The difference between direct primary care and concierge medicine

It can often feel like your doctor is quick to get out the door and on to see their next patient. Unfortunately, that's because they're often on tight schedules.

A University of Chicago study¹ found that most physicians don't have enough time to fulfill all of their patients’ needs. Survey results showed it would take more than 24 hours a day for doctors to follow nationally recommended guidelines for preventive care, chronic disease care, and acute care visits. This is due to their average number of patients.

Many people desire a more personal doctor-patient relationship. That's what makes practice models like direct primary care (DPC) and concierge medicine (CM) attractive. They each offer more personalized healthcare to patients who are willing to pay extra for it.

In this article, we'll take a closer look at what makes them different so you can better understand your options.

In this blog post, you'll learn the following:

• What direct primary care is and who it's best for.
• What concierge medicine is and who it's best for.
• How you can get your medical expenses reimbursed by your employer.

Concierge doctors vs. primary care doctors: What's the difference?

According to the National Institutes of Health², the average primary care exam lasts 18 minutes. That's not much time for someone who has serious medical concerns or for someone who values a close connection with their doctor.

Gevorg Nazaryan is a healthcare technology specialist and co-founder of Docus³. He's worked closely with more than 350 doctors to enhance healthcare delivery using AI-driven solutions. While both DPC and CM aim to enhance your healthcare experience and prioritize patient engagement, he said there are some crucial differences to consider.

"Both give personal attention and focal care," Nazaryan said. "But DPC is cheaper for routine needs while CM provides comfort and convenience at a premium."

Let's go over each model in more detail below to help you make a smart choice about your health.

What's the meaning of direct primary care?

DPC is a membership-based model where patients pay their physician directly through a monthly, quarterly, or annual fee rather than paying through an insurance provider.

This fee covers primary care services, which can include the following:

• Clinical and laboratory services
• Consultative services
• Care coordination
• Comprehensive care management

However, this fee only covers some services. For that reason, some DCP practices suggest their patients enroll in a high deductible health plan (HDHP) as well. With a health insurance plan, they'll have additional coverage in case of an emergency.

The goal of this model is to give physicians consistent revenue without forcing them to spend time coding and billing like a primary care doctor would. The reduced administrative burden frees them up to spend more time with their patients.

In turn, patients experience longer visits with their primary care physician. According to Starlight Health⁴, a DPC model allows physicians to spend roughly 30, 60, or even 90 minutes with each patient per visit.

Patients also receive quick access to their doctor by phone, text, email, video chat, same-day or next-day appointment times, and, in some cases, even house calls.

Now, let's compare some of the pros and cons.

The pros of DPC:

• Many DPCs offer monthly memberships. You can cancel your membership at any time.
• With DPCs, patients make periodic payments that cover several services, rather than depending on insurance for each visit.

The cons of DPC:

• Physicians don't accept insurance or participate in government programs.
• While a membership fee is often more affordable than traditional health insurance, some medical services aren't covered. This means patients could end up paying out-of-pocket if they go to a specialist, urgent care, or the hospital.
• If a patient has a DPC membership with an HDHP that comes with a health savings account (HSA), they can't make contributions to their HSA in most states.

Who is DPC best for?

"DPC fits families or individuals who wish to have regular and immediate primary care within specific reasonable costs," Nazaryan said. "Also, it's designed for ailment management looking for chronic conditions to be economically maintained."

Given that DPC physicians don't accept insurance like Medicare or Medicaid, younger, middle-income patients typically benefit more from DPC than older or low-income patients.

What's the meaning of concierge care?

CM, concierge care, or boutique medicine is another membership-based model that provides premium care to patients who can afford it.

People pay an annual fee to receive greater access, medical attention, and patient care from a concierge primary care doctor. With smaller patient lists and more time on their hands, these doctors can focus on building long-term, personal relationships with their patients.

Unlike DPC doctors, concierge physicians charge a patient's insurance company for their visit in addition to charging a membership fee. This allows concierge medical practices to have two forms of revenue while giving patients the help they need to pay for any services not covered by their membership fee.

Here are some of their pros and cons.

The pros of CM:

• Unlike DCP doctors, concierge doctors accept payment through their patient's insurance in addition to a membership fee.
• With CM, patients gain access to their doctor's direct phone line. They can speak to their doctor at any time, either by phone or in person, through same-day appointments.
• If a patient has a major health problem, a concierge primary care doctor can coordinate specialist visits or hospital care as needed.

The cons of CM:

• Concierge medical care requires an annual membership fee, paid in full or through monthly installments. The contract is for an entire year, and a patient can't cancel it midyear.
• It's more expensive than DPC. According to Forbes Health⁵, membership fees and monthly costs can range from $1,200 to $10,000 per year.
• Like DCP, the federal government doesn’t consider CM an acceptable non-insurance option under the ACA.

Who is CM best for?

Concierge practices tend to cater to higher-income patients compared to DCP.

"CM is designed for affluent clients seeking a range of services 24/7," Nazaryan said. "This model is useful for all those with multiple health issues or very busy lives."

How to get reimbursed for out-of-pocket medical expenses

Many of the health costs not covered by DPC or CM are reimbursable through an employer with a health reimbursement arrangement (HRA). An HRA allows employers to reimburse their employees tax-free for qualifying medical costs. So whether a patient uses DPC, CM, or traditional primary care, they can get their healthcare expenses covered. Employees only need to meet their specific HRA’s participation requirements.

Three of the most popular HRAs include:

• Qualified small employer HRA (QSEHRA): A QSEHRA is a cost-effective alternative to group health insurance. It's a health benefit for small employers with fewer than 50 full-time equivalent (FTE) employees. Employees must have a health plan with minimum essential coverage (MEC) to participate.
• Individual coverage HRA (ICHRA): An ICHRA is a flexible health benefit solution for organizations of all sizes. Employees must have a qualifying individual health insurance plan to participate.
• Group coverage HRA (GCHRA): A GCHRA, also known as an integrated HRA, is an excellent way to supplement a traditional group health insurance policy to help employees with their out-of-pocket expenses.

If your employer offers an HRA, they can reimburse you for more medical expenses than DPC or CM can cover. An HRA can even reimburse you for your concierge medical fees for any services you’ve received during the benefit year.

Conclusion

Both direct primary care (DPC) and concierge medicine (CM) offer patients peace of mind in knowing they can receive the personalized care they want at any time. DPC tends to come at a lower cost, but those with serious medical issues may prefer the 24/7 access that comes with the higher price tag of CM. An HRA can fill the gaps in coverage left by both of these options.

This blog article was originally published on February 24, 2021. It was last updated on November 7, 2024.

1. The University of Chicago
2. National Institutes of Health
3. Docus
4. Starlight Health
5. Forbes