With misdiagnoses, poor health outcomes, and unsatisfied physicians and patients in its wake, Direct primary care vs traditional primary care was due for a revolution for quite some time now. In truth, the shortcomings of insurance-based health care further highlights the value of direct primary care more than ever. It comes as no surprise that more and more physicians and patients are making the switch to value-based, patient-oriented health care.
The success rates of direct primary care have experienced a recent surge, with the concierge medicine segment holding the dominant share of the market beginning 2022. According to a study conducted by IMARC Group, this new and improved health care model’s market size clocked in at $16.3 Billion in 2023 IMARC Group anticipates the market to reach $45.8 Billion by 2032, exhibiting a growth rate (CAGR) of 12.15% between 2024 to 2032.
There are three major industry breakthroughs that are responsible for the current success rates of direct primary care.
First, there has been an influx of patient interest when it comes to exploring alternatives to traditional health care. The insurance-based health care model has overcharged, underprioritized, and mistreated patients for the longest time, and both primary care physicians and their patients have had enough. This growing dissatisfaction towards traditional, insurance-based health care serves as a catalyst for the emergence of direct pay practices across the U.S.
Patient retention in concierge medicine has led to the health care industry’s second major breakthrough: an incremental rise in direct pay practices within the last five years. The industry has witnessed a slew of direct pay practices setting up shop in every state, especially after the pandemic. This is a great contributor to the success rates of direct primary care because more DPC practices mean more accessible preventive care for patients.
Lastly, the movement towards regulatory clarity within the concierge medicine space has contributed greatly to the success rates of direct primary care. The growth in popularity of direct primary care has led legislative bodies to take notice of this new and improved health care model. Industry-wide regulation is a fundamental step to ensuring direct pay practices are streamlined and scaled at large, for the benefit of both physicians and patients.
Compared to traditional, insurance-based healthcare, direct primary care outcomes have significantly improved because patients are happy and satisfied with the treatment they are receiving.. This is one of many definitive differences between direct primary care vs traditional primary care. The latter has not favored the patient’s best interests at heart for a long time now, hence the birth of the former.
From medical errors, long wait-times, to absurd medical charges, the traditional, insurance-based model has left patients feeling fed up and undervalued. Many regard direct primary care as a modern health care revolution, given that it has everything the insurance-based model does not have: a direct, tight-knit relationship between doctor and patient.
In DPC and concierge models, patients have direct access to their primary care physician. It is not uncommon for DPC practices to integrate telemedicine, electronic health records (EHRs), and mobile apps to improve overall health care delivery. This is something that is unheard of in the insurance-based model. In fact, a study conducted by private firm ECG Management Consultants reveals that, in insurance-based health care, the average wait for a patient’s third appointment is a whopping 38 days.
The study used mystery shoppers to assess average wait times for patient appointments. As per the authors of the report, the third appointment is a key metric for patient access. “Waits longer than two weeks are significant because rates of no-shows and cancellations tend to increase after 14 days, ultimately affecting patient outcomes, provider productivity, and organizations’ financial performance.”
The COVID-19 pandemic was also a turning point in concierge medicine success rates. At a time when hospitals were overloaded and visits to the doctor’s office were discouraged, patients sought personalized, preventive care more than ever.
Although a considerable percentage of COVID-19 cases were tagged as severe and required hospital confinement, a larger percentage of patients experienced mild to moderate symptoms and were successfully treated at home in isolation. Thankfully, there were no better physicians to respond to this type of medical situation than DPC physicians.
In 2021, a survey conducted among 3,500 respondents revealed a zero percent closure rate for direct primary care practices.
A survey conducted by the American Association of Retired Persons (AARP) also shows that 90% of patients in direct primary care practices are satisfied with the care they receive, in contrast to the 67% satisfaction rating of patients in the traditional, insurance-based model. Moreover, 97% of direct primary care patients agree that “their doctors take a personal interest in their health care”, making that one-third higher than those in the traditional, insurance-based practice.
For many primary care physicians, transitioning to direct primary care is like coming home to a practice they are passionate about and are familiar with. Concierge medicine success rates are rooted on the fact that physicians are focused on what actually matters: patients and their well-being.
In traditional, insurance-based health care, primary care physicians are bogged down by administrative tasks, like reimbursement claims and billing codes. Clinic days are often overloaded, leaving traditional primary care physicians with an average of 15-20 minutes per patient.
This is telling insight on the comparative effectiveness of direct primary care . Dr. Rob Lamberts, MD affirms that transitioning to a concierge medicine practice restored his patient advocacy. “A large percentage of face-to-face time is devoted to actual care. My waiting room is usually empty, and my average wait time is still under 10 minutes. The obvious advantage to this is better care. There simply is more time to think about things, to listen to patients, and to educate them.”
A key factor behind the success rates of direct primary care is the presence of time. Clocking in conversations and devoting time for follow-ups are prerequisites to nipping any illnesses at the bud.
The American Academy of Family Physicians (AAFP) released a policy statement detailing that they have found direct primary care to be adherent to American health care’s principal advocacy: “to protect and enhance the intrinsic power of the relationship between a patient and his/her family physician to improve personalized medicine outcome s and lower overall healthcare costs”.
Dr. Zev Cohen, MD, a Concierge doctor who transitioned from the traditional, insurance-based model, has no regrets about switching to a direct primary care practice. “For patients who are coping with chronic conditions, it is tremendously comforting to know they can connect easily and frequently with me. The outreach goes both ways, as I check in often with my most vulnerable patients to see how they are faring, not just physically, but mentally and emotionally.”
As of November 2024, the industry has witnessed significant developments in health care reform. As patients become increasingly drawn to the enhanced access and convenience DPC practices offer, the need for federal and state regulation has never been greater.
With two bipartisan bills moving through Congress as of writing, it is exciting to witness DPC become part of the greater conversation in health care legislation. Organizations such as DPC Coalition and Health Rosetta continue to spearhead policy influence, technological integration, and financial sustainability of direct primary care, and public adaptation within the health care landscape.
There are two bipartisan bills physicians and patients should keep tabs on:
H.R. 3836, or the Medicaid Primary Care Improvement Act. A major contributor to the success rates of Direct Primary Care, this newly passed bill clarifies that Medicaid programs can offer direct primary care services even when patients do not have a federal waiver from the Centers for Medicare & Medicaid Services (CMS).
This bill grants wider DPC accessibility among lower-income patients, allowing them to experience the benefits of value-driven, patient-focused primary care.
H.R. 3029, also known as the Primary Care Enhancement Act. Once passed, this particular bipartisan bill grants patients the freedom to join DPC and concierge medicine subscriptions while still being eligible to contribute to their Health Savings Accounts (HSAs) or High Deductible Health Plans (HDHPs). This is a substantial move towards adopting DPC into mainstream health care across the U.S.
The Primary Care Enhancement Act removes barriers for patients with HSAs to subscribe to DPC arrangements. IRS rules have restricted how DPC subscriptions are used in conjunction with HSAs and HDHPs for the last decade. Should H.R. 3029 be approved by the House of Representatives, this will open up DPC access to millions of Americans, giving them the opportunity to maximize both their HSA tax benefits as well as personalized primary care that is unique to direct pay models.
Regulatory clarity pushes DPC mainstream and brings forth wider medical options and better patient care to different markets, whether it be patients who have private insurance, HSAs, or even Medicaid benefits.
The success rates of direct primary care is evidenced by the steady rise of patients and providers that are joining the industry. The growth of DPC’s market size is testament to the scalability of concierge medicine. Compared to the early 2000’s when there were only a few hundred DPC doctors across the U.S., the concierge medicine landscape has grown to more than 15,000 physicians as of 2024.
As private practice success rates continue to grow exponentially each year, this goes to show how bright a future is in store for physicians and patients alike in the DPC and concierge medicine space. American healthcare is in the midst of a long overdue transformation. Finally, millions of patients are reaping the benefits of direct patient care.
