University of Wisconsin–Madison Medical College of Wisconsin

Defining the Place of Direct Primary Care in a Value-Based Care System

Lindsey E. Carlasare, MBA

WMJ. 2018;117(3):106-110.

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Introduction: Direct primary care, one of several retainer-based practice models, is a niche practice type that offers an alternative to the traditional fee-for-service and insurance-based practices most prevalent in US health care. In Wisconsin, the prevalence of direct primary care practices is higher than in most other states. The market for direct primary care practice may be growing along with the industry shift to value-based care and an increase in physicians’ desire to reduce the increasing administrative work and regulations that detract from patient care and increase burnout. Many physicians are seeking ways to reduce these burdens so they have more time with patients. Some are transitioning their practice to a retainer-based model, such as direct primary care, in which they collect a retainer from patients in exchange for more time, freer communication, and less paperwork.

Objective: The objective of this review is to provide information about the direct primary care practice model, possible drivers to this model of care, and its advantages and drawbacks for physicians and patients. This discussion also aims to evaluate the care model’s place in the shift to value-based care, and key positions and policy from leading organizations.

Methods: A literature review was conducted to collect and analyze current evidence about the prevalence of retainer-based practices, the average fees associated with such models, the contributors to physician burnout that may lead to a transition to the direct primary care model, and the relevant ethical and policy considerations associated with direct primary care.

Discussion: Eighty-two percent of Wisconsin physicians report some level of burnout. Estimates demonstrate an increase in the number of direct primary care practices, and that Wisconsin is among the top 3 states with the highest number of direct primary care practices. The literature suggests that since the early stages of modern retainer-based models, patient fees have decreased and the patient base for these practices has expanded. The practice model is relatively rare, although there are indicators that its presence has increased in recent years.

Conclusions: Physicians seeking strategies to reduce administrative burden, spend more time with patients, or simply streamline their practice may experience benefits in transitioning to a retainer practice such as direct primary care. There are foundational concepts about direct primary care, including advantages, drawbacks, and ethical considerations, to heed when transitioning to this model. There is a need for further research to quantify key data about direct primary care and its effects on patient outcomes and physician burnout and satisfaction.

Author Affiliations: American Medical Association, Chicago, Ill.
Corresponding Author: Lindsey E. Carlasare, MBA, Senior Policy Analyst, Professional Satisfaction and Practice Sustainability, American Medical Association, 330 N Wabash Ave, Suite 39300, Chicago, IL 60611; phone 312.464.4122; email
Funding/Support: None declared.
Financial Disclosures: The author is employed by the American Medical
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