Professional services firm cuts ER utilization 44% with direct primary care layer
Case study by Corry Hull, REBC®, CSFS®
44%
ER utilization reduction (year 1)
$65
PEPM DPC membership cost
3.2x
ROI on DPC investment
78%
Primary care utilization increase
The Challenge
A 190-life professional services firm had high ER utilization driven by lack of primary care access. Their plan had a $250 ER copay that wasn't deterring unnecessary visits. Primary care visit rates were low. The CFO wanted to reduce claims without shifting more cost to employees.
The Approach
A direct primary care (DPC) membership was added as a plan overlay at $65 PEPM. The DPC practice provided same-day access, 24/7 messaging, and on-site visits quarterly. The ER copay was restructured to waive for true emergencies and increase for non-emergency use. A site-of-care protocol was implemented for imaging and outpatient procedures.
Note: This case study is a composite of multiple employer engagements. ER utilization data is from TPA claims reports. DPC attribution methodology follows standard industry practice. Sources: TPA claims reports; DPC practice utilization data; site-of-care protocol documentation.
Methodology & Verification▾
Baseline
ER visits per 1,000 members in the 12 months prior to DPC implementation.
Intervention
DPC membership overlay added at plan year start; site-of-care protocol implemented simultaneously.
Measurement period
12 months post-DPC implementation vs. prior 12-month baseline.
Savings methodology
ER savings = (baseline ER visits × average ER cost) minus (post-DPC ER visits × average ER cost). DPC cost = PEPM × enrolled members × 12.
What was excluded
DPC setup costs and employee communication costs excluded from ROI calculation.
Employer size
190 benefit-eligible employees; ~155 enrolled in medical.
Funding type
Self-funded with DPC overlay.
Source / verification
ER utilization verified against TPA claims data. DPC utilization from practice management system.