How do you sell direct primary care to employers?
You sell direct primary care to employers by solving a problem they already feel, which is that their people can't get in to see a primary care doctor quickly and their health plan costs keep climbing. The usual buyers are self-funded employers and the brokers and third-party administrators (TPAs) who advise them. The deal itself is simple, a flat monthly fee per enrolled member or per eligible employee, written into a contract that covers eligibility files, enrollment windows, reporting and how either side can leave. Employer sales are already a large share of DPC, and Hint Health's 2026 report found that nearly 60% of memberships on its platform were employer-paid in 2025.
This guide walks through who buys, how employer pricing usually works, the contract terms that save you trouble later, how DPC fits HSA plans and ICHRA under the 2026 rules, and what the outcome evidence honestly says. If you are still at the planning stage, the 2027 guide to starting a DPC practice covers the groundwork first.
Why employers are paying attention in 2027
Employers are under real cost pressure. KFF's 2026 Employer Health Benefits Survey, released in October 2026, found that average family premiums rose 5% in a year, and that workers' own contributions toward family coverage rose 9%.
In dollars, KFF reports the average total family premium reached $28,303 in 2026, with workers paying $7,471 of it, and the average single-coverage deductible was $1,955.
KFF's press release on the survey also notes that 44% of large firms said they raised the share of premiums workers pay to deal with higher projected costs, and 21% raised deductibles or other cost sharing. That is the backdrop for every employer conversation you will have. Benefits leaders are being asked to hold costs down without making the plan feel worse to employees, and a DPC membership that makes primary care easy to reach is one of the few things they can add that employees notice right away.
Who buys DPC for employees?
Four kinds of buyer come up in employer DPC deals: self-funded employers, the brokers and benefits consultants who advise them, TPAs and health plan partners, and small businesses paying for their own staff.
Self-funded employers
Self-funded employers pay their employees' claims directly, usually with a TPA processing claims and stop-loss insurance covering large losses. Because every avoidable claim is their own money, they have both the motive and the freedom to carve primary care out and pay a DPC practice directly. Fully insured employers can buy DPC too, but the money they spend on memberships sits on top of a premium that does not shrink when claims fall, so the conversation is mostly about access and recruiting rather than plan savings.
Brokers and benefits consultants
Most mid-sized employers do not shop for benefits on their own. A broker or consultant sets the plan design and brings options to the renewal meeting, so one good broker relationship can open many employers. Brokers want to know that you can handle enrollment without creating work for them, that you report cleanly, and that their client's employees will actually be seen quickly.
TPAs and health plan partners
TPAs administer self-funded plans and send the eligibility files you will rely on. Some TPAs and regional plans build DPC into a plan option, sometimes with a lower deductible for members who use the DPC practice. Even when the TPA is not the buyer, it is worth meeting them early, because their file formats and timelines decide how smoothly enrollment runs.
Small businesses paying directly
Small employers, often under 50 people, sometimes simply pay the membership for each employee as a perk. These deals are smaller but faster, and they often come through word of mouth from employees who are already members.
How much do DPC practices charge employers per employee?
Employer pricing usually sits below retail pricing, because a group brings many members at once and pays reliably.
Hint Health's Trends in DPC 2026 report put the median employer-sponsored membership at $65 a month in 2025, compared with $99 for a retail individual membership.
That gap is normal, and it is a pricing decision rather than a discount you owe anyone. Our guide on how much to charge for DPC membership shows how the two medians have moved over time, and the break-even panel size guide helps you check that a lower employer rate still works at the panel size you can care for.
