How to Insure Your Direct Primary Care Practice?

How to Insure Your Direct Primary Care Practice

A guide to malpractice and liability coverage for the direct primary care model

Direct Primary Care (DPC) is rapidly evolving from a niche healthcare model into a broader form of membership-based primary care. The global DPC market is now valued at roughly $64.5 billion to $67.8 billion, and it continues to expand as patients and employers pay a predictable monthly fee directly to physicians for routine care. Thus, reducing reliance on traditional fee-for-service insurance.

More than 3,000 DPC practices now operate across the U.S., while thousands of self-funded employers have incorporated DPC into their benefits.

What DPC Practices Provide

DPC practices offer preventive care, chronic disease management, wellness and integrative services, and other primary care through a direct patient relationship. Physicians entering the model come from specialties including family and general practice, internal medicine, and pediatrics.

Endocrinologists, hematologists, and gastroenterologists are especially common among the specialists delivering chronic disease management and structured wellness programs within this model.

Some physicians establish focused, concierge-style practices for a select membership population, while others participate through larger networks or as part-time or “side gig” physicians.

Why DPC Practices Need Specialized Insurance

Although DPC membership agreements are generally distinct from traditional health insurance, physicians remain exposed to professional liability risks arising from patient care. The challenge is finding direct primary care Medical Malpractice Insurance that accurately reflects how the practice actually operates.

DPC can combine conventional clinical primary care with chronic care management, integrative wellness, and even aesthetic services and telehealth. This combination can make underwriting, insurance rating, and coverage considerably more complex than for a conventional practice.

The good news: there are carriers actively leaning into this niche and developing insurance products purpose-built for the DPC model, rather than forcing it into a standard primary care risk category.

For that reason, it is important to work with an insurance carrier that understands the DPC model and can evaluate the complete range of services rather than treating the practice as a standard primary care risk.

What differentiates Admitted vs. Surplus Lines Coverage

The insurance market for DPC practices can involve both “admitted” and “surplus lines” policies. The appropriate option depends on the practice's structure, location, specialty, and expansion plans. 

For a physician practicing within a single county or state, an admitted policy tailored to the relevant specialty may be appropriate. A DPC organization expanding through interstate telehealth can face more varied regulatory requirements, making surplus lines coverage an important consideration.

Depending on the arrangement, combining both coverage approaches can also help address cyber privacy liability and other technology-related exposures.

How DPC Networks and MSOs Are Reshaping the Market

The growth of DPC has produced larger centralized organizations and Management Services Organizations (MSOs). Platforms and networks such as Hint Health, Marathon Health, and Everside Health can support functions including billing, employer contracting, network navigation, technology, and compliance.

Aggregating “Side Gig” Doctors and the Malpractice Question

Other network aggregators, such as Healthcare2U, or Authonomy DPC,  build regional or national provider arrays by contracting with independent and part-time primary care physicians. This allows physicians, including those participating in DPC as a side practice to serve regional or national employer groups without becoming employees of one centralized medical organization.

These arrangements also create an important insurance distinction. DPC networks generally do not become risk-bearing health insurance entities simply by organizing or administering DPC services. In more than 35 states, qualifying DPC membership agreements are specifically recognized as clinical service arrangements rather than health insurance.

Is DPC Legal? What Corporate Practice of Medicine Rules Mean?

DPC is legal, but organizations must still comply with applicable state laws. More than 35 states have enacted laws addressing DPC membership arrangements and establishing that qualifying agreements are not health insurance, generally removing them from traditional state insurance commissioner oversight.

Corporate Practice of Medicine (CPOM) rules create another consideration for larger DPC organizations. Where applicable, non-physician entities cannot own medical practices or control clinical judgment.

An MSO structure can address this separation by providing administrative, credentialing, technology, and other business services while independent professional medical corporations retain responsibility for patient care and clinical decisions.

Choosing the Right DPC Insurance

Whether you are establishing a standalone DPC practice, joining a network, adding telehealth, or expanding across state lines, your DPC malpractice insurance should reflect the actual risks of your practice.

Look for an insurance carrier that understands:

•      Your specialty and complete range of clinical services

•      Chronic care, integrative wellness, and aesthetic services

•      Telehealth and interstate operations

•      Cyber Privacy and technology exposure

•      MSO or network arrangements

•      The underwriting and rating considerations unique to DPC

The Doctors' Insurance Agency has been providing professional liability insurance for three decades. As healthcare delivery evolves, insurance products must evolve with it. For DPC physicians, the objective is therefore not simply to purchase direct primary care practice insurance, but to obtain coverage from a carrier that understands the model well enough to properly evaluate its risks and coverage needs.