What Is Direct Care? Meaning, Model & How It Works

Direct care is a way of paying for medical care in which patients, or their employers, pay the practice directly, usually through a flat monthly membership, instead of the practice billing insurance for each visit. The membership covers a defined set of services, such as visits, messaging, telehealth and basic in-office care, so there are no copays or claims for the care it includes.

The model has several names depending on the specialty and the price point: direct primary care (DPC), concierge medicine, and direct specialty care. This guide covers what direct care means, how the membership model works, what a patient gets, and how it compares with conventional, insurance-based care.

What is direct care?

Direct care is a payment model, not a type of medicine. The physician practices the same medicine; what changes is who pays and how. In a direct-care practice the patient pays the practice a recurring fee, typically monthly, and in return gets ongoing access to the physician for the services the membership covers. Insurance is not billed for those services, which removes the coding, claims and prior authorizations that come with fee-for-service billing.

Most patients in direct care still keep insurance, or a high-deductible plan, for what a practice cannot provide on its own: hospital stays, surgery, specialist care and emergencies. The membership covers the routine, predictable care; insurance covers the rare, expensive events.

What does "direct care" mean in other settings?

The phrase has a second, older meaning. In workforce and staffing language, "direct care" or "direct patient care" means hands-on work with patients, as opposed to administrative or support roles. A direct care worker is usually a home health aide, personal care aide or nursing assistant, a workforce of roughly five million people in the United States according to PHI's 2025 Key Facts report. "Direct patient care hours" on a job listing or nursing application means time spent with patients. That sense of the term is unrelated to the payment model this guide describes.

How does the direct care model work?

A direct-care practice sells memberships. Each membership plan sets a price, a billing cycle and what is included, and the practice usually offers a few tiers: an adult plan, a child or family plan, and sometimes a plan for employer groups. Patients enroll, pay automatically each month, and use the practice as often as they need to within what the plan covers.

Because the practice is not paid per visit, it has no reason to schedule a visit for something a message can solve, and no reason to keep visits short. Most direct primary care practices keep panels well below the conventional model, which is what pays for longer appointments, same-day access and direct messaging with the physician. Our guide to how many patients a doctor sees a day sets out the numbers on both sides.

Many practices also negotiate wholesale prices for labs, imaging and generic medications and pass them on to members, which is one reason the total cost to the patient can be lower than the membership alone suggests.

What is typically included in a direct care membership?

Every practice defines its own plans, but a direct primary care membership commonly includes:

Office visits with no copay, including annual physicals
Same-day or next-day appointments when something is urgent
Telehealth visits and secure messaging with the care team
Chronic disease management, with follow-up between visits
Basic in-office procedures and point-of-care tests
Access to discounted labs, imaging and medications

What is not included matters just as much: hospital care, specialist visits, surgery and emergency care sit outside the membership, which is why most members pair it with insurance.

What are the types of direct care?

Three variants share the same payment model and differ in scope and price.

Direct primary care (DPC): a monthly membership for primary care, usually with no insurance billing at all. The volunteer-maintained national DPC mapper lists more than 3,000 DPC practices across all 50 states.
Concierge medicine: a membership, often annual and at a higher price, for enhanced access and longer visits. Some concierge practices still bill insurance for visits on top of the fee. Our comparison of concierge medicine vs direct care covers the differences in detail.
Direct specialty care: the same model applied to a specialty, such as psychiatry, endocrinology, cardiology or functional medicine, with a membership or package price in place of per-visit insurance billing. See direct specialty care for how specialists structure it.

How is direct care different from insurance-based care?

The table compares direct care with conventional, insurance-based primary care on the points patients and physicians ask about most.

	Direct care	Conventional insurance-based care
Who pays	The patient or employer, directly, by membership	The insurer per visit, plus copays and deductibles
Price	A known monthly fee	Varies by visit, code and plan; often known only after the bill
Visit length	Commonly 30 to 60 minutes	Commonly 15 to 20 minutes
Panel size	Smaller, with fewer patients seen each day	Larger, often 20 or more patients a day
Access between visits	Messaging and telehealth included	Usually a portal message or a new appointment
Paperwork	No claims or prior authorizations for covered care	Coding, claims, denials and prior authorizations
Hospital and specialist care	Outside the membership; covered by insurance	Covered by the same insurance plan

Can patients use an HSA for a direct care membership?

Yes, in most cases, from 2026. Under the One Big Beautiful Bill Act and IRS Notice 2026-05, a direct primary care membership no longer disqualifies a patient from contributing to a health savings account, and the fee can be paid from the HSA, as long as it stays at or under $150 a month for an individual or $300 a month for a family. This is general information, not tax advice; patients should check their own plan.

Why do employers offer direct care?

For employers, benefits are often the largest cost after payroll, and direct care gives them a fixed monthly price for primary care plus the chance to reduce downstream spending on emergency visits and hospital stays. We interviewed Gayle Brekke, an actuary and the founder of Primary Care Mindset, about how direct care fits into benefits design, and her view is that routine, predictable care is a poor fit for insurance in the first place.

“Research, including my own, shows that Direct Primary Care, with its good access to a personal doctor, can help save on emergency room visits, hospitalizations, and other costly downstream care. Thus, DPC is a way to better control benefit dollars while improving the health of employees and their families.”Gayle BrekkeFounder of Primary Care Mindset

Our guide to direct care benefits for employers covers how those contracts are structured.

What software does a direct care practice need?

A direct-care practice needs software built around memberships, not claims. SigmaMD is an EMR for direct primary care, concierge and direct specialty practices, and runs the membership side and the clinical side in one system.

In SigmaMD, practices set up retail and employer membership plans with their own pricing, discounts and billing cycles, and members pay automatically by card or ACH. Memberships can be paused, changed or canceled from the patient's chart, and enrollment forms are completed and saved as part of signing up. Patients book visits, message the care team, join video visits and complete forms from the SigmaMD patient app, which is the direct access a membership promises.

On the clinical side, SigmaMD Scribe listens to the visit and drafts the note into the practice's own template, which matters when visits run 30 to 60 minutes. Sigma AI reviews the chart before a visit, summarizes what is still open, and answers questions about one patient or the whole panel. Our guide to what to look for in a DPC EMR goes through the rest of the checklist, and what an EMR is covers the basics.

If you are starting a direct-care practice or moving an existing one onto memberships, book a demo and we will walk through how your plans, billing and visits would run on SigmaMD.