Common DPC employer pricing models
| Pricing model | How it works | Works well when | Watch out for |
|---|---|---|---|
| Per member per month (PMPM) | Flat monthly fee for each enrolled employee and dependent | Enrollment is voluntary and you want to be paid for who actually joins | Monthly reconciliation as people join and leave |
| Per employee per month (PEPM) | Flat fee for every eligible employee, enrolled or not | The employer wants a predictable budget and high enrollment | Low enrollment makes it feel expensive to the employer later |
| Age-banded rates | Different monthly fees for children, adults and older adults | The workforce mixes young families and older workers | A slightly harder invoice to explain |
| Employee-only plus family tiers | One rate for the employee, another covering spouse and children | The employer offers dependent coverage | Make sure each tier stays at or under the HSA fee cap if HSA plans are involved |
| Hybrid with a minimum | PMPM with a minimum monthly floor or a small setup fee | Groups with uncertain enrollment | Keep the floor modest so it does not stall the deal |
Most practices keep the fee flat and not tied to how often members visit. Pegging the price to utilization brings back the claims logic DPC is meant to replace, and it gives you a reason to wish people would come in less, which is the opposite of the model. If an employer wants protection, a short initial term or a reopener after twelve months is a cleaner answer.
What should a DPC employer contract include?
A good employer contract is mostly about the plumbing, who is eligible, how you find out, when you get paid and how the relationship ends. These are the terms worth having in writing before the first employee enrolls.
| Contract term | What to spell out | Why it matters |
|---|---|---|
| Eligibility file | Who sends it (employer, TPA or broker), format, and how often (weekly or monthly) | You can't onboard or bill people you don't know about |
| Enrollment windows | Open enrollment dates, new-hire enrollment, and mid-year changes | Keeps enrollment from trickling in at random |
| Effective and end dates | When membership starts after enrollment and when it ends after someone leaves the job | Avoids caring for people nobody is paying for |
| Pricing and invoicing | Rate per member or employee, tiers, invoice date, payment terms and late fees | Prevents surprises on both sides |
| Services included | What the membership covers and what is sold separately (labs, medications, procedures) | Required for HSA qualification and avoids disputes |
| Capacity and access | Panel limits, new-member intake pace and expected response times | Protects access for current members |
| Reporting | What you report, how often, and in what form (de-identified, aggregate) | This is how the employer justifies renewing |
| Privacy | No individual health information to the employer, plus HIPAA terms where a plan is involved | Protects patients and keeps trust |
| Term and termination | Initial term, renewal, notice period and what happens to members if the contract ends | Gives members a path to stay on as individuals |
| State law compliance | A clause that follows your state's DPC statute | Some states limit what an employer contract can say |
Two of these deserve a little more attention. Capacity limits matter because a 300-person employer can fill a solo panel quickly, and the AAFP reports an average panel of 504 patients in 2025 across all its survey respondents, 53% of them practicing in DPC. Phasing enrollment, or setting a cap per employer, protects the patients you already have. Termination terms matter because employees build real relationships with their doctor, and a clause that lets them convert to an individual membership at your retail rate keeps those relationships intact if the employer ever walks away.
Once a contract is signed, the hard part is keeping enrollment moving. Our guide to tracking employer group enrollment lays out a staged pipeline from first call to the last employee onboarded.
State law matters, and Washington is the clearest example
Before you write an employer contract, read your state's DPC statute. Washington shows why. Under RCW 48.150.050, a Washington direct practice may accept a fee paid by an employer on behalf of an employee, but it "shall not enter into a contract with an employer relating to direct practice agreements between the direct practice and employees of that employer, other than to establish the timing and method of the payment of the direct fee by the employer."
In practice that means a Washington practice can be paid by an employer, but the agreements themselves stay between the practice and each patient, and the employer contract stays narrow. Other states have their own definitions and limits, so check the summary in direct primary care laws by state and have a local healthcare attorney review your template.
How DPC fits HSA plans and self-funded HDHPs in 2027
From January 1, 2026, Public Law 119-21 lets people in a qualifying DPC arrangement keep contributing to a health savings account, as long as the monthly fee stays at or under a cap. IRS Rev. Proc. 2026-24 keeps that cap at 150 dollars a month for one person and 300 dollars a month for a membership covering more than one person in 2027.
For employer sales, three points from IRS Notice 2026-5 come up again and again:
- Employer-paid fees can't be double-dipped. Q-18 says that when the employer pays the DPC fee, including through pre-tax salary reduction in a section 125 cafeteria plan, the employee cannot also reimburse that fee from their HSA.
