Types of primary care services

Primary care services are now offered through an increasing number of venues and providers, including:

Traditional community PCPs generally offer in-person visits, and can perform laboratory and other tests, although their hours are often limited to the business day. Many also now offer virtual visit options. They are usually paid through the health benefit plan, and the payment model is usually fee-for-service.
Virtual primary care (VPC) is increasingly offered by health plans and by third-party vendors, and allows for patient care anywhere in the country. Virtual primary care providers are often licensed in multiple states; they are generally paid through a combination of population fees (a per-participant, per-month cost) and fee-for-service for services delivered. While VPC is gaining traction, state regulations affecting licensure, prescribing practices and payment could impact access over the coming years.
Direct primary care is offered by PCPs who do not participate in insurance. Patients or their employers pay a monthly or annual fee that covers all PCP professional services and can cover a limited set of laboratory tests. Members still need a health insurance plan because over 90% of medical expenses would not be covered by a direct primary care plan, including diagnostic tests, specialty care and hospitalizations.
Membership practices charge a modest annual fee (around $200 per participant) and provide virtual care nationwide and in-person care in cities where they have offices. They generally bill an access fee to employers and fee-for-service for care delivered.
Concierge practices charge a substantially higher fee (often $2,000 or more per participant per year), and each clinician takes care of a small number of patients and offers enhanced access, often including a physician's cell phone number. They generally bill fee-for-service to health insurance for care delivered in person at their offices, and their fees are rarely subsidized by employers.
Onsite/near-site clinics can offer primary care to employees at high-density worksites, although they usually do not provide care for dependents or children. Onsite clinic vendors also offer virtual primary care, providing a hybrid model with in-person and virtual options. These clinics usually charge the employer for operating costs and do not charge for individual patient encounters.
Retail clinics generally offer acute care, although some also offer primary care and mental healthcare. Some also provide ongoing care for chronic diseases. Most are staffed by advance practice clinicians, are paid fee-for-service and participate in employer-sponsored health insurance.
Executive physicals are generally offered only to executives, and sometimes include tests that are not evidence-based. They can cost from $2,000 to over $10,000 per year, and generally do not provide ongoing primary care.

See also: Why is Congress watching these two drivers of rising healthcare costs?

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