Direct Primary Care

Landing DPC Employer Contracts, Part 4: The Small-Employer Playbook

David Craig, MD
May 15, 2017
October 26, 2023

In the previous part of this series on DPC employer contracts, we covered tactics for finding and engaging with self-funded employers, nearly all of which are large organizations. Of United States businesses with more than four employees, however, 72% actually have fewer than 20 total workforce members, and this figure goes up to an eyebrow-raising 95% if you include midsize companies with 20 to 99 employees.¹

Given this, being able to make your DPC practice appealing to small- and medium-sized employers will open a huge number of opportunities for you, and we’re going to spend this fourth installment of the series giving you a playbook to do just that!

The final part of the series will follow soon, but if you don’t want to wait, you can download our full ebook on DPC employer contracts right now: “Secrets of Direct Primary Care: 5 Keys to Landing Employer Contracts.”

Key #4: Have a Playbook for Smaller Employers, Too

Smaller employers are not often self-funded, but that doesn’t mean you should give up on them as potential partners. One major benefit of small organizations, for instance, is that they can move much faster than bigger groups. “There’s at least a year of lead time on these contracts with larger businesses,” said Dr. John Birky of Wellspring Family Healthcare.

Dr. Jeffrey Davenport of One Focus Medical concurred: “One bigger company just started with me a month or two ago, and we started talking for real about a year ago. The full lead time was even longer, maybe two-and-a-half years, starting from meeting the CEO at a business referral group.”

Understanding these smaller companies and their needs will put you in the best spot to form relationships with them, should the opportunity arise.

“Small companies can be nimble,” Dr. Davenport continued. “The boss from a granite company down the road made a decision out of the blue, and the next month I’m getting people from his company when they smash their finger or whatever. He’s driving them to the office, saying, ‘Hey, add this guy,’ and I treat them.”

With this reality of deal speed in mind, attempting to land a few less-than-large employers while you work on bigger ones in the background can be a smart idea. Understanding these smaller companies and their needs will put you in the best spot to form relationships with them, should the opportunity arise.

Employers Without Health Benefits

“Truly small companies, most of the time, they don’t offer their employees anything for healthcare,” said Dr. Davenport. “The owners are looking for something to take care of their employees, though. They want to do right by them; they just can’t afford insurance. If they’re not doing anything, the motivation to offer DPC is pretty straightforward. Here’s a finite, budgeted line item for DPC, and since a large percent of medical care is primary care, it’s very valuable. I try to tell the small companies, ‘If you can’t pay for insurance, maybe you can pay for this.'”

A DPC membership, of course, won’t cover certain important medical needs, such as specialist care or hospital stays, but it will be dramatically better than no health coverage at all. Furthermore, many people purchasing health plans on their own will end up with a high-deductible plan. Pairing such a plan with a “free” DPC option from their employer would allow many of them to avoid the majority of potential medical bills while ensuring that they have a safety net for catastrophic events.

Fully Insured Employers

Fully insured employers are likely to be your most difficult targets for DPC partnership. These companies don’t stand to benefit from the potential cost savings of DPC, and they’ve also already committed to a hefty expense in order to provide health benefits to their workforce. Convincing them to spend even more on healthcare may be a hard sell.

Some DPC physicians have already noticed people arriving on their doorstep due to these high-deductible plans, even when their employer hasn’t specifically promoted the approach.

One angle to use, however, is the current trend toward high-deductible health plans (HDHPs). Even if a company is fully insured, its employees will often find that a plan with a high deductible is the only economically feasible option among the choices that they have. If you come across an employer in this situation, you can pitch yourself as a cost-efficient way for its workers to cover the gap that exists between needing no medical care at all and needing so much that they get past their many-thousand-dollar deductible.

Some DPC physicians have already noticed people arriving on their doorstep due to these high-deductible plans, even when their employer hasn’t specifically promoted the approach. “I’ve noticed some impact,” said Dr. Birky. “Word gets out a little bit.”

Dr. Davenport also favors the pairing of DPC and HDHP: “If you have 15 pretty healthy workers doing granite, what do they really need? Stitches, a splint, somebody who tells them to quit smoking. Basically you need an urgent care clinic. I always say, insurance should be what insurance is for: very big, very expensive, unforeseen expenses. Not primary care that you know you’re going to need. I did not plan to fly off the front of the four wheeler a few years ago, but it happened. I had to go to the ER, but when was the last time I really had an expense like that? Probably never.”

If a company is game, you can take this approach even further and possibly save the organization money. “For companies that do offer some type of insurance, I talk to them about raising deductibles and saving on premiums and then paying for DPC memberships out of company pocket,” says Dr. Davenport.

To the right firm, the value-added, “high-touch” services of a DPC clinic can also be attractive for use as a perk in recruiting and retaining top employees. Some companies offer free lunch or gym memberships to woo talent, and these businesses are primed to see your DPC offering similarly. Show them all the ways that you provide value beyond the typical medical system, and you may end up on their benefits list, despite not helping their bottom line directly.

“Some fully insured employers will see value in employees not missing work because they’re healthier,” says Megan Freedman of the Free Market Medical Association. “Or value in their employees having a better connection with their doctor via DPC. That’s where their ROI is. Happier, healthier employees who have less absenteeism and better overall health and wellness can be successfully promoted to a smaller employer.”

Small- and medium-sized employers can be great partners for DPC clinics; the trick is just in knowing how to appeal to their specific needs and incentives. Let us know how the strategies in this article work for you, and then come back next time for the fifth and final part of the series, as we discuss (and overcome!) possible roadblocks you might encounter when trying to establish DPC employer contracts.

Or, if you don’t wait to wait, get our full ebook on DPC employer contracts right now: “Secrets of Direct Primary Care: 5 Keys to Landing Employer Contracts.”

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