- The HDHP itself can't pay the membership before the deductible. Q-15 says the rule protects HSA eligibility but does not let the insurance plan cover DPC fees pre-deductible, so the employer pays the membership outside the plan.
- The contract terms decide whether the arrangement qualifies. Q-14 looks at what the arrangement covers, not what members happen to use, so keep labs and medications you sell separately clearly outside the membership.
Our DPC HSA rules for 2027 post goes deeper on the exclusions and paperwork. For an employer, the short version is that a qualifying membership at or under the cap no longer forces a choice between DPC and the company's HSA plan.
Does DPC work with ICHRA?
An individual coverage health reimbursement arrangement (ICHRA) lets an employer give employees a set amount to buy their own individual health insurance instead of offering a group plan. The rules come from the 2019 HRA final rule issued by the Departments of the Treasury, Labor and Health and Human Services, which applies to plan years beginning on or after January 1, 2020.
ICHRA and DPC can work side by side. Public Law 119-21 made Exchange bronze and catastrophic plans HSA eligible from 2026, and Notice 2026-5 (Q-5) says buying one through an ICHRA does not change that. An employer can fund the ICHRA for insurance and pay the DPC membership separately, which gives employees an individual plan for big events and a doctor they can actually reach for everything else. If your patients are choosing plans, our guide on what insurance to pair with DPC walks through the options.
One thing did not change. The House version of the 2025 budget bill would have written ICHRA into law and renamed it the "CHOICE arrangement," but the Senate removed that provision before the bill became law, so ICHRA still runs under the 2019 rule.
How to pitch DPC to an employer
The pitch that works starts with the employer's problems, not with how DPC works. Ask first, then match what you offer to what they tell you.
Lead with access
Ask how long it takes an employee to see a primary care doctor today, and what employees do when they can't get in. Then describe what membership looks like at your practice, such as same-day or next-day visits, direct messaging with the doctor and longer appointments. Be specific about your own access standards and only promise what your panel can deliver.
Talk about time away from work
Employees who can message their doctor or get a short visit near work often lose less of the day to care. Rather than quoting a national absenteeism statistic, offer to track what you can measure for this group, such as visits handled by message or telehealth, and share it in your reports.
Be honest about claims savings
Employers will ask whether DPC lowers their plan costs. The best-known independent study is a 2020 Milliman analysis for the Society of Actuaries of one employer that offered a DPC plan option. After adjusting for health differences, Milliman found that DPC members used fewer services, driven mainly by lower emergency department and other facility use.
The same study estimated the employer's net costs for DPC members were 1.3% higher at the midpoint, within a range from a 5.2% reduction to a 7.8% increase. Part of the reason was plan design, since that employer paid the membership and also waived the medical deductible for all services. Milliman also stressed that people who choose DPC tend to be healthier, so any study has to adjust for who enrolls.
That is a fair story to tell an employer. Utilization can fall, but savings depend on plan design and enrollment, and the way to know for this employer is to measure. Offering a clear reporting package does more for trust than a big savings number ever could.
Make it easy to say yes
Bring a one-page summary, a sample contract, a sample report and a short enrollment timeline. Offer an on-site or virtual open-enrollment session, and a simple sign-up link employees can use from their phones. Brokers especially appreciate a practice that already knows how its eligibility files and invoices work.
What reporting do employers want from a DPC practice?
Reporting is what turns a one-year pilot into a renewal. Keep it de-identified and aggregate, so the employer never sees an individual's health information, and send it on a regular schedule, usually quarterly.
Most employers and brokers want some version of the following:
- Enrollment, the number of eligible employees, enrolled employees and dependents, and the change since last period.
- Engagement, the share of members who have had a visit or a message, and how many have completed a first visit.
- Access, average time to an appointment and how quickly messages are answered.
- Visit mix, in-person, telehealth and messaging, plus the share of issues handled without a referral.
