Direct Primary Care Is Having a Moment — Should Your Company Offer It?
Direct primary care gives employees unlimited access to a primary care physician for a flat monthly fee — no claims, no copays, no prior authorizations. For self-funded employers, it can reduce ER visits, cut specialist referrals, and lower total plan costs. But it only works if it is implemented thoughtfully.
VP of Employee Benefits · BHC Insurance · Independent Benefits Consultant
Direct primary care is not a new concept, but it is gaining serious traction among self-funded employers who are tired of watching their employees use the emergency room for problems a primary care physician could have handled in fifteen minutes.
The model is straightforward. An employer pays a flat monthly membership fee — typically $50 to $100 per employee — to a direct primary care practice. In exchange, employees get unlimited access to their physician: same-day or next-day appointments, extended visits, phone and text consultations, and care that is not filtered through an insurance billing department. No copays. No prior authorizations. No claims.
For employers who have watched primary care access erode under high-deductible health plans, DPC offers something genuinely different.
Why Primary Care Access Has Deteriorated
The shift toward high-[deductible health plans](/blog/are-hsa-plans-becoming-and-executive-benefit) over the past decade solved one problem — it reduced premium costs — while creating another. When employees face a $1,500 or $3,000 deductible before insurance pays anything, many of them stop going to the doctor for routine issues. They delay care, ignore symptoms, and end up in the emergency room when a condition that was manageable in March becomes a crisis in October.
This is not a behavioral failure. It is a rational response to financial incentives. When a primary care visit costs $150 out of pocket and the employee is not sure they can afford it, they wait. The plan pays less in the short term and far more in the long term.
Direct primary care removes the financial barrier to primary care access entirely. The monthly fee is prepaid. The visit is free at the point of care. Employees use primary care the way it was designed to be used — proactively, frequently, and before problems escalate.
What DPC Actually Covers
A well-run DPC practice handles the full scope of primary care: preventive visits, chronic disease management, acute illness, minor procedures, mental health screening, medication management, and care coordination.
Many DPC physicians also offer services that are difficult to access in a traditional fee-for-service practice — extended appointments, direct physician communication, and the kind of relationship-based care that produces better outcomes for patients with complex or chronic conditions.
DPC does not replace the health plan. Employees still need coverage for hospitalizations, specialist care, surgery, and catastrophic events. DPC works alongside the health plan, handling the high-frequency, lower-cost primary care layer that drives a disproportionate share of downstream utilization.
"DPC doesn't just improve access to primary care — it changes the economics of the entire plan. When employees have a real relationship with a primary care physician, expensive downstream utilization goes down."
The Financial Case for Employers
The financial argument for DPC rests on a straightforward premise: better primary care access reduces expensive downstream utilization.
Employees with a trusted primary care physician are less likely to use the emergency room for non-emergency conditions. They are more likely to have chronic conditions managed proactively, reducing hospitalizations. They are more likely to receive appropriate specialist referrals rather than self-referring to specialists who order more tests and procedures than necessary.
Several studies and employer case studies have documented meaningful reductions in ER visits, specialist utilization, and total plan costs among employers who have implemented DPC alongside a self-funded plan. The monthly membership fee is typically more than offset by reductions in claims.
The math is most compelling when DPC is paired with a higher-deductible plan design. The employer saves on premium, uses some of those savings to fund the DPC membership, and ends up with a plan that costs less and delivers better access.
What to Look for in a DPC Partner
Not all DPC practices are equal. Before committing to a DPC arrangement, employers should evaluate the practice's panel size — how many patients each physician carries — and whether that panel allows for the access and relationship quality the model promises. A DPC physician carrying 800 patients is not delivering the same experience as one carrying 400.
Employers should also evaluate geographic coverage. DPC works best when employees can actually get to the practice. In markets with limited DPC availability, some vendors offer virtual DPC arrangements, which can extend access but may not replicate the full value of an in-person relationship.
Understand the contract terms: what is included in the membership fee, what is billed separately, how the practice handles after-hours care, and what happens if the practice closes or the physician leaves.
Finally, assess how the DPC practice integrates with the rest of the health plan. The best arrangements include care coordination support — the DPC physician communicates with specialists, reviews hospital discharge summaries, and helps members navigate the broader health system.
Implementation Considerations
DPC is most effective when employees understand it and use it. That requires intentional communication at open enrollment and throughout the year. Employees who do not know the DPC practice exists, or who do not understand that visits are free, will not change their behavior.
Employers should also consider how DPC interacts with their HSA-eligible plan design. Under current IRS guidance, a DPC membership fee paid by the employer may disqualify employees from contributing to an HSA if the DPC arrangement is structured as a health plan. This is a nuanced area that requires careful structuring — work with your benefits attorney or advisor to ensure the arrangement is designed correctly.
DPC is not the right fit for every employer or every market. But for self-funded employers in markets with DPC availability who are serious about improving primary care access and reducing downstream costs, it deserves a serious look.
Direct primary care is one of the few benefits strategies that genuinely improves both cost and quality at the same time. If your employees are using urgent care and the ER as their primary care entry point, that's a problem DPC is specifically designed to solve.
Sources & Further Reading
- Direct Primary Care Coalition: DPC Practice and Employer Adoption Overview — Industry overview of direct primary care practice models, membership structures, and employer adoption trends.
- Health Affairs: Direct Primary Care and Total Cost of Care — Research on the relationship between DPC investment and total health plan cost — the financial case for employer DPC programs.
- KFF Employer Health Benefits Survey 2024 — Primary Care Access — Data on primary care utilization rates and the access barriers that DPC is designed to address for employer plan members.
- PBGH: Direct Primary Care as an Employer Benefit Strategy — Employer coalition guidance on DPC program design, vendor selection, and integration with self-funded health plans.
- American Academy of Family Physicians: Direct Primary Care Practice Profile — AAFP data on DPC practice characteristics, services included, and the primary care access improvement DPC delivers.
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About the Author
Corry Hull, REBC®, CSFS®
VP of Employee Benefits · BHC Insurance
Corry Hull, REBC® CSFS®, is VP of Employee Benefits at BHC Insurance and the founder of Employer Benefits IQ (www.employerbenefitsiq.com). He is a Certified Health Rosetta Advisor — one of fewer than 200 nationwide — and a multi-year presenter at United Benefit Advisors (UBA) national conferences. He specializes in self-funded health plan design, PBM contract strategy, stop-loss structuring, group medical captives, and ACA/ERISA compliance for mid-market employers. His work has been recognized by Health Rosetta (Rosie Award, 2026), UBA (Producer Peak Performer, 2025–2024), and BHC Insurance (Producer of the Year, 2021–2025). His employer-education content has been referenced in BenefitsPro and cited within the Health Rosetta advisor community. All consulting and brokerage compensation is fully disclosed.