How advanced primary care works

Advanced primary care (also called direct primary care or direct care) is simple in concept: employers contract directly with primary care clinics and providers to deliver comprehensive primary care to employees. In practice, advanced primary care is an employer-sponsored program that sits alongside your health plan.

Rather than routing every primary care visit through your health plan and receiving claims for services, you pay a fixed per-employee cost and give your workforce easy access to a dedicated primary care model while disintermediating claims from the self-funded plan. That model typically includes:

• Unlimited primary care visits with no copays
• Same-day or next-day appointments
• Longer visit times (30-60 minutes vs. 7 minutes)
• 24/7 access via phone or video
• Coordination with specialists when needed​

Some Advanced Primary Care models take it a step further and include a direct care network which creates a better savings and makes the employee experience even stronger. Those services could include the following:

• Behavioral health
• Physical therapy
• Imaging 
• Durable medical equipment
• Cardiovascular testing
• Pulmenology services

Advanced primary care vs. your health plan:

• Advanced primary care handles: primary care, preventive care, chronic disease management, behavioral health, and many labs, prescriptions, and in-office procedures
• Your health plan handles: hospital care, surgery, complex specialty care

In this model, employees have no co-pays, deductibles, or bills. They see a simple experience: when they need care, they contact their provider and get seen quickly.

From a budget standpoint, employers typically pay $75-$200 per employee per month for advanced primary care access, depending on services and geography. That’s it. Predictable, transparent, no surprises at renewal time.

What advanced primary care actually includes

Most advanced primary care (and other direct care) partnerships cover:

• On-site or near-site clinics
  Clinics on or close to worksites where employees can be seen during the workday or close to home
• Unlimited visits
  Employees can be seen as often as clinically appropriate, without worrying about per-visit cost
• Preventive care without barriers
  Annual physicals, screenings, routine labs, and biometric testing without copay or deductible barriers
• Chronic disease management
  Regular follow-up for diabetes, hypertension, asthma, COPD, and other chronic conditions + providers know each patient’s history, medications, and risks
• Mental health support
  Integrated counseling, short-term therapy, or streamlined referral to specialized behavioral health, depending on the model
• Virtual access
  Phone, video, and secure messaging for remote or field-based staff
• Medication coordination
  Guidance on generics and cost-effective options, and in some cases, direct dispensing or pharmacy coordination

Who benefits the most from advanced primary care?

Advanced primary care is especially effective for:

• Government agencies
  State, local, and federal employers with tight budgets that need predictable costs from their advanced primary care program
• School districts and universities
  Teacher and staff retention is critical, and advanced primary care improves both access to care and retention
• Hospitality and service industries
  High turnover environments where healthcare benefits actually influence retention decisions
• Manufacturing and logistics companies
  Workforces with physically demanding jobs and higher injury rates benefit from accessible primary care
• Mid-sized employers (100–2,000 employees)
  Large enough to negotiate direct partnerships, nimble enough to pivot quickly
• Self-funded employers
  Those already assuming the financial risk of health spending want to reduce that risk with advanced primary care

Advanced primary care does not replace health insurance. It works alongside your health plan – most often a  self-funded, or level-funded arrangement that covers hospital and specialty care while advanced primary care covers day-to-day primary care needs. specialty care while advanced primary care covers day-to-day primary care needs.

The underlying problem with traditional healthcare plans

Rising costs with limited access

Premiums for employer-based family coverage have risen steadily and are now close to the price of a new car each year. Yet employees still wait weeks to see primary care providers and face significant out-of-pocket costs when they do.​

Chronic disease is driving spend

Chronic and mental health conditions account for about 90% of healthcare expenditures in the United States. Diabetes, cardiovascular disease, arthritis, and similar conditions each carry direct costs in the hundreds of billions of dollars annually and are major drivers of employer claims.

Traditional plans do little to change this trajectory. They pay for care when the problem is serious, but they do not structurally reward early intervention.

Employees avoid necessary care

High copays and deductibles cause employees to make financial decisions about whether to see a doctor. A primary care visit might be $100-150 out-of-pocket, while an emergency department visit can easily exceed $1,500. When access is inconvenient and expensive, people wait. By the time they seek care, it is often in a high-cost setting.

