DPC can address many of the issues at
the heart of the current primary care crisis.
Through the use of appropriately sized
patient panels and a reduction in the nonclinical
administrative burden, PCPs can
provide more high-value primary care that
will result in better outcomes, cost reductions,
and enhanced patient and provider
satisfaction.
More Patient Time and Enhanced
Access Equals More Care
Excluding the time spent interacting
with patients via telephone or electronic
communications, the average amount of
time physicians spend with the patient in a
DPC practice is higher than in a traditional
primary care practice. According to the
2017 Medscape Physician Compensation
Report, most family physicians (70%)
spend between 13 and 24 minutes with
each patient and 21% spend 12 minutes
or less (Medscape, 2017). Because of a
heavy administrative burden (coding and
documenting in EHRs), even a portion of
this time is often not spent facing the
patient (Eskew, 2016). By contrast, in DPC
26 DALLAS MEDICAL JOURNAL • February 2021
practices, office visits average about 35-40
minutes (Busch et al., 2020, p. 13; Eskew
& Klink, 2015, p. 796). In addition to more
time spent with patients in the office, many
DPC practices include home visits (“house
calls”) and telehealth encounters in their
covered services.
Cost Reduction
For a number of reasons, including the
variety of DPC iterations, the small size
of most practices, and the general desire
of most DPC providers to reduce their
administrative and reporting burden, there
is currently a relative paucity of data on
cost and quality outcomes in the literature.
The existing literature does, however,
suggest the potential for DPC to reduce
unnecessary care and lower costs for
patients, employers, and the healthcare
system.
The 2020 Society of Actuaries report
includes a case study that analyzed data
from a single employer that offers a DPC
benefit option and a traditional benefit
option and compared cost outcomes
during the same two-year period3 between
912 members enrolled in DPC and 1,074
members enrolled in the traditional option
(Busch et al., 2020). The following are key
results from the case study:
• DPC members had 19.90% lower
claim costs for employers on an unadjusted
basis and 12.64% lower claim costs on
a risk-adjusted basis during the two-year
period.
• DPC members had 36.39% lower ER
usage on an unadjusted basis and 40.51%
lower usage on a risk-adjusted basis than
those in traditional plans.
• DPC members experienced a 53.6%
reduction in ER claims cost on a riskadjusted
basis.
• DPC members experienced 25.54%
lower hospital admissions on an unadjusted
basis and a 19.90% lower rate on a
risk-adjusted basis.
These findings support previous analyses
that suggest that primary care models
with smaller panel sizes and a higher
frequency of encounters can lead to lower
healthcare costs (Ghany et al., 2018).
Importantly, the reductions in healthcare
costs are evident not just at the system
level, but at the patient level as well. Most
DPC practices do not charge any costsharing
for services covered under the DPC
subscription fee. Since as many as roughly
3 in 10 Americans have delayed or forgone
seeking medical treatment due to costs
(Saad, 2018), removing financial barriers
that are often the cause of patients
forgoing care such as missing follow-up
visits should lead to improved care and
better health outcomes.
Patient Satisfaction
According to the Society of Actuaries
market survey, on average, “DPC members
are able to schedule an appointment with
their DPC provider within one day, wait
just four minutes in the DPC office for
scheduled appointments to begin, and
spend 38 minutes with the DPC clinician
during visits” (Busch et al., 2020). Most
DPC members are able to access their
personal EHRs through a patient portal
(58%) and are also able to manage their
enrollment through the DPC practice’s
website (58%). Practices in the survey
indicated that they expect the DPC model
of care to:
• Improve patient satisfaction with primary
care experience (98%).
• Increase the extent to which patients
rely on their PCPs to navigate the health
system for nonprimary care services
(81%).
• Lower patient out-of-pocket costs for
primary care services, including the DPC
membership fee (81%).
iterations of the DPC delivery model is
the division between “pure” and “hybrid”
models. A pure DPC model includes
only patients whose care is financed
by the membership fees, while hybrid
models include both member patients
and patients in the traditional third-party
payment system. DPC practices exhibit
a range of iterations, from small and
independent practices with varying levels of
network affiliation to larger practices that
employ physicians and grow by marketing
themselves directly to large employers
(Eskew & Klink, 2015).
A 2018 AAFP survey reported that 80%
of DPC practices were pure DPC, while
14% of practices were hybrid DPC. Of the
hybrid practices, 42% plan to operate the
model “indefinitely.” Approximately 35%
of current DPC practices converted from a
more traditional practice setting, including
participating in Medicare (Quinn, 2018).
As of November 2020, the DPC Frontier
“Mapper” lists 1,350 DPC practices
across 48 states and Washington, D.C.,
with the vast majority being pure DPC
models (DPC Frontier, 2018).
According to a market survey done by
Milliman, Inc. and published by the Society
of Actuaries in May 2020, the majority
of DPC practice revenues typically come
from monthly or annual DPC subscription
fees, and the average per-person monthly
DPC fees reported in the analysis were
“$40 for children and ranged from $65 to
$85 for adults, depending on age. Most
DPC practices do not charge a per-visit
fee for services covered under their DPC
memberships (89%).” Also according to
the analysis, “DPC practices usually have
fewer patients than traditional primary care
practices, typically fewer than 1,000 and
most often around 200 to 600” (Busch
et al., 2020, pp. 7, 12). The 2018 AAFP
survey found that 17% of DPC practices
have achieved their full desired panel size
of 600 patients (Quinn, 2018).
The DPC fee generally covers primary
care services that may include preventive
care, office visits for acute and chronic
illnesses, home visits, lab tests, basic
medication, care coordination, 24/7
access and follow-up visits—in person
or via phone, email, and telehealth. Care
coordination may include navigating
patients to lower-cost or discounted
ancillary services, such as lab tests and
imaging. The subscription fee does not
cover specialists or emergencies, and it
is recommended that patients also have
a high-deductible health plan/wraparound
catastrophic policy.
How DPC Could Address the
Current Crisis in Primary Care