Direct Primary Care May Become Much More Popular Thanks to New Law

 A new provision related to direct primary care (DPC) in the recently enacted reconciliation bill will create more opportunities for physicians in small towns to open independent practices, Jeff Davenport, MD, of Edmonton, Oklahoma, said Tuesday.

"What an opportunity for small-town America to have a doctor be able to practice in a model like this and have more expanded opportunities," Davenport said at an event sponsored by the American Academy of Family Physicians. Although some families might not be able to afford to pay for DPC with post-tax dollars, "maybe their company can provide an opportunity for them or pay for them, and that creates the supply and demand."

The new law making it easier for some patients to enroll in direct primary care will be a boon for physicians and patients in small towns, said Jeff Davenport, MD. (Photo by Joyce Frieden)

Under the DPC model, patients or their employers pay a primary care physician a flat monthly rate -- a typical rate is $70 per month -- for unlimited primary care, which includes text messaging and phone calls with the physician as well as in-office and virtual visits. Often, a package will also include discounted rates for imaging, lab tests, and other services that the physician's office has negotiated for patients.

Under current law, however, patients who are insured with a health savings account (HSA) paired with a high-deductible health plan cannot participate in DPC arrangements. But as of Jan. 1, 2026, under a provision known as the Primary Care Enhancement Actopens in a new tab or window, these patients will be able to participate in DPC. In addition, they will be able to pay their DPC premiums -- up to $150 per month for an individual and up to $300 per month for DPC arrangements that cover spouses and family members -- through their HSA, in which the funds are tax-deductible.

And employers "are now allowed to put together a health benefit that would include a DPC arrangement, a high-deductible health plan, and an HSA, and either put money as the employer into that HSA -- through which the patient can pay the doctor -- or pay the doctor directly to take care of the employees," explained Jay Keese, executive director of the DPC Coalition.

"You can knit this all together in a health benefit plan that makes sense for your employees, and this should come before the deductible," he added. "So what was a high-deductible health plan is a slightly less high-deductible health plan under the new rules."

The number of people who enroll in a DPC arrangement is going to jump thanks to the new law, predicted James Gelfand, president and CEO of the ERISA Industry Committee, which represents large employers. "Almost every plan now has a high deductible, but it doesn't meet the [official] definition of a high-deductible health plan," he said. "And if you ask employers or patients, 'Why are you choosing this plan that still has a high deductible, but you don't get this wonderful [HSA] tax benefit?' ... The reason they'll give you is because they want first-dollar coverage for primary care -- and in some cases, for other physician office visits."

But now that they'll be allowed to have a DPC arrangement along with an HSA and a high-deductible health plan, "there's going to be millions of people for whom that calculus has changed," he said. Although there are currently about 60 million people enrolled in HSAs, "I wouldn't be surprised if that 60 million number jumps significantly as marketers get it all paired together ... and especially as employers start to get on board bringing these things together, you're going to see a major shift."

Clint Flanagan, MD, founder and CEO of Nextera Healthcare, a DPC provider based in Longmont, Colorado, predicted that as DPC plans become more popular, healthcare spending in the U.S. will drop from $5 trillion annually to about $4 trillion, "although that may take some time. As you drill down to the employee, getting better primary care will serve the patient in tremendous ways." He noted that whereas in some cities, fee-for-service patients who want an annual physical have to wait 6 months, a DPC physician "could get you in that week or maybe the next day for a checkup. Engagement goes up significantly."

In addition, a patient's initial visit in a DPC model usually takes an hour because "we want to understand where you are on your healthcare journey and move the dial forward on optimal health," he said. That longer visit is possible, he told MedPage Today in an interview, because instead of the typical 2,000-to-3,000-patient panel that a fee-for-service primary care doctor has, DPC physicians' panels are usually around 500 to 1,000 patients.

Clint Flanagan, MD, owner of a direct primary care business, predicted that increased participation in direct primary care would lower healthcare spending. (Photo by Joyce Frieden)

But getting more doctors to leap into the new model may take some time because "nobody likes change, especially physicians," warned Davenport, adding that many physicians will be concerned about how they can attract patients. "This is just one more opportunity for us, through our experience and already doing it, to explain to them, 'Look, there will be so many people looking for you now; you've just got to put your name in the phone book. You've just got to open your shingle and pound the pavement and find the companies, because there's just going to be more and more opportunity for patients to be able to find this type of care.'"

Kelly Parker-Mello, MD, a pediatrician in Portsmouth, New Hampshire, said that the DPC model has enabled her to do home visits for newborns for the first 2 months. "One of my favorite parts of my job is getting to go and sit on the floor with a family and a new baby and show them how to swaddle their baby and when to be concerned," she said.

And, "I'm amazed at how many ER [emergency room] visits I saved by saying 'Just call me if you think it's an emergency,' because the majority of the time, they don't need an ER; they just need advice," she added.

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