Administration and uncertainty

HR teams spend significant time handling claims issues, appeals, and plan renewals. Finance leaders prepare for 6-10% increases each year without much control over drivers.

Coverage without access

On paper, employees have insurance. In practice, long waits, complex networks, and out-of-pocket costs discourage use, especially for preventive and chronic care.

Advanced primary care is designed to attack these specific failure points — access, prevention, and chronic condition control — rather than just financing the status quo.

How advanced primary care changes the incentives

Advanced primary care changes who you pay, how you pay them, and what they are accountable for.

In an advanced primary care model, employers pay a predictable per-member fee, rather than paying per visit. This removes the incentive to bill for volume and reduces the administrative burden of fee-for-service claims, so clinicians can focus on members and outcomes. When the model is focused on the member, rather than generating claims, clinicians can focus on:

• Same- or next-day access
• Longer, more comprehensive visits
• Preventive care and risk reduction
• Proactive chronic disease management
• Coordinating specialty and hospital care when needed

This model rewards early contact, regular follow-up, and better control of chronic conditions.

Real-world data from employer advanced primary care models points in the same direction, even across different settings. Studies of both onsite and near-site primary care models have shown great results.  Although both models increase utilization, studies show that near-site models deliver stronger access and higher utilization than on-site models, delivering even more value. Both models show substantial reductions in urgent care and emergency department visits, and fewer hospitalizations, along with lower total spending in most categories.​

In one employer-sponsored comprehensive primary care program, use of onsite and near-site clinics was associated with 33% lower emergency department spending and 16% fewer hospital visits, despite higher primary care use, demonstrating how shifting care into advanced primary care settings can reduce overall costs and risk.

Employees actually start to use their benefits as intended: early, often, and in the right setting through advanced primary care. That is where cost and risk begin to move in a measurable way.. That is where cost and risk begin to move in a measurable way.

Fewer emergency room visits

Primary care visits are far less expensive than emergency department visits. When Primary care visits are far less expensive than emergency department visits. When employees have rapid access to primary care, they use the ER less for non-emergencies.

Comparing typical employer-paid costs

• Emergency department visit in a large employer plan: around $2,500 per visit on average (plan + member combined)
• Primary care office visit in a commercial plan: roughly $100-$150 allowed amount for a mid-level visit
• Advanced primary care membership: ranging from $50-$200 per employee per month for unlimited primary care access, depending on services and geography

For example, if a 500‑employee group prevents even 50-100 avoidable emergency department visits per year at roughly $2,500 per visit, they will avoid about $125,000-$250,000 in annual plan spending, while shifting that care into a predictable advanced primary care budget.

Better chronic disease management

Chronic diseases account for the majority of employer health spend. They respond best to consistent, coordinated primary care.​

With regular visits and ongoing monitoring, employees with diabetes, hypertension, obesity, and other chronic conditions:

• Have more stable lab values and blood pressure readings
• Stay on evidence-based therapy with timely medication adjustments
• Receive coaching on nutrition, activity, and other risk factors
• Get complications identified and treated early

Studies of advanced primary care show significant reductions in hospitalizations and acute events among chronically ill members, with measurable improvements in biometric risk markers across large populations.​

A single avoided diabetic hospitalization or cardiac event can save tens of thousands of dollars. Advanced primary care increases the odds that those events are avoided or delayed.

Reduced absenteeism and improved productivity

Poorly controlled chronic conditions and delayed care drive absenteeism and presenteeism. Both are expensive.

Chronic illness, pain, and mental health conditions significantly increase missed workdays and limit performance while on the job. When employees can see a clinician quickly, get ahead of problems, and access behavioral health support, they take fewer sick days and are more effective when present.​

Advanced primary care programs that track productivity routinely find hundreds of dollars per engaged member in avoided productivity losses on top of direct medical savings.

