As modern healthcare continues to evolve, more individuals are turning to direct primary care (DPC) to manage their basic healthcare needs. Operating under a membership-based model, DPC clinics offer patients unlimited access to their primary care physician, affordable healthcare, and transparent pricing. While the scope of services provided by DPC facilities covers many everyday medical needs, a traditional health insurance plan or reputable healthshare is still necessary for things like specialist visits, major surgeries, or emergency care.
Here, we’ll discuss the basics of direct primary care, the scope of services provided by most DPC clinics, and what situations require traditional health insurance or healthshare coverage.
Direct Primary Care: Understanding the Basic Principles
Direct primary care is a healthcare model that eliminates the middleman, aka insurance companies or their representatives. Patients pay a set monthly or yearly membership fee to a DPC clinic. In exchange, they get unlimited access to their primary care physician, same or next-day appointments for urgent needs, and affordable coverage for primary care services.
Here are just a few of the key benefits of direct primary care:
- Unlimited office visits – Patients can see their primary care doctor as many times as necessary to address their health concerns.
- Unhurried appointments – DPC providers typically see fewer patients than doctors operating under the traditional healthcare model. This enables them to spend more time with each patient.
- Personalized care – With unlimited visits and more time for each one, doctors can truly get to know their patients and their unique needs. This gives them more information to create and implement personalized treatment plans for optimal health outcomes.
- Preventative care – Many urgent or emergency care visits are avoided, thanks to DPC’s focus on health, wellness, and disease prevention. Patients can easily get screenings and routine check-ups at no additional cost, eliminating the barriers that often prevent people from seeking preventative care.
- Remote consultations – Patients can reach their primary care provider by phone, email, or video conference if an in-person visit isn’t possible or needed.
The Scope of Services Provided by DPC Clinics: What’s Included In a Direct Primary Care Membership?
While the scope of services may vary slightly between direct primary care clinics, most provide all the essential services you’d expect from your primary care doctor. With a DPC membership, patients get:
- Diagnosis and treatment for acute illnesses
- Management of chronic diseases
- In-office procedures (Examples: Toenail removal, minor procedures, some injections)
- Unlimited office visits – either in-person or by phone, email, or video conference
- Some diagnostic testing (Examples: EKG, pregnancy test)
In addition to the scope of services provided in-house, many DPC clinics have agreements with outside labs, imaging facilities, and pharmacies to provide discounted services to their patients. Here at Ark Family Health, our members pay cost plus 10% for labs, imaging, and medication when done or obtained at our partner facilities.
While discounts may vary between DPC clinics, one of the key benefits of direct primary care is transparent pricing. Whatever isn’t fully covered by DPC membership is clearly explained so there are no surprise bills or costs.
When Is Traditional Health Insurance or a Reputable Healthshare Necessary?
While direct primary care offers many benefits, there are certain situations where traditional health insurance is essential. This include things like:
- Specialist Care: If you need to see a specialist for complex health issues, traditional insurance or a reputable healthshare can help cover the costs. DPC doctors can refer you to specialists, but the fees for specialist visits and treatments are not typically included in the DPC membership.
- Hospitalization and Emergency Care: Direct primary care memberships do not cover hospital stays, most surgeries, or emergency room visits. Having traditional health insurance or a reputable healthshare ensures you are protected financially in case of serious medical emergencies or surgeries.
- Prescription Medications: DPC clinics often provide discounted prescriptions for commonly-prescribed medications. For expensive medications or for chronic conditions requiring ongoing treatment, however, traditional health insurance or a reputable healthshare can significantly reduce your out-of-pocket cost.
Balancing the Scope of Services Provided by Direct Primary Care with Traditional Health Insurance or a Reputable Healthshare
Many patients find that combining direct primary care with a high-deductible health insurance plan or reputable healthshare provides the best of both worlds. The DPC model ensures accessible, personalized primary care, while the insurance plan or healthshare covers catastrophic events and specialist care.
Ark Family Health: Your Source for Direct Primary Care in the Phoenix Area
At Ark Family Health, we’re committed to providing comprehensive, affordable, and patient-centered primary care services. With convenient locations in Peoria and Gilbert, we’re able to serve individuals, families, and businesses throughout the greater Phoenix area, including Chandler, Scottsdale, Glendale, and more.
We invite you to learn more about our membership plans today and see why direct primary care is transforming the healthcare experience!