Years of receiving care from a traditional doctor’s office and receiving bill after bill from her health care provider left Cedar Park resident Mandy Botts looking for an alternative option for health care.

Botts said she now uses Impact Family Wellness—a subscription-based provider with clinics in Cedar Park, Liberty Hill and Thorndale—to fulfill her primary health care needs and avoid surprise bills.

Called direct primary care, this model involves patients paying a monthly membership fee to their providers, and can eliminate some of the back and forth with third-party payers, such as insurance.

“I got to a point with our insurance where everything was like, bill, bill, bill, after you go to the doctor,” she said. “I pay this membership fee, and ... I can go in, and I know what it’s going to cost.”

What you need to know

Direct primary care is a developing model in the health care field that does not require patients to have insurance to receive select primary health care services, said David Miller, practice manager at Premier Health MD, a DPC practice located in Cedar Park. At a typical DPC practice, many services are covered through the monthly fee or discounted and paid by cash.

DPC patients can receive most of the services offered at a traditional clinic, including chronic disease management, annual physicals, sick visits, treatment for acute injuries, urgent care and lab testing, according to local DPC providers.

Miller said the DPC model allows providers more one-on-one time with patients since they aren’t spending several hours a day completing billing paperwork for insurers.

“It’s a great option for patients but also a really great option for providers as we get to actually take care of patients instead of doing paperwork all day for insurance companies,” said Monica McKitterick, family nurse practitioner and owner of Impact Family Wellness.

Demand for DPCs
  • Roughly 240% increase in DPC membership in the U.S. from 2017 to 2021
  • 21% increase in DPC membership during 2020; fee-for-service adult primary care visits decreased 10%
  • 159% increase from 2017 to 2021 in the number of active DPC clinicians per 100,000 people
  • 40 states where DPC clinics operate as of 2021, up from 20 in 2019
  • 1,600 DPC practices nationwide serving more than 300,000 patients
  • At least 12 DPC practices in the Austin, Liberty Hill, Cedar Park, Lakeway, Round Rock and Hutto areas
Diving in deeper

The DPC model was introduced to the health care industry about two decades ago as a form of concierge medicine, Euphoria Health Founder and CEO Dr. Chris Larson said.

Larson said concierge medicine requires patients to pay a monthly membership fee, while still billing their health insurance companies. This practice is known as “double-dipping,” according to a May 2020 study from the DPC Coalition.

Pricing at area DPC clinics ranges from $70-$100 per month for adults, and most clinics have packages for families, according to local providers. This price can cover visits, telehealth services and various treatment options, but it does not include advanced testing, X-rays or specialty care.

For these services, patients are often referred out to imaging centers and specialists, and can choose to bill the cost through their insurance or pay an out-of-pocket fee. The fee is often reduced through a partnership the DPC practice has with the referred provider, Miller said.

DPC memberships can be a more affordable option for those who are uninsured, said Jamie Keller, a retired nurse and owner of Cornerstone Patient Advocacy. Keller works as a liaison between patients and providers, and helps guide patients toward the best plan for their health care.

Miller said a lot of the patients at Premier Health MD do not have health insurance, though several local providers still encourage people to have some form of catastrophic coverage, if they are able to, as DPC cannot cover emergencies.

“We can take care of about 80% of your health care needs, but there is a time and a place for traditional insurance,” McKitterick said. “Medical insurance was meant to be like your car insurance where it’s used when things go really bad.”

What else?

Several local health care professionals said they believe today’s primary care system needs a fix.

"It’s really hard in the insurance-based world because you have to see 30-ish patients a day, and you just do paperwork all day,” McKitterick said.

About 97% of physicians surveyed in the study by the DPC Coalition reported having a better relationship with their patients, and 98% reported a better ability to practice medicine under the DPC model.

DPC providers have a smaller set of patients, can visit with patients for longer periods of time and are able to be more accessible to their patients, sometimes 24/7 by text, video and other communication channels, according to the study.

In traditional practices, doctors are often held to certain metrics, Keller said, which can restrict them from being able to focus on patient care.

“The system is a lose-lose; it’s a lose for the physicians; it’s a lose for the patients,” Keller said.

Survey says

The Direct Primary Care Coalition surveyed 200 physicians for a May 2020 study. At the time, the number represented 10%-20% of all DPC physicians.
  • Reasons providers choose DPC:
    • Providing better care: 96%
    • More time for visits: 85%
    • Less paperwork: 78%
  • Physicians felt better about:
    • Personal and professional satisfaction: 99%
    • Ability to practice medicine: 98%
    • Quality of primary care: 98%
    • Relationships with their primary care patients: 97%
What are the options

Though some providers consider DPC as an alternative to the standard, fee-for-service model, it probably isn’t the best for every patient, Miller said.

A membership may not be financially beneficial for a person who is generally healthy and only visits the doctor about twice a year, Miller said.

Leander resident Trudi Komorn transitioned to the model when her longtime family doctor adopted it. Because Komorn has an autoimmune disease and her husband has other medical issues, she said the membership is beneficial and gives her peace of mind, despite the cost. It allows her family 24/7 access to their doctor and same-day appointments.

Factors to consider when choosing a medical provider
  • Overall status of health
  • Insurance coverage
  • Satisfaction level with current health care
  • Amount of doctor's office visits per year
  • Management needed for any chronic conditions
Looking ahead

Area health care providers said the DPC model will likely continue to grow in the coming years. However, Larson said it will be awhile until it becomes the main form of primary care.

McKitterick said for the model to grow, patients need to be educated on what it is. She said society has made people believe they absolutely need insurance, when that’s not always the case. People can choose to pay cash for a lot of procedures, which can be significantly cheaper than going through insurance, she said.

“[Insurance companies] have a really expensive product that is incredibly confusing, and no one understands, yet everyone buys it,” she said. “I think if people were more educated on what their insurance actually does and doesn’t do, they would stop buying it.”

As DPC clinics continue to put down roots in the health care industry, Keller said specialty doctors, such as dermatologists and ophthalmologists, will also more than likely begin implementing the model at their practices.

Quote of note

"[Doctors] are looking for new ways to provide the best care possible. I think [direct primary care] is going to catch on because it’s the only way to take care of people," Keller said.