- Services delivered at the practice, such as labs drawn and medications dispensed at cost, with savings estimated only where you can show your method.
- Member feedback, a short satisfaction survey or a net promoter score.
If the employer is self-funded and willing to share claims data through its TPA, an annual look at emergency and urgent care use for members versus non-members can be valuable. Treat it carefully, adjust for who enrolled, and present it as one employer's experience rather than proof.
Running employer accounts without dropping the ball
Employer accounts bring a steady stream of small jobs that live between your tools. Eligibility files arrive from a TPA, new hires need welcome messages, terminated employees need a conversion offer, invoices need reconciling against enrollment, and quarterly reports need data from your EHR, billing and messaging. None of these are hard, but they are easy to lose when they sit in five different places.
Tabflows is a dedicated tech team that connects the tools a clinic already uses, such as the EHR, billing and messaging, so the work between them gets done, with tasks, follow-ups and patient context in one place. For employer groups that means the new-hire welcome, the termination follow-up and the quarterly report each have an owner and a due date instead of living in someone's inbox.
Where to go next
Selling DPC to employers works best when the basics are already solid, a price that covers your costs, a panel with room to grow and a contract that follows your state's law. From there, start with one or two self-funded employers or a broker who already believes in primary care, measure carefully and let the reports make the case at renewal. If you want to see how other practices in your area are positioned, the DPC Finder lists every DPC practice we know of.
FAQs
How do you sell direct primary care to employers?
Start with self-funded employers and the benefits brokers and third-party administrators who advise them. Lead with the employer's own problems, such as slow access to primary care, time away from work and rising plan costs, then offer a simple per-member or per-employee monthly fee, a clear contract with eligibility files and reporting, and an easy enrollment process. Hint Health's 2026 report found nearly 60% of memberships on its platform were employer-paid in 2025, so this is a large and established part of the DPC market.
How much do DPC practices charge employers per employee?
Practices price employer groups per enrolled member per month, per eligible employee per month, or with age bands, and most keep the fee flat rather than tied to how often members visit. Employer rates usually sit below retail, because a group brings many members at once and pays reliably. Hint Health's Trends in DPC 2026 report put the median employer-sponsored DPC membership at $65 a month in 2025, compared with a $99 median for retail individual memberships.
Can an employer pay for DPC if employees have an HSA?
Yes, from 2026. Public Law 119-21 lets people in a qualifying DPC arrangement stay HSA eligible if the fee stays at or under the monthly cap, which IRS Rev. Proc. 2026-24 keeps at 150 dollars for one person and 300 dollars for more than one person in 2027. IRS Notice 2026-5 (Q-18) adds that when the employer pays the fee, including through a section 125 cafeteria plan, the employee cannot also reimburse it from their HSA.
Does DPC work with ICHRA?
It can sit alongside one. Under the 2019 federal rule, an individual coverage HRA lets an employer reimburse employees for individual health insurance they buy themselves. Many employees with an ICHRA buy bronze or catastrophic plans, which Public Law 119-21 made HSA eligible from 2026, and IRS Notice 2026-5 (Q-5) says buying one through an ICHRA does not change that. The employer can then pay the DPC membership separately. A proposal in the House version of the 2025 budget bill to rename ICHRA as CHOICE arrangements was removed before the law passed.
Does DPC save employers money?
The evidence is mixed and depends on plan design. A 2020 Milliman study for the Society of Actuaries found lower risk-adjusted use of services, mainly emergency and facility care, for one employer's DPC enrollees, but the employer's net costs came out 1.3% higher at the midpoint, within a range of a 5.2% reduction to a 7.8% increase, partly because the employer also waived the deductible. Honest pitches focus on access and measured results rather than guaranteed savings.
Do state DPC laws limit employer contracts?
Some do. Washington's RCW 48.150.050 lets a direct practice accept a fee paid by an employer on behalf of an employee, but it bars the practice from contracting with the employer about the employees' direct agreements other than to set the timing and method of payment. Check your own state's DPC statute before you write an employer contract.