Medicine without the claim —What Is Direct Primary Care?
Direct primary care is a practice model where patients pay the physician a flat recurring fee — usually monthly — for primary care, and the practice stops billing insurance for those services. No claims, no coding for reimbursement, no collections cycle. The trade is straightforward: smaller panels and lower overhead in exchange for revenue you can forecast to the dollar.
- Monthly
- A flat membership fee instead of per-visit claims
- Smaller
- Panels, because revenue no longer depends on volume
- Predictable
- You know next month's revenue on the first
How the model actually works
The membership replaces the claim
Patients pay a recurring fee that covers the primary-care services you define — visits, communication, basic in-office procedures, often labs at cost. Because there is no third-party payer for those services, there is no coding-for-reimbursement, no denials queue and no accounts receivable to chase.
It is not insurance, and should never be sold as insurance
DPC covers primary care only. Most patients keep a high-deductible plan or another arrangement for hospitalization, specialists and catastrophic care. How DPC agreements are regulated differs by state — several states have specific statutes saying a DPC agreement is not insurance, and the requirements vary. Have your agreement reviewed where you practice.
Panel size is the whole economics
Revenue is membership fee times panel size, so the model works when you can serve a smaller panel well. Physicians typically run several hundred patients rather than a few thousand, which is what makes longer visits and same-day access possible.
Overhead falls where billing used to be
The staff time, software and vendor fees that existed to produce and defend claims largely disappear. What replaces them is a membership system: pricing, enrollment, recurring billing, failed-payment recovery and retention reporting.
Employers are the growth channel most practices miss
Local employers buying DPC memberships for their staff add members in blocks instead of one at a time, with a single invoice. It is the fastest way to a viable panel in most markets.
What changes operationally on day one
You price a membership instead of a fee schedule
A flat monthly fee, often tiered by age, sometimes with a household rate and an employer rate. Model it against the panel size you can realistically serve, not the one you hope for.
Enrollment becomes the front-desk job
Agreement signed, card or bank account on file, first payment processed. That two-minute moment replaces the eligibility check and the claim.
Billing runs monthly, automatically
Charges process on schedule, declines retry with a self-serve update link, and memberships renew on their anniversary. Nobody should be invoicing patients by hand.
You watch retention, not collections
Active members, churn, monthly recurring revenue and employer-group counts become the numbers that run the practice.
Practices That Got Off The Treadmill.
Select a practice to see how their membership revenue compounded month over month.
“We dropped two of our worst PPO contracts in year one. The membership plan replaced that revenue and then some — and we finally control our own fee schedule.”
- Members
- 612
- MRR
- $38.9K
- ARR
- $467K
- MRR Growth
- +284%
- Write-offs
- -$186K
Direct primary care questions physicians ask
- What is direct primary care?
- A model where patients pay the practice a flat recurring fee for primary-care services and the practice does not bill insurance for those services. It replaces per-visit claims revenue with predictable membership revenue.
- Is direct primary care the same as concierge medicine?
- They overlap but differ. Concierge practices typically charge a higher retainer and often still bill insurance for visits; DPC practices charge a lower monthly fee and usually opt out of insurance billing entirely for the services covered.
- Does direct primary care count as insurance?
- No. DPC covers primary care, not hospitalization or catastrophic events, and most patients pair it with a separate plan. Several states regulate DPC agreements specifically and state that they are not insurance — the rules vary, so have your agreement reviewed locally.
- How much does a DPC membership cost?
- Fees are set by each practice and commonly scale by age, with household and employer rates. Price yours from the panel size you can serve and the overhead you actually carry, rather than from a national figure.
- Can patients use an HSA or FSA to pay a DPC fee?
- This is a tax question, and the treatment of periodic DPC fees has been the subject of changing federal guidance. Confirm the current rules with a tax adviser before telling patients anything.
- What software does a DPC practice need?
- Two things: an EHR for clinical records, and a membership system for pricing, enrollment, recurring billing, dunning, employer groups and revenue reporting. BoomCloud™ is the second one and runs beside whichever EHR you choose.
Run the membership side without a billing department
Price your tiers, enroll patients and employer groups on autopay, and see monthly recurring revenue in one dashboard.
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