Lower pharmacy and specialty costs

Advanced primary care teams are positioned to:

• Choose cost-effective medications when multiple options exist
• Guide patients toward generics and clinically appropriate alternatives
• Coordinate referrals so that specialty care is targeted and necessary

Given that pharmacy and specialty costs are high-growth components of employer healthcare spend, even modest improvements can meaningfully affect the trend line.

Preventive care becomes routine

Under traditional plans, copays and deductibles often deter preventive visits. With advanced primary care, primary and preventive care through the partner is typically available with no out-of-pocket cost.

Employees gain:

• Annual physicals without delay
• Biometric screenings (blood pressure, glucose, cholesterol)
• Age-appropriate cancer screenings
• Early support for stress, anxiety, or other behavioral health needs

Early detection and steady monitoring lead to better survival and lower costs over time.​

Faster, more thoughtful visits

The common experience of waiting weeks for a 15-minute visit is replaced by:

• Same- or next-day access
• Visits long enough to address context, not just a single symptom

When care is convenient and unhurried, people are more likely to use it and to follow through on care plans.

A clinician who knows the employee

In advanced primary care and other direct care models, clinicians typically manage smaller patient panels than in traditional practices. That allows clinicians to:

• Know patient histories without re-reading charts at every visit
• Recognize risks early based on patterns over time
• Coordinate specialty care so it complements primary care rather than duplicating it

Patients with strong, continuous relationships with their primary care team have better outcomes and more efficient care use.

Behavioral health is integrated

Many advanced primary care models include counseling and behavioral health services within the primary care relationship. Burnout, anxiety, depression, and chronic stress are handled as part of care instead of being referred out into long queues.

For high-stress fields such as education, government, and hospitality, this is a material change.

Impact on retention

Advanced primary care improves retention in two ways:

• It raises the perceived value of benefits because employees can actually use them.
• It improves health and stability, which keeps experienced employees in the workforce longer.

Government and education employers that add onsite or near-site primary care report measurable improvements in retention and satisfaction, with clear savings from avoided recruiting, onboarding, and lost productivity.

This is a multi-year strategic relationship. Treat the selection process with the same discipline as a major technology or capital investment.

Key evaluation areas:

• Clinical model and staffing: Panel sizes, clinician mix, use of care teams, and integration of behavioral health
• Access footprint: Onsite, near-site, network, and virtual options that match where your employees work and live
• Proven performance: Published case studies, third-party analyses, or claims-based results demonstrating cost reductions, utilization shifts, and health improvements
• Data and transparency: Regular reporting on key metrics and openness about methodology
• Contract terms: Reasonable commitment periods, clear exit clauses, and alignment on performance expectations

Ask pointed questions about expected engagement among high-risk members, predicted changes by cost category, and how they will support your internal communications.

Advanced primary care is already reshaping costs and access for employers. Below are three case studies of government, manufacturing, and high‑risk populations.​

Public-sector employer: bending the cost trend

A county government employer facing an expected 8% annual health plan trend implemented an advanced primary care program for its workforce. Within the first year, the plan:​

• Turned the projected 8% increase into a 2.4% decrease in per-employee-per-year (PEPY) costs, a swing of roughly 10.5 percentage points across the full population.
• Generated about $70,000 in net savings in year one and more than $200,000 in combined employer and employee savings, while achieving 80% engagement and a 95+ NPS from members.

Industrial employer: fewer acute visits, multimillion-dollar savings

A large industrial manufacturer struggling with high ER and urgent care use added community-based advanced primary care centers for employees and families. Over three years, with about 30% of eligible employees enrolled, the program delivered:​

• 83% fewer emergency room visits and 80% fewer urgent care visits among advanced primary care members
• $2.32 million in net healthcare savings (about $7,420 lower PEPY costs for enrolled members) plus more than $540,000 in out-of-pocket savings for employees.

High-risk population: pharmacy-driven savings with partial enrollment

A retail employer with a high-risk, aging population introduced an advanced primary care and pharmacy services model, with only about 20% of 200 eligible members enrolled. Even at that enrollment level, the plan saw:​

• 45% lower total per-employee-per-year costs for enrolled members compared with non-enrolled peers
• Nearly $200,000 in total savings across the health plan, driven by better chronic disease management, medication optimization, and coordinated primary care