Direct Primary Care Offers Employers New Wellness Option

A New York Times article profiles Becker Trucking's decision to pay $54 per employee per month to a primary care provider called Qliance. Employees get unlimited doctor visits, 24-hour e-mail access to the medical staff, and same-day or next-day appointments. There is no insurance involved in their primary care: no expensive premiums, no complicated claims, no mysterious denials. This type of health care model is called direct primary care, and it is getting a closer look not just from businessmen like Mr. Riordan, but also from researchers and government officials who see it as an effective way to lower costs.

Direct primary care derives from an unlikely source: the so-called concierge practices that began appearing a decade ago, catering primarily to the affluent. But this is more like concierge medicine for the masses. The idea is that routine, mundane primary care should not require expensive insurance and can be cheaper without it. Direct primary care practices charge $50 to $60 a month for adults, with lower fees for children. Depending on the practice, the monthly fee also may cover certain lab tests, basic X-rays and stitches for cuts.  But the fee does not cover anything beyond primary care. Typically employers combine direct primary care with high-deductible insurance plans, needed to cover hospitalizations and visits to specialists.

Even though Becker pays Qliance for primary care and pays half of each worker’s $5,000 annual deductible for insurance, the company’s costs dropped 11 percent in 2010. Costs had been rising about 14 percent annually.  Doctors who work for Qliance are salaried reducing the financial incentive to order unnecessary tests. Direct primary care practices keep costs low by sidestepping the bureaucracy associated with insurance and reducing unnecessary and expensive trips to the hospital or emergency room.  Direct primary practices are also less likely to refer to a specialist for something they can handle themselves.

Such practices already operate in 24 states, treating more than 100,000 patients, according to the Direct Primary Care Coalition.