploring innovative solutions, Direct Primary Care (DPC) is a health care model that aims to simplify and improve access to primary care services by establishing a direct relationship between patients and health care providers. This approach is reshaping the health care dynamic by fostering direct relationships between patients and providers, bypassing the traditional insurance-driven system. 

While it sounds good in theory, you may be wondering how this exactly works. With DPC, employers pay a fixed monthly fee per employee to a DPC provider, ensuring predictable health care costs. Unlike a traditional fee-for-service model, employees and their eligible dependents have unlimited access to the primary care practice with no copays or deductibles.

This direct access fosters a proactive approach to health. Additionally, DPC providers often offer extended appointment times and services, along with direct communication to patients, allowing for more thorough and personalized consultations. This emphasis on preventive care reduces the likelihood of more serious health issues. Further, a patient-centered experience enhances the overall health care experience, resulting in healthier, satisfied employees. 

A DPC model is also typically highly customizable - providers often collaborate with employers to tailor health care packages that align with the specific needs of their employees. This customization ensures that employees receive the most relevant and effective health care services, promoting a healthier and more productive workforce. 

There are long-term benefits to DPC as well. By establishing a direct relationship with primary care providers, employees are more likely to engage in ongoing health management. This continuous, relationship-based care contributes to better long-term health outcomes, reducing overall costs for the health plan.

There are clearly many advantages to DPC. But what about the administrative processes associated with this model? 

That’s where an experienced third-party administrator (TPA) comes in. The TPA can manage arrangements for utilization outside the DPC provider, such as access to a wrap network or a reference-based pricing solution. The TPA should also share data with the DPC to help providers coordinate and improve patient care. Communication is key to a successful DPC arrangement.

The DPC model offers a promising alternative for employers with self-insured health plans, providing a cost-effective, patient-centered approach to health care. When managed well, DPC can be a game-changer in promoting a healthier, more engaged, and productive employee base. 

With vast experience supporting clients using DPC, Nova serves as an educator and facilitator, effectively managing steerage opportunities and engaging with the DPC practice to improve plan performance and meet health plan goals. Learn more about how we maximize the DPC arrangement for an enhanced member experience and improved health outcomes.