Question 1

What is direct primary care (DPC) and how does it work for employers?

Accepted Answer

Direct primary care (DPC) is a primary care model where employers pay a flat monthly membership fee (typically $50–$100 per employee per month) directly to a DPC practice, giving employees unlimited access to primary care with no copays or deductibles. DPC eliminates insurance billing for primary care, allowing physicians to spend more time with patients and provide same-day or next-day appointments. Employers typically pair DPC with a high-deductible health plan for catastrophic coverage.

Question 2

How do I compare DPC vendors for my employer group?

Accepted Answer

Compare DPC vendors on: geographic coverage (do they have practices near your employees), physician panel size (DPC physicians typically see 600–800 patients vs. 2,000+ in traditional primary care), services included (in-office procedures, labs, generic medications), access model (in-person, virtual, or hybrid), employer reporting capabilities, and per-employee-per-month (PEPM) cost. For multi-location employers, national DPC networks (Nextera, Paladina, Premise Health) offer broader coverage than single-practice DPC.

Question 3

What is the difference between a DPC practice and an on-site clinic?

Accepted Answer

A DPC practice is a freestanding primary care practice that operates on a membership model, serving patients from multiple employers and individuals. An on-site clinic is a healthcare facility located at the employer's workplace, typically staffed by a nurse practitioner or physician employed by or contracted with the employer. On-site clinics require a minimum of 200–300 employees at a single location to be cost-effective. DPC is more accessible for smaller employers and those with dispersed workforces.

Question 4

Can DPC work with an HSA-compatible high-deductible health plan?

Accepted Answer

DPC membership fees are not HSA-eligible expenses under current IRS rules (Notice 2004-23), which means employees cannot use HSA funds to pay DPC membership fees. However, DPC pairs well with HDHPs from a cost perspective — the DPC membership covers primary care with no additional cost-sharing, while the HDHP provides catastrophic coverage. Employers can offer DPC as a separate employer-paid benefit alongside an HDHP/HSA plan.

Question 5

How much does DPC cost and what is the ROI for employers?

Accepted Answer

DPC membership fees typically range from $50–$100 per employee per month (PEPM), or $600–$1,200 per employee per year. Employers typically see 15–30% reduction in total healthcare costs when combining DPC with an HDHP, primarily through reduced ER visits, fewer specialist referrals, and lower prescription costs (DPC physicians often dispense generic medications at wholesale cost). Most employers see positive ROI within 12–18 months of implementing DPC.

Direct Primary Care & Advanced Primary Care Vendors