Direct Primary Care Delivers Savings for North Carolina

Published May 9, 2016

North Carolina physicians, patients, and at least one public-sector employer are paying less for better health care by entering into direct primary care agreements, in line with current state law.

Direct primary care (DPC) patients typically pay providers a monthly membership fee of $50 to $100 in exchange for a suite of preventative care services. North Carolina has 16 direct primary care practices, excluding large groups such as MedLion and Paladina, which no longer publish their practice locations, according to DPC Mapper, a tool that maps direct primary care locations.

Private Benefits, Public Savings

Katherine Restrepo, health and human services policy analyst at the John Locke Foundation in North Carolina, says direct primary care allows patients to see their true health care costs and enables doctors to spend more time treating patients by cutting down on paperwork and reducing patient loads.

“Direct primary care injects price transparency into the health care sector,” Restrepo said. “Doctors can spend more time with their patients, and patients benefit from having around-the-clock access to their primary care doctor for an affordable monthly fee similar to the cost of a gym membership.”

One county expects to save $1 million by providing government employee health benefits through a direct primary care agreement, Restrepo wrote in an article for Forbes on March 22.

“In North Carolina, Union County is on track to save $1 million in health care claims under its first-year contract with Paladina Health—an innovative health care delivery organization within the DPC movement,” Restrepo wrote. “That’s $1 million saved on just 37 percent of Union County’s 1,983 covered lives who seek preventative care from a board-certified physician at Paladina’s near-site clinic.”

Concerned About Potential Hurdles

Dr. Philip Eskew, founder of DPC Frontier, says the biggest obstacle to expanding direct primary care in North Carolina and other states is potential unnecessary regulation by uninformed or misinformed lawmakers.

“Ignorance is by far the greatest hurdle,” Eskew said. “Most of those opposed to direct primary care think they understand it, but they usually have no idea what they are talking about. This ignorant opposition crowd has run the gamut from insurance companies, most commonly, to legislators, to medical societies, to any other interested party.”

Eskew says lawmakers should focus on clarifying laws to make it easier for patients to take advantage of direct primary care, which he points out is a legal health care model.

“Policymakers often don’t realize that direct primary care is already legal,” Eskew said. “We are simply seeking legislation to clarify gray areas in the law and lower legal barriers to entry.”

Healthy Policy Prescription

Brian Forrest serves 1,200 patients and employs two physicians at Access Healthcare, his direct primary care practice in Apex, North Carolina.

Forrest says any legislation to be considered should protect providers from being regulated as a form of insurance.

“The key thing is that the state consider direct primary care not to be a form of insurance and thus not regulated by the Department of Insurance,” Forrest said. “This is the single most important thing that needs to be in any state legislation, and it encourages the growth of a wider variety of direct primary care practice types.”

Forrest says lawmakers should leave regulation of practices to the North Carolina Medical Board, a government agency, and keep providers free from unnecessary administrative busywork.

“The legislation should make it clear that direct primary practices are regulated only by the [state] medical board, as are all other practices,” Forrest said. “Lastly, there should be no administrative hoops, like filing annual reports or restrictions on advertising that make it harder to run a direct primary care practice.”

Luke Ferree ([email protected]writes from New York, New York.

Internet Info:

Katherine Restrepo, “Direct Primary Care: Restoring the Doctor-Patient Relationship,” Spotlight, John Locke Foundation, February 11, 2016: