Rising healthcare costs continue to put pressure on employers, forcing many to rethink how they build and fund their benefits packages. At the same time, employees are facing longer wait times, rushed appointments, and growing frustration with the traditional healthcare system. As employers look for new levers to pull to control costs without sacrificing access to quality care, direct primary care (DPC) is having a moment in the sun. 🌞
What is Direct Primary Care (DPC)?
Direct primary care (DPC) is a healthcare model that gives patients unlimited access to a primary care provider for a flat monthly membership fee, rather than billing insurance for each visit. Practitioners intentionally keep the member pool smaller, so they are able to offer a higher level of access and more personalized care. Members get access to quicker appointments and virtual care, where they can receive routine primary care services and lab tests without additional copays or deductibles.
For many, it’s a welcome change from traditional health insurance, where people can often struggle to get timely appointments for simple care. A minor illness like strep throat, the flu, or a sinus infection can mean waiting days—or even weeks—for an appointment. Employees can often end up at urgent care or the emergency room for issues that could have been handled in a primary care setting.
The DPC model allows providers to book appointments faster and spend more time with each patient, which makes it easier to catch health concerns early, manage chronic conditions, encourage preventive care, and build stronger, long-term relationships between patients and their care team.
What Direct Primary Care is NOT
It’s important to note that direct primary care is not full health insurance. It covers everyday primary care needs and basic diagnostic testing, and traditional insurance covers the rest; specialists, hospital visits, emergency care, surgeries and other major medical expenses.
For employers, this distinction is important. Direct primary care is not designed to replace a comprehensive health plan—it works alongside one. Instead of employees navigating the traditional system for every minor concern, they have a dedicated primary care resource for basic needs, while their health plan remains in place for the bigger moments.
Pairing DPC with a Group Health Plan
If you already offer a traditional group health plan, pairing it with direct primary care can be a practical way to strengthen your benefits package without disrupting the coverage employees rely on. Your group plan continues to cover major medical needs like hospitalizations, specialist visits, surgeries, and other high-cost claims, while DPC gives employees faster, more convenient access to routine and preventative care.
Pairing DPC with an ICHRA
Direct primary care can also be a valuable addition to an Individual Coverage HRA (ICHRA). Because employees choose their own health plan with ICHRA, they’ll naturally end up with different levels of coverage. Some may have opted for a lower-premium Bronze plan with a higher deductible, while others may have opted in to broader coverage and lower out-of-pocket costs with a Gold plan. Direct primary care can be a great benefit addition to make sure that everyone has consistent access to primary care, regardless of the level of health coverage they chose with the ICHRA.
Layering DPC alongside your ICHRA can be especially valuable for employees enrolled in high-deductible health plans (HDHPs), where out-of-pocket costs may discourage them from seeking routine care. A DPC membership helps remove that barrier by making primary care accessible, while an HSA gives employees a tax-advantaged way to save for eligible medical expenses that fall outside their DPC membership or insurance coverage.
Cost and ROI Considerations for Employers
Direct primary care is purchased on a per member per month (PMPM) basis, where monthly fees are typically below $200. Membership pricing can vary by age group, and family members may be able to bundle to receive discounts. Employers can choose to fully fund the benefit, offer it as a voluntary employee-paid option through payroll deduction, or split some of the cost with employees.
Every workforce is different, so potential return on investment can be hard to measure. According to MedCity News, employers are measuring outcomes in three major categories:
- fewer ER and urgent care claims
- reduced absenteeism / returning to work faster
- improved employee retention because of the benefit
This makes sense, as one of the biggest reasons employees turn to an urgent care clinic or emergency room for non-emergency conditions is because they can’t get a timely appointment with their primary care provider. By removing that barrier, direct primary care can help employees receive treatment earlier, before minor illnesses become more serious or more expensive to treat. The same is true for preventive care. When routine checkups, screenings, and vaccinations are easier to access, employees are more likely to stay on top of their health, reducing the likelihood that preventable conditions develop into more complex and costly medical issues.
Is Direct Primary Care Right for Your Business?
Direct primary care may be worth exploring if access to primary care has become a challenge for your workforce. For example, if you’re located in a large metropolitan area where providers are booked weeks in advance or a rural community with limited healthcare options.
While it isn’t a replacement for health insurance, DPC can be a valuable addition to your benefits strategy by improving access to care, encouraging preventive services, and helping employees address health concerns before they become more serious.
How a Benefits Administrator Can Help
The right benefits strategy looks different for every employer, which is why working with an experienced benefits administrator can make all the difference. At Benafica, we specialize in helping employers design and administer ICHRAs and QSEHRAs that align with their workforce, budget, and long-term goals. If you’re considering adding direct primary care alongside an HRA, we can help you structure employee classes, build contribution strategies, coordinate enrollment, and educate employees on how their benefits work together.
Our support doesn’t stop after implementation. We continue to provide enrollment assistance, compliance guidance, reporting, and ongoing feedback to help employers refine their benefits strategy as their workforce and healthcare needs evolve.
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