Colorado’s Direct Primary Care Bill: A Better Way to Pay for Healthcare?

Kelsey Ray | The Colorado Independent | April 10, 2017

Coloradans frustrated with the high costs of primary healthcare, take heed: A bill to protect a lower-cost model heads today to the state House floor after passing committee in both chambers. Fed up with the administrative burdens of “fee-for-service” insurance billing, family doctors across the country increasingly are turning to a payment model called direct primary care, in which patients and their primary care physicians enter into payment agreements that eliminate the middleman of traditional insurance.

Much like gym memberships, direct primary care patients pay a monthly fee —it’s usually between $25 and $80, depending on factors like the patient’s age — in exchange for access to primary care services like consultations, lab work and clinical visits without insurance copays or deductibles. Proponents say the model reduces administrative hours and leads to lower costs. House bill defines how such agreements must work and makes it clear that direct primary care payment models are not insurance. The bill’s Senate sponsor, Democrat John Kefalas, says the bill will help ensure that the model is allowed to advance here in Colorado. Despite a growing popularity, the percentage of doctors offering direct primary care payment models remains very small.

There are currently more than 600 such practices operating in all but three states, and more than 10 percent of them are in Colorado. The Affordable Care Act requires that patients purchase health insurance or incur a penalty, so direct primary care providers typically recommend that their patients also purchase insurance. But the model allows such patients to buy higher-deductible plans that serve more as stop-gap measures, knowing that they will be able to afford the majority of their routine visits and treatments...