Primary care providers—originally general practitioners who would later specialize into modern internal and family medicine physicians—served as lone practitioners for much of the 20th century, playing a central role in both the healthcare system and their local communities.¹ After World War II, the prominence of PCPs declined as specialty care expanded, influenced by changes in medical education, reimbursement models, technology, and public demand². Today, rising healthcare costs, workforce shortages, and systemic pressures have highlighted underinvestment in primary care. The market is seeking solutions that remove barriers, enhance education, and support population health management³.

Shifts in Primary Care

Primary care remains a core component of all health plans, but fee structures and market pressures have changed the patient–provider relationship. Patients often face rushed appointments, long wait times, low reimbursement rates, and high administrative burdens. These factors contribute to burnout among PCPs and have led the Association of American Medical Colleges (AAMC) to project a shortage of 17,800 to 48,000 primary care physicians by 20344. Insurance requirements, market consolidation, and operational pressures limit PCPs’ ability to deliver optimal care. Patients are also demanding broader access, digital solutions, self-service options, and hybrid care models. In response to these growing challenges, Spring Consulting Group’s client edHEALTH, a captive health coalition serving educational institutions, is proactively pursuing primary care solutions to meet the evolving needs of its member schools. Direct primary care (DPC) has emerged as a strategic tool for employers seeking to improve access, enhance preventive care, reduce avoidable acute care utilization, and generate a return on investment5.

Direct Primary Care

At the core, direct primary care provides patients with unlimited access to a primary care team for a flat monthly fee, typically outside of traditional health plan coverage. Most DPC solutions guarantee same-day or next-day appointments, longer visit times, higher patient satisfaction, and bundled care for preventive, chronic, and acute conditions6.

DPC models vary depending on vendor capabilities and employer priorities. Options include onsite or near-site clinics, virtual-first networks, retail clinics, preferred-access arrangements, navigation and concierge support, digital tools such as AI and wearables, incentives for engagement, and plan design levers to drive utilization. Providers include retail brands, technology-driven platforms, and employer-focused businesses leveraging onsite, near-site, and virtual-first care models.

DPC emphasizes relationship development and improved access rather than gatekeeping. It positions primary care as a strategic entry point, controlling downstream utilization, referrals, and chronic disease management. Separating primary care from traditional insurance networks may allow patients to access the best available care, facilities, and providers. DPC models can also incorporate risk-based approaches, including capitation or partial-risk arrangements.

Patients increasingly expect convenience, engagement, and integrated behavioral health. DPC partners are responding with retail-style access, care navigation, and satisfaction-focused services. Employers can align DPC partnerships with broader human resources initiatives, such as curated networks, direct contracting, and programs addressing social determinants of health.

Virtual-First Primary Care

In addition to DPC, other access models such as virtual-first primary care and urgent care clinics are shaping the future of healthcare delivery. Virtual-first primary care models are increasingly being adopted as a complementary approach to in-person care. These models prioritize digital access by encouraging patients to connect with their care team through telehealth visits, chat, or app-based platforms before turning to in-person appointments. Virtual-first care can improve access, reduce wait times, and support patient engagement, particularly for populations who may struggle with transportation or scheduling barriers.

When integrated effectively, virtual-first models can serve as a gateway to coordinated care by addressing routine concerns, managing chronic conditions, and promoting preventive health measures. However, challenges such as continuity of care, patient trust, and integration with existing electronic health records must be carefully managed to ensure quality outcomes. For employers, virtual-first networks can complement direct primary care by expanding access and helping to balance costs without sacrificing patient experience.

Market Shifts and Employer Considerations

Employers, particularly self-funded ones, must increasingly shape their healthcare strategy to maximize value. Primary care represents a relatively small portion of overall healthcare spend, and immediate savings may be limited. However, long-term investment in DPC can yield measurable benefits over three to five years. Successful DPC implementation requires attention to challenges such as geographic coverage gaps, referral coordination limitations, regulatory uncertainty, and member education. Employers should prioritize integration with existing health plan solutions, coordinate utilization and data tracking to ensure savings are captured accurately and deploy clear communication and engagement strategies.

When implemented effectively, DPC models shift the healthcare narrative toward value-based care, improve access, strengthen care coordination, and enhance patient satisfaction, ultimately supporting both employee health and organizational objectives.

1Starfield, B., Shi, L., & Macinko, J. (2005). Contribution of primary care to health systems and health. The Milbank Quarterly, 83(3), 457–502.
2Bodenheimer, T., & Pham, H. H. (2010). Primary care: Current problems and proposed solutions. Health Affairs, 29(5), 799–805.
3Petterson, S., Liaw, W. R., Tran, C., & Bazemore, A. W. (2015). Estimating the residency expansion required to avoid projected primary care physician shortages. Annals of Family Medicine, 13(2), 107–114.
4Association of American Medical Colleges. (2023). The complexities of physician supply and demand: Projections from 2023 to 2034.
5Rosenthal, T. C. (2012). The medical home: Growing evidence to support a new approach to primary care. JAMA, 308(21), 2335–2336.
6Direct Primary Care Coalition. (2022). What is direct primary care? Retrieved from https://www.dpcare.org/