Cometh the moment, cometh the care model. That’s one way of interpreting a new study commissioned by the Society of Actuaries, and performed by Milliman researchers, that evaluates the direct primary care (DPC) model. Often touted by advocates as a way to “cut out the middleman” and allow for greater patient-physician engagement, DPC is membership-model primary care, with a monthly or annual fee paid by the patient (or their employer) for unlimited access to a range of services for no additional out-of-pocket payment, and without billing insurance for care delivery.
In the study, Milliman reviewed existing literature, conducted a survey of nearly 200 DPC practices, and performed an in-depth analysis of one employer’s DPC offering. Their findings: higher physician satisfaction; smaller panel sizes (on average 445 patients per practice); and statistically significant decreases in overall demand for services (down 12.6 percent) and ED utilization (down 40.5 percent). All that for a monthly fee of between $65 and $85 per adult patient—resulting in a slight net increase in employer benefit costs (1.3 percent) but higher enrollee satisfaction.
The Milliman study is one of the first detailed analyses of the potential benefits of this newish care model, and the results suggest that there is promise for the approach. Critics rightly raise some doubts: could there could ever be enough physician supply to make this model work at national scale? And does the model encourage cherry-picking of more affluent, lower-utilizing patients, making the remaining risk pool more costly to cover?
But in a post-COVID world, with primary care doctors increasingly concerned about revenue stability, and employers looking to control spend (and searching for sweeteners to offset a potential shift to narrower referral networks), the model has the potential to play a greater role in future benefit design. Especially if coupled with a (potentially lower-cost) virtual-first approach, DPC could prove an attractive option for physicians and patients to move away from the fee-for-service, productivity-driven primary care model.