Pay Flat Fees to Doctors With Direct Primary Care

Ever need to wait a week or more to see your primary care doctor? Perhaps you should follow the lead of Debra Sallee, 58, a Seattle hair salon owner. For a flat fee of $79 a month, she can see her family physician as often as she wants—with no co-payments or health insurance forms. "It's just so convenient. They are at my beck and call," she says.

For several years, Sallee has been a member of Qliance, a primary care provider with four locations in and near Seattle. Her fee pays for round-the-clock e-mail or Skype access to the medical staff as well as same- or next-day (or evening) appointments for non-emergency medical care.

Sallee and Qliance are part of a growing movement known as direct primary care. For a set monthly fee, patients receive a full range of preventive services, such as wellness examinations, screenings and basic mental health care. Qliance also provides urgent care, including treatments for respiratory infections. Monthly fees are based on age, ranging from $54 to $89.

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Direct primary care is an outgrowth of a concept known as concierge care, which provides unlimited access to physicians for hefty premiums ranging from $2,000 to $5,000 a year. Direct primary care provides many of the same services at a much lower price, eliminating the administrative costs and hassles of insurance. "It's concierge care for the masses," says Dr. Erika Bliss, a family physician and chief executive officer of Qliance. More than 80 medical practices nationwide belong to the Direct Primary Care Coalition. (Some members offer higher-priced concierge services.)

The trend has had an impact on concierge care. "We've seen more and more demand," says Dan Hecht, chief executive officer of MDVIP, a Boca Raton, Fla.–based concierge care company, with 565 affiliated physician practices in 40 states. MDVIP's 200,000 patients each pay between $1,500 and $1,800 annually—a lower price than many concierge competitors.

Primary care providers typically provide most of a patient's care, including coordinating the oversight of patients with diabetes, asthma, heart ailments and other chronic conditions. Providers such as Qliance and Cambridge, Mass.–based Iora Health also coordinate all specialist and hospital care.

When Your Insurance Falls Short

Direct primary care may be a good option for those without insurance or who have high-deductible policies, such as Sallee. She pays a health insurer $311 a month for a policy with a deductible of $2,750, which she considers "catastrophic" insurance for high-cost hospital services. She pays Qliance separately.

Many employers who offer high-deductible plans are paying the fees for direct primary care. In these cases, the employer-based insurance covers the costs of specialists, hospital care and major tests once the patient meets the deductible.

Employers and unions pay Iora Health $50 a month to cover each worker and retiree in the Boston area; Dartmouth, N.H.; Las Vegas; and Brooklyn, N.Y. "Our practices aren't designed for rich people to have conveniences," says Dr. Rushika Fernandopulle, chief executive officer of Iora Health.

Direct primary care could get a big boost next year. Under the federal health care law, these practices will be able to operate in state-based health insurance exchanges. However, insurers on exchanges must offer a basic benefits package that includes hospital, drug and other coverage, so direct primary care practices will likely team up with other health plans.

If you're considering a direct primary care practice, get a list of provided services and talk with a physician in the practice. Also, some practices that are similar to concierge care may accept insurance but charge a monthly fee for extra services. For options in your area, visit the Web site of the Direct Primary Care Coalition (www.dpcare.org).