Direct Health Care: a Proven Model in Montana

Imagine Alaskans’ having better access to affordable, individualized health care. Costs can go down, even as more Alaskans increase their access to the providers they need. This future will require multiple changes in policy and attitudes, but one reform that should play a big role is protecting the direct health care (DHC) model, sometimes known as direct patient care (DPC).

DHC involves a contractual agreement between a patient and a provider for health care services in the form of a membership or subscription. It eliminates the price-distorting influence of third parties like insurance companies for basic care, and, instead, allows patients to pay flat (typically monthly) fees for routine visits with and regular access to their providers without having to worry about unforeseen bills.

DHC does not rely on health insurance or cost-sharing groups and should be legally classified differently. With inappropriate regulation out of the way, services can flourish. In Montana, for instance, legislation protecting DHC practices fostered a boom across the state, producing better health care access and lowering costs for Montanans. Alaska should do the same.

Montana passed its legislation, SB 101, in 2021, authorizing direct patient care agreements. The law establishes that DHC is not health insurance, while making the agreements subject to consumer protection laws. Prior to that, the DHC model existed under Montana regulation but was not protected by statute.

Now, the state has at least 17 DHC providers, according to the Frontier Institute, including primary care doctors, naturopaths, nurse practitioners, and pharmacists. One DHC team/facility focuses specifically on diabetes care and management, while another DHC provider visits patients in their homes or other locations — increasing access to the kind of individualized, affordable care many people need.

Since the implementation of SB 101, Montana’s average monthly membership fee for DHC is just $77 for comprehensive primary care. The Frontier Institute estimates that Montana’s DHC industry provides approximately “5,000 Montana patients with affordable, high-quality health care.”

If the direct care model were to work as well in Alaska as it does in Montana — and why wouldn’t it? — thousands of our neighbors would benefit immensely. The model has been proven in Montana, and Alaska should join the movement to usher in this innovative approach to delivering health care.