What is Direct Care?

This article is the first in a series of resources aimed at supporting direct care physicians. Find out more about Elation for Direct Care.

Direct patient care is the delivery of health-care services to people who are being treated for or suspected of having physical or mental diseases. Both face-to-face and telehealth-based preventative care and first-line monitoring are included in direct patient care.

For almost all of America’s history, Americans paid their provider directly for care. It was only in the 20th century that health insurance outpaced out-of-pocket pay as the primary revenue source for medical practices. But since the turn of the 21st century, direct care has made a resurgence.

In 2005, there were fewer than 150 physicians practicing in direct primary care, concierge, and other direct care models. This number grew 5x in the next five years, to 756 in 2010, and then even more rapidly to an estimated 6,500 direct care physicians across the country by the end of 2015.



Average DPC patient panel after the first 6 months on Elation.



The amount of patients a single DPC provider on Elation manages on average.

1 to 55


DPC practice models on Elation range from 1 to 55 physicians.

The complexities of contracting with insurers have placed more demands on physicians in recent years, leading more to choose direct care. This alternative payment model has helped strengthen the relationship between patients and physicians in many communities, allowing physicians more control over their patient panel sizes, practice staffing, and care delivery.

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 leads to fewer unnecessary tests, less frequent hospital visits, and lower total cost of care.

Less charting = more time with patients.

Lisa Davidson, MD

Understanding Direct Care

Direct care is a departure from the fee-for-service model. Instead of receiving reimbursement for each service rendered, physicians receive a per-patient amount per month, quarter, or year. This fee can range from $50 per month to thousands or more per year, depending on the practice’s level of service and operating model. For patients, the subscription fee covers almost all primary care services including clinical, laboratory, consultative services, care coordination and comprehensive care management. In addition to direct care, many patients elect to acquire a high-deductible wraparound policy to cover the emergency care that is not covered under direct care.

Direct care providers generally exist outside the traditional insurance system. Thus in direct care, patients or employers pay membership fees directly to practices. This medical practice model means that physician contracts are not with insurers but directly with patients or with businesses, as a benefit for employees, which can result in large savings for employers.

Within direct care, business models vary significantly. Some direct primary care practices or “DPC” practices rely solely on a monthly retainer fee and aim to keep care affordable while serving a wide range of patient demographics. Others offer concierge care with round the clock access to physicians in exchange for a higher retainer fee, appealing to wealthier patients.

Many practices use hybrid models to combine elements of direct care and fee-for-service, and bill insurance in addition to contracting directly with patients. Hybrid practices are popular for physicians who want to continue to see insurance patients while also transforming their practice towards direct care. Providers interested in a hybrid model should consult legal counsel to make sure they are compliant with insurance regulations.

The goal of direct care is to spend more time with the patient rather than documenting that visit. At the same time, good record keeping is paramount to good patient care and communication is integral to coordination and maintenance of that care.

Ken Rictor, MD

Deciding to Join the DPC community

Physicians have much to consider in starting a direct care practice. Whether graduating medical school, transitioning from a fee-for-service model, or considering leaving employment at a health organization, the stakes are high. Patients, staff members, legal counsel, business partners, and technology vendors must all be consulted during the decision making process.

It’s helpful for physicians considering direct care to connect with other physicians and talk to them about their experiences. Going to direct care-oriented events can also help inform your choice. There are also resources online, including this e-book, which has an appendix with more resources for those interested in learning more.

Direct care restores the physician-patient relationship. Elation is accelerating the direct care movement. The software is very simple to use and perfect for any direct care practice.

Michael Kagen, MD