direct primary care
Direct primary care, explained.
If you have never heard the term, this page is for you. It is written from the
published record: the American Academy of Family Physicians, the Journal of the American Board of
Family Medicine, the New England Journal of Medicine, and the Society of Actuaries. Every claim carries a
number; the numbers are listed at the bottom.
"The Direct Primary Care (DPC) model is a practice and payment model where
patients/consumers pay their physician or practice directly in the form of periodic payments for a defined set
of primary care services."
American Academy of Family Physicians, Direct Primary Care policy, updated September 20241
how the money works
Three ways a primary care practice gets paid.
The difference is not the medicine. It is who the practice answers to when it decides how
long your visit is.
Insurance-billed
the usual model
- ·The practice bills your insurer per visit, per code.
- ·Revenue follows visit volume, so panels run large and visits run short.
- ·Copays, deductibles, prior authorizations, and a billing office between you and the doctor.
Concierge
retainer plus insurance
- ·An annual retainer for access and the practice still bills your insurance.
- ·Fees run higher: practices calling themselves "concierge" averaged $183 a month, against $77 for those calling themselves DPC.3
- ·The AAFP notes concierge practices tend to serve higher-income patients.2
Direct primary care
one flat fee, nobody billed
- ✓One periodic fee covers a defined set of primary care services.1
- ✓No third-party billing, and any per-visit charge stays below the monthly fee. That is the three-part legal definition researchers use.3
- ✓Recognized in federal law: the Affordable Care Act names the "qualified direct primary care medical home plan."15
why it changes the visit
Fewer patients per physician. That is the whole trick.
The often-quoted panel of 2,500 patients per primary care physician "seems to arise in
the literature anecdotally, without a basis in research."8
Modelled against current guidelines, a panel that size would need more hours than a day holds.
26.7hours a day a physician would need to deliver guideline-recommended preventive, chronic and acute care to a 2,500-patient panel.7
14.1of those hours are preventive care alone. It is the first thing that gets dropped when the day is full.7
~413patients in the average DPC panel, per the AAFP's 2024 data brief; the Society of Actuaries survey found 445.2,6
99%of DPC practices offer same-day appointments.2 Here, that means a message, a video visit, or a same-week appointment during business hours.
what the evidence says
What is established, and what is still young.
established · continuity
Seeing the same doctor is associated with living longer.
A systematic review of 22 studies found 18 reported statistically significant reductions in mortality with increased continuity of care, with generalists and specialists alike.9 A 2020 review focused on primary care found the same direction in 9 of 12 studies of all-cause mortality.10 DPC is built around one physician who knows you.
established · primary care itself
More primary care, better population health.
The National Academies' 2021 report calls primary care a common good and describes it as the only part of health care where a greater supply is associated with better population health and more equitable outcomes.11
actuarial · one employer, two years
Lower emergency use and lower total claims.
Milliman's evaluation for the Society of Actuaries compared roughly 900 DPC members with 1,100 traditional members at one employer: emergency department visits 40.5% lower and total claim costs 12.6% lower after risk adjustment. Hospital admissions were too few to judge, and the authors flag self-selection as a limit.6
honest · the open questions
Outcome studies are still few, and the critics have a point.
A JABFM analysis argues DPC "shows theoretical promise" for first-contact care and continuity but that rigorous comparative studies are still needed.4 The New England Journal of Medicine warns that when physicians leave traditional practice, patients who cannot pay a fee lose access.5 We think a small, transparent practice with published prices is part of the answer. We do not think the question is settled.
what it is not
Four things direct primary care is not.
Not these
- –Not insurance. The membership covers primary care. Keep insurance for hospitals, specialists, emergencies, imaging, and prescriptions. Virginia law requires us to say so, and we would anyway.
- –Not concierge. One flat fee, nobody billed. No retainer stacked on top of insurance claims.
- –Not an urgent care or an emergency room. A DPC practice runs on usual business hours. When something cannot wait, the emergency room is still the right door.
- –Not a discount on more medicine. The point is time, not volume. Time is what lets a physician do less when less is right.
What it is, here
- ✓$250 a month, flat. Higher than the national median of about $70,6 on purpose: a smaller panel, longer visits, an in-office movement lab, and a records system the physician built and runs.
- ✓One physician at every visit, board-certified in family medicine.
- ✓Adults, from prevention to long-term conditions. Who it's for →
- ✓The technology in-house: your record, portal and assistant on the practice's own servers, not rented.
Sources
Peer-reviewed journals, the specialty's own academy and board, the National Academies, and the actuarial profession. No vendor sites, no blogs.
- American Academy of Family Physicians. Direct Primary Care (policy statement), updated September 2024. aafp.org/about/policies/all/direct-primary-care.html
- American Academy of Family Physicians. Direct Primary Care: practice and payment models, with the 2024 DPC data brief. aafp.org/practice-operations/…/direct-primary-care
- Eskew PM, Klink K. Direct Primary Care: Practice Distribution and Cost Across the Nation. J Am Board Fam Med. 2015;28(6):793-801. doi:10.3122/jabfm.2015.06.140337
- Cole ES. Direct Primary Care: Applying Theory to Potential Changes in Delivery and Outcomes. J Am Board Fam Med. 2018;31(4):605-611. doi:10.3122/jabfm.2018.04.170214
- Song Z, Zhu JM. Primary Care: From Common Good to Free-Market Commodity. N Engl J Med. May 24, 2025. doi:10.1056/NEJMp2501717
- Milliman, for the Society of Actuaries. Direct Primary Care: Evaluating a New Model of Delivery and Financing. May 2020. soa.org/resources/research-reports/2020/direct-primary-care-eval-model
- Porter J, Boyd C, Skandari MR, Laiteerapong N. Revisiting the Time Needed to Provide Adult Primary Care. J Gen Intern Med. 2023;38:147-155. doi:10.1007/s11606-022-07707-x
- Raffoul M, Moore M, Kamerow D, Bazemore A. A Primary Care Panel Size of 2500 Is neither Accurate nor Reasonable. J Am Board Fam Med. 2016;29(4):496-499. jabfm.org/content/29/4/496
- Pereira Gray DJ, Sidaway-Lee K, White E, Thorne A, Evans PH. Continuity of care with doctors: a matter of life and death? A systematic review of continuity of care and mortality. BMJ Open. 2018;8:e021161. doi:10.1136/bmjopen-2017-021161
- Baker R, Freeman GK, Haggerty JL, Bankart MJ, Nockels KH. Primary medical care continuity and patient mortality: a systematic review. Br J Gen Pract. 2020;70(698):e600-e611. bjgp.org/content/70/698/e600
- National Academies of Sciences, Engineering, and Medicine. Implementing High-Quality Primary Care: Rebuilding the Foundation of Health Care. 2021. nap.nationalacademies.org/catalog/25983
- Grady D, Redberg RF. Less Is More: How Less Health Care Can Result in Better Health. Arch Intern Med. 2010;170(9):749-750. jamanetwork.com (Less Is More series)
- American Academy of Family Physicians. Choosing Wisely recommendations (American Family Physician collection). aafp.org/pubs/afp/collections/choosing-wisely.html
- U.S. Preventive Services Task Force. About the USPSTF. uspreventiveservicestaskforce.org/uspstf/about-uspstf
- Patient Protection and Affordable Care Act, Pub. L. 111-148, §1301(a)(3) (42 U.S.C. §18021(a)(3)): qualified direct primary care medical home plans. congress.gov (PLAW-111publ148)