Smart Benefits: Is DPC the Next Big Benefit?

Rob Calise, GoLocalProv Business/Health Expert

Smart Benefits: Is DPC the Next Big Benefit?

Direct primary care (DPC) is an innovative approach to rising healthcare costs that’s growing in popularity nationally, including in Rhode Island. Under the model, consumers pay their primary care physician directly, usually through a flat membership fee, and get unlimited access to services like office visits and lab tests.

The idea behind the framework is that patients get more time with their physician, when they need it. And, by cutting out the insurance carrier, they also benefit from more transparent pricing, reduced confusion about payment, and less expensive services for routine care. But a DPC plan isn’t necessarily for everyone. Before jumping on board, there are key features consumers should be aware of:

You Still Need Insurance: A DPC membership doesn’t replace health insurance. Patients will still want to purchase coverage for services rendered outside of a DPC such as specialty doctor visits and ER visits.
The Plans May Not Scale Well: As membership in a plan grows, the physicians may have less time for the personalized relationships or prompt access that DPC promises, which could lead to patient dissatisfaction.
Patients Need to be More Involved: Since consumers will need to clearly understand what their DPC plan does and doesn’t cover, they may need to spend more time to avoid unexpected expenses and to handle administrative tasks such as retainer payments for the service.

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Right now, most members in DPC practices pay for the fee directly out of pocket. But some employers are looking at the concept as an added employee benefit for which they would pay all or part of the membership fee. Since a deeper physician-patient relationship can drive better outcomes, the investment may be worth it.

Rob Calise is the Managing Director, Employee Benefits of The Hilb Group of New England, where he helps clients control the costs of employee benefits by focusing on consumer-driven strategies and on how to best utilize the tax savings tools the government provides. Rob serves as Chairman of the Board of United Benefit Advisors, and is a board member of the Blue Cross & Blue Shield of RI Broker Advisory Board, United HealthCare of New England Broker Advisory Board and Rhode Island Business Healthcare Advisors Council. He is also a member of the National Association of Health Underwriters (NAHU), American Health Insurance Association (AHIA) and the Employers Council on Flexible Compensation (ECFC), as well as various human resource associations. Rob is a graduate of Bryant University with a BS in Finance

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