What is direct care?

June 8, 2022

Leona Rajaee

As the name suggests, direct care describes a relationship between a healthcare provider and a patient that does not involve intermediaries such as insurance companies. The direct care practice operates on patient membership fees and does not rely on insurance reimbursements. The independent physician in a direct care practice also does not have to wait for insurance review and approval prior to caring for the patient.

Direct care essentially harkens back to the days of the family doctor who engaged with the patient, taking phone calls and even making house calls as needed. The provider contracts directly with the patient for basic healthcare services, much as it was in the days before health insurance outpaced out-of-pocket pay as the primary revenue source for medical practices. The trend is now turning back to direct care as a preferred model of care delivery.

The number of direct care practices is growing significantly as patients learn more about the structure of the practice. Many patients do not understand or do not believe the simplicity of the model, as they are used to having to work with insurance companies for their healthcare services. Direct care providers find that they need to educate potential patients as to the direct care model and possibly even convince them that is legitimate.

Direct care practices charge a flat monthly membership fee, typically between $50 and $100 per month. Some practices have tiers of membership levels, based on age primarily. The monthly fee covers basic services such as immunizations, checkups, and visits for illness or injury. Outside services such as lab tests or hospitalizations are generally not covered. For those, direct care patients may carry high deductible, catastrophic insurance.

The direct care model of healthcare delivery benefits patients and independent physicians. For physicians, adopting a direct care model can improve work-life balance, reduce practice overhead, bring higher per patient revenues, and maintain physician autonomy. For patients, direct care can mean a greater degree of access to, and time with, physicians. Improved communication and more regular, engaged care lead to fewer unnecessary tests, less frequent hospital visits, and lower total cost of care.