Direct Primary Care: One Step Forward, Two Steps Back | Health Care Economics, Insurance, Payment | JAMA | JAMA Network

P rimary care is the bedrock of reform of the US health system. New payment and care delivery models emphasize the importance of primary care medical homes with reimbursement prioritizing value over volume. It remains unclear how best to restructure US health care spending to attain the Triple Aim (ie, improving the experience of care, improving the health of populations, and reducing per capita costs of health care) as well as the 4 C’s of primary care (contact, continuity, comprehensiveness, and coordination). Of the myriad models emerging over the last decade, direct primary care (DPC) is unique in its renunciation of insurance companies and other third-party payers. Instead, patients contract directly with a primary care physician to pay a recurring out-of-pocket fee in exchange for a defined set of primary care benefits.1 DPC models vary in their structure, yet they generally provide coverage for acute care and long-term care, basic disease treatment, discounted prescriptions, vac

P rimary care is the bedrock of reform of the US health system. New payment and care delivery models emphasize the importance of primary care medical homes with reimbursement prioritizing value over volume. It remains unclear how best to restructure US health care spending to attain the Triple Aim (ie, improving the experience of care, improving the health of populations, and reducing per capita costs of health care) as well as the 4 C’s of primary care (contact, continuity, comprehensiveness, and coordination). Of the myriad models emerging over the last decade, direct primary care (DPC) is u