The doctor-patient relationship is making a comeback as Direct Care models gain traction with practices and locations growing. Within this model of Direct Care, Direct Primary Care (DPC) is thriving, with hundreds of new clinics opening annually. According to the 2023 AAFP Practice Profile survey, 9% of family physicians are now operating a DPC practice, a notable increase from 5% in 2021 and 3% in 2022, underscoring a growing trend in the adoption of DPC.
DPC is a model of Direct Care in which a membership fee is paid directly to the practice in exchange for all of a member’s primary and preventative care. Importantly, while Direct Care (e.g., hybrid or concierge practices) may incorporate insurance in some ways, true Direct Primary Care models aim to empower clinicians and patients by completely removing insurance from the equation.
What we’ve learned at Hint over the past 10 years, is that various approaches within the DPC model are proving to be successful. Each of these have their own unique structure and focus, including standard practices, sub-specialties like Pediatrics or Geriatrics, DPC Plus (which includes additional services), house-call only practices, onsite/near-site clinics, and virtual DPC. In this article we outline a number of the different focuses that we see often, and although it is not exhaustive, it provides insight to anyone considering a transition into this growing industry.
In a standard DPC model, members pay a monthly or annual membership fee directly to the clinician or practice. This fee covers all primary and preventive care services, including office visits, virtual consultations, routine lab work, and more, with no additional costs. The model emphasizes comprehensive, personalized primary care, focusing on accessibility and quality of care. Most DPC practices, about 93%, are clinician owner-operated, meaning the clinicians directly manage and run the practice. This ownership structure allows for a more individualized approach to care and ensures that the practice's operations and patient interactions are closely aligned with the clinician’s values and standards.
Some standard DPC practices may operate within DPC Co-Ops or Collective. These are groups of independent DPC practices that band together to share resources, negotiate better rates for supplies and services, and offer a wider range of services to members. This collaborative approach allows DPC physicians to maintain the independence of their practices while benefiting from the collective power of a larger group.
Another approach within the standard DPC framework is the Franchise or Managed Service Organization (MSO) DPC structure. These practices are part of larger groups that provide a standardized model of care across multiple locations. These DPC practices benefit from shared resources, marketing, and operational support. This structure helps expand the reach of DPC by ensuring a consistent care model across different locations, often backed by a larger physician-led organization.
While these variations enhance the operational structure of standard DPC practices, the core principle remains the same: members pay directly for primary care services without insurance involvement, ensuring a more direct and personalized healthcare experience.
Sub-Specialty DPC models cater to specific patient groups or medical needs, offering tailored care within the DPC framework. These models focus on particular patient populations, such as pediatrics or senior care, men's and women's health, and LGBTQ+ health. Pediatric DPC practices emphasize developmental monitoring, family education, and comprehensive pediatric services. Senior Care DPC is designed to manage chronic conditions, coordinate geriatric care, and perform detailed assessments for the elderly. Additionally, some DPC practices specialize in men’s health, offering services focused on conditions and preventive care specific to male members, while women’s health practices provide comprehensive care related to reproductive health, gynecology, and other gender-specific needs. LGBTQ+ health-focused DPCs address unique healthcare needs within the LGBTQ+ community, including hormone therapy, mental health support, and preventive care. This focused approach allows clinicians to effectively address the specific health requirements and enhance the care experience for these diverse groups.
DPC Plus models go beyond traditional primary care by integrating additional specialty services or wellness programs into the same membership model. These practices may offer specialized care in areas like dermatology, mental health, or orthopedics, alongside primary care. One of the most prominent specialties we see in DPC Plus practices is weight loss support, including tailored programs and support for members seeking to manage their weight effectively. DPC Plus practices might also include emerging services like ketamine therapy and other innovative treatments, along with integrated wellness services such as nutrition counseling, mental health support, or fitness programs. This holistic approach enhances patient well-being and minimizes the need for external referrals, creating a more seamless and personalized care experience. By focusing on both traditional and emerging health needs, DPC Plus provides comprehensive care that addresses a wide range of medical conditions and wellness goals.
House-Call Only DPC models focus on providing primary care services directly in the patient’s home, offering a highly personalized and convenient healthcare experience. These practices emphasize accessibility and comfort, catering to members who prefer or require in-home visits. By eliminating the need for members to travel to a clinic, House-Call Only practices provide a unique level of care that is tailored to the individual’s environment and lifestyle. This model is particularly beneficial for members with mobility issues, chronic conditions, or those seeking a more intimate doctor-patient relationship. House-Call Only DPC practices deliver comprehensive care in the most convenient setting possible, ensuring that healthcare is accessible and personalized to meet each patient’s unique needs.
On-site and near-site DPC clinics are located within or near an employer’s premises, providing easy access for employees during work hours. Near-site clinics are sometimes shared by multiple employers in a specific area. Physicians working in these clinics are usually salary employees hired directly by the employer or through a third-party provider (e.g., Premise Health, Crossover Health). The focus on providing Comprehensive primary care, including routine check-ups, vaccinations, lab tests, chronic disease management, and, sometimes, holistic wellness programs. In these types of practices, the employer covers the cost of the clinic through a flat fee, which is typically paid monthly per employee, giving access to care without co-pays, deductibles, or any out-of-pocket expenses at the point of care. The DPC clinic may be offered as a stand-alone benefit or as part of a broader health benefits package that includes traditional insurance for more extensive or specialized care. (For a deeper dive into how one one-site/near-site clinic’s successful implementation of technology streamlined operations, check out this case study.)
Virtual DPCs focus on delivering primary care services primarily or entirely through telemedicine, allowing members to access care via phone or video calls. While in-person visits may still be available as needed, the emphasis is on providing convenient and accessible virtual care, particularly benefiting members in remote areas with limited access to primary care. This model offers physicians greater flexibility in managing their schedules and patient load, making it an attractive option for those seeking a better work-life balance. Additionally, Virtual DPCs are highly scalable, enabling practices to reach a broader patient population without the need for physical office expansion, which is particularly advantageous in densely populated regions or rural communities. Virtual DPCs represent a significant evolution in the Direct Primary Care landscape, offering a modern, flexible approach to healthcare that prioritizes both patient convenience and the efficiency of healthcare delivery. (Learn how Dr. Erika Bliss of Equinox Primary Care implemented a virtual-only DPC membership.)
The resurgence of the doctor-patient relationship through the Direct Primary Care (DPC) model is reshaping healthcare into a more personalized and accessible experience. By prioritizing direct patient payment and eliminating insurance complexity, DPC enhances the quality of care while fostering stronger clinician-patient connections. What's more, physicians practicing DPC report significantly lower levels of burnout, with only 12% experiencing burnout compared to 46% among those not practicing DPC. As DPC continues to evolve with various models and specializations, its commitment to simplicity and patient-centered care remains unwavering. This dynamic approach not only addresses diverse healthcare needs but also paves the way for more innovative and flexible care solutions.
To learn more about how to build a practice that prioritizes meaningful patient relationships, innovative care models, and a sustainable work-life balance, download our DPC Playbook.