Direct Primary Care: A Predictable Path Forward for CFOs? (Part 2)

As financial pressures grow, CFOs are eyeing Direct Primary Care as a more stable, patient-focused alternative—though not without risks and regulatory challenges.

For a CFO, uncompensated care is an acute sore spot. High-deductible health plans (HDHPs) are on the rise as payers and employers attempt to control costs, leaving more patients unable to afford care.

In part one of this two-part story, we examined how looming Medicaid cuts are pressuring CFOs even more to find stable financial footing, and how direct primary care models could offer a viable solution for some markets.

Direct primary care models (DPC) allow patients to pay a recurring flat fee directly to providers for defined primary care services, bypassing insurers and the complexity of claims-based billing. Direct primary care models could offer CFOs a clearer, more predictable revenue path, but they also come with certain risks and patient expectations.

Risks, Regulations, and Patient Expectations

Despite its benefits, DPC requires careful implementation. Patients may misunderstand what is (and isn’t) covered.

"Clear contracts and a detailed fee schedule of services included are essential to set expectations," said Hari Prasad, CEO of Yosi Health, a New York City-based concierge medicine provider. Furthermore, some states have regulatory ambiguity around direct patient-provider contracts.

Affordability is another concern, particularly for lower-income patients. Still, for many, especially those navigating Medicaid instability or HDHPs, DPC offers value. "Patients appreciate knowing they will not face surprise bills for covered primary care," Prasad said.

To prepare for these risks around regulations and patient expectations, CFOs should engage compliance teams early to navigate state-specific DPC regulations, develop patient education materials to clarify the scope of services, and potentially offer sliding scale or hybrid models to expand access while preserving financial sustainability. There is room for flexibility within the DPC model if providers can develop a clear, comprehensive strategy around implementation.

Balancing Innovation with Ethics and Trust

The pay-first aspect of DPC echoes broader conversations in the industry around pre-payment. Just a few months ago, the industry witnessed the backlash aimed at Cleveland Clinic for implementing its pay-now policy, enough that it was reversed shortly after. While Cleveland Clinic’s model was inherently different from a DPC model, the incident still highlights the ethical factors in implementing a new payment model and how it affects healthcare access to lower income patients.

Rick Gundling, senior vice president at HFMA, points out that, "As out-of-pocket costs for consumers have grown… providers are much more at risk for nonpayment." However, Gundling also emphasizes the need for trust: "Compassion, patient advocacy, and education should be part of all patient discussions."

At the recent annual HFMA conference, Gundling presented a five- step framework for CFOs to make ethically-sound financial decisions.

"Ensuring a good financial experience for patients is important for many reasons—it reduces administrative costs and improves financial results for healthcare organizations, it enhances patient satisfaction and loyalty, and—perhaps most importantly—it helps patients make better decisions about their healthcare," said Gundling.

For DPC to succeed, health systems must tread carefully, and, like every innovation in healthcare, must combine financial innovation with a commitment to transparency and equity.

As financial tension grows to new heights, the industry demands a plan to reshape outdated processes. For finance leaders, the time is right to explore how.