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On Retainer: Direct Primary Care Practices Bypass Insurance

Dave Chase

Under the "direct primary care" model, patients pay a monthly fee for basic medical services. Learn about the history and current landscape of physician practices offering this arrangement.

Direct primary care (DPC) is an emerging model that has gained some attention in California and nationally in recent years. Sometimes referred to as "retainer practices," DPC practices generally do not accept health insurance, instead serving patients in exchange for a recurring monthly fee — usually $50 to $80 — for a defined set of clinical services.

This issue brief describes the landscape of DPC practices, which collectively have more than a half million people on their rolls. Five large practices that use the retainer model are highlighted in the issue brief. The patient rosters are estimations:

  • Iora Health, with 2,400 patients
  • MedLion, with 3,000 patients
  • Paladina Health, with 8,000 patients
  • Qliance, with 7,200 patients
  • White Glove Health, with 40,000 patients via self-insured employers and 450,000 via health plans

DPC providers help keep costs low by avoiding unnecessary referrals and by referring mainly to specialists willing to offer significant discounts. Despite this advantage, the DPC model may be hampered by low awareness among health plans and primary care physicians, resistance from some insurers, and resistance from competing hospitals and specialists.

The complete issue brief is available as a Document Download.