Zak Holdsworth is the CEO of Hint Health. 

Zak Holdsworth

The vast majority of our country’s healthcare delivery is paid for using an insurance-based fee-for-service (FFS) model. However Warren Buffet has accurately described this status quo as the “tapeworm of the economy.” The overwhelming number of physicians who are increasingly seeking to escape the way in which they’re forced to practice medicine today would likely agree.

As a result, primary care practices across the country have turned to direct primary care (DPC) as a model where providers collect a monthly fee directly from their patients, or their employer sponsors, in exchange for a predetermined list of services. It’s a significant shift that provides transparent prices, aligned incentives, and little to no administrative overhead. It is not insurance and not FFS. That, in turn, makes for happier physicians and happier patients.

While DPC practices are rapidly gaining traction, the industry is still on a journey to build an interconnected ecosystem that collectively outperforms the current FFS model. There’s no silver bullet solution to achieve this goal, but three specific steps can help us get there.

For DPC to truly be successful, a key first step requires an achievable ROI for the stakeholders involved. Practices need to have the tools available to make the transition to a DPC model without significant risk of headache, employers should expect to unlock savings for their employee population, and patients should receive a hands-on and seamless experience.

To optimize the process, physicians should look for a well-rounded system that reduces the complexity of direct-to-consumer membership management and employer direct contracting, helps eliminate perceived risk during a DPC transition, and scales as a practice evolves. By removing the manual effort involved, stakeholders can reap the benefits of the DPC model and create a sustainable model for their practice.

Working with large employers can bring new levels of complexity and operational overhead due to unique contracts that many physicians may not have dealt with in the past. However, as sponsors of health plans, employers can also help scale DPC practices quickly, given their large potential employee and dependent member populations. While a growing number of employers recognize the value of providing a direct primary care plan, there’s still much opportunity for employer education to drive further awareness of the benefits.

 of healthcare consumers found 68% of participants were initially unfamiliar with the DPC model, however once it was explained that the all-inclusive primary care program could lower costs, improve outcomes, and raise satisfaction, 83% of those surveyed expressed interest in signing up if DPC was provided through their current or future employer. Additionally, more than half of the respondents indicated they would be willing to chip in each month for the promise of better primary care services.

The benefits of this employee education are clear too – one advanced primary care model 

saved an employer 11% per employee per month

Tapping into these networks and clearly explaining the benefits of a DPC model fosters the opportunity for exponential growth.

For the DPC movement to continue building momentum, it’s crucial to look outside the four walls of primary care. Primary care only accounts for 

, but has significant influence on patient decisions impacting most other areas of expenditure. To ensure the fundamental principles of price transparency, aligned incentives, and low overhead costs are adopted across the healthcare system, direct care contracting must be integrated into downstream care. Doing so will amplify the impact of core DPC offerings and help to grow the ROI for both the individual patient and employer purchaser.

 of DPC practices are already working to make this possible by providing physicians with access to specialist expertise to deliver high-quality care while also preventing co-payments and out-of-pocket costs for patients traditionally associated with specialist visits. This, in turn, empowers physicians to spend more time with their patients and build stronger relationships.

The DPC movement has a long and exciting road ahead as it works to help physicians escape the FFS hamster wheel that prioritizes volume over value, but the path is clear and the value is demonstrable through the many physicians increasingly turning to this model. In fact, Hint even witnessed 21% growth in DPC practices during the depths of the pandemic.

If we can continue to build on the success that the DPC movement has already seen, there’s no doubt we will ultimately end up with an ecosystem of transparently-priced, direct-pay relationships grounded in a foundation of affordable primary care. It’s a win-win-win scenario for the physicians, employers, and patients involved.

Articles

Why you should pay attention to the future of direct primary care.

What the future of direct primary care looks like

Direct primary care (DPC) is a physician-led movement that gives forward-thinking providers the ability to operate outside of one of the biggest headaches in healthcare today: the insurance middleman. Under this rapidly growing business model, providers collect a monthly fee directly from their patients, or their employer sponsors, in exchange for a predetermined list of services. It’s completely transparent, there are no guessing games, no copayments, no insurance claims submitted, and no third-party billing of any kind.

It’s ultimately a big shift away from the fee-for-service challenges that most physicians are familiar with, and is helping providers achieve the quadruple aim: better outcomes, lower costs, and a better experience for both patients and physicians alike. In fact, under the DPC model, patients and physicians can spend more quality time together and better foster their relationships.

How to use local SEO to grow your medical practice

Physicians enter their field to make a difference for patients, but when they’re constantly forced to choose between making the right choices for patients or what will drive the most profit, it leads to an incredible amount of emotional strain that can lead to burnout. This has a huge impact on healthcare organizations as physician turnover is extremely expensive and doctors can make more clinical errors (opening liability). Many physicians in training avoid specialties that have a high rate of burnout leading to staffing problems. Patients are likely to leave if their physician also departs, especially if they’ve built strong relationships and trust.

While there are many aspects to burnout, the only way to tackle this growing trend is to address the root cause: eliminate perverse financial incentives and enable physicians to work for their patients rather than the healthcare system. DPC is one of the only models that truly overcomes these challenges by allowing physicians to operate outside of today’s traditional payment models by:

Moving physicians off the volume treadwheel that forces many to focus on simply maximizing revenue rather than focusing on health outcomes.

Reducing the administrative burden that often takes up one-third of a physician’s time and is required for reimbursement.

Providing physicians with a population’s health to manage instead of a volume to simply process for claims.

Enabling physicians to provide quality care and practice at the top of their license with routine activities that utilize the full extent of their education, training, and experience.

Unless a healthcare organization begins to move towards models like DPC that eliminate the root causes of burnout, there shouldn’t be any surprise when physicians leave so that they can prioritize the needs of their patients—and their own mental health—rather than a health system’s bottom line.

One of the biggest barriers for physicians considering transitioning to a DPC model is the risk associated with no longer accepting insurance, or only accepting insurance for some services, which has typically been the biggest foundation of a practice’s revenue. We understand it may seem like a daunting task since this business model is fundamentally restructuring the way that primary care is being paid for and delivered.

While many physicians are exhausted with the dystopian way in which they’re forced to practice medicine today, change can be scary, and many want to know that DPC is a successful alternative to the status quo. There’s no shortage of physicians who can speak to the results of their transition to DPC. Just consider Nextera Healthcare, which saved a school district in Colorado over $1.4 million after rolling out a membership model without sacrificing quality. By setting up on-site and near-site clinics for the school, there were 72 percent fewer hospital claims, a 62 percent reduction in surgical care, and a 74 percent decrease in ER claims.

Additionally, as DPC has gained traction over the past several years (and now includes practices in nearly every state across the country), so too has the number of partners willing to support these physicians. For instance, member management platforms can create a roadmap for physicians and help eliminate the complexity and administrative challenges of adopting a DPC business model.

No longer will physicians need to worry about the complexity of direct-to-consumer membership management and employer direct contracting. Instead, there is an entire ecosystem of partners who are helping ensure that physicians will soon be able to have a population already waiting once they make the switch, along with the tools that already exist to ensure a seamless way to securely handle member enrollment, employer plan administration, eligibility management, billing, invoicing, payments, collections, and much more.

Failure to provide patient records can result in a HIPAA fine

DPC is becoming increasingly common across the country, with nearly every state having at least one practice that has adopted this business model. Physicians who are interested in hearing from others who have transitioned to DPC need only to look to their neighbors to hear firsthand how the business model was adopted and its performance since. They can provide advice and support to those who are considering taking this journey.

Additionally, there is a growing number of bite-sized, step-by-step training and coaching programs designed to help physicians succeed with DPC at all stages—whether they’re designing their business model, launching a practice, or seeking to grow.

Physicians should expect to see DPC continue to gain traction—not only from the wave of practices that are embracing this model, but also the growing number of recognizable names in healthcare (such as athenahealth) providing support to those making the transition to this business model.

This includes growing interest from the federal government and, specifically, the Centers for Medicare & Medicaid Services (CMS). The agency recently released a new Medicare program that allows for the formation of “Direct Contracting Entities” that contract with Medicare in the way a health plan does.

Ultimately, this means that some of the most important stakeholders in our country’s healthcare system are taking notice of DPC and validating this model as one that prioritizes “value over volume.”


Direct primary care (DPC) is becoming increasingly popular, but many physicians may be unfamiliar with the model. What exactly is DPC?