Healthcare2U (HC2U) commissioned Milliman to assess the potential financial impact of its DPCadvantage program on employer healthcare costs. DPCadvantage is a hybrid direct primary care (DPC) model that employers purchase on a per-employee basis, offering care via both in-person and telehealth appointments. The model presumes a meaningful share of routine, avoidable, and manageable healthcare utilization currently flows through traditional fee-for-service claim pathways at unnecessarily high cost, and that a well-designed primary care access and navigation infrastructure can redirect a substantial portion of that utilization into lower-cost settings before expenses escalate. By increasing access to primary care through 24/7 primary care availability, $0 visits for primary care and chronic disease management, urgent care coverage, as well as other key product features, HC2U believes it can reduce the overall cost of healthcare for employers.

Milliman used its proprietary Consolidated Health Cost Guidelines Sources Database to randomly simulate employer groups. Select groups were then combined to create three cohorts for the analysis (low risk, average risk, and high risk) in order to study how cost deflection results could vary based on different employer risk profiles. Healthcare services that could plausibly be deflected by HC2U's program were identified in each cohort and corresponding subsets, and HC2U's assumed deflection percentages were applied to the deflectable services to estimate potential employer savings.

Key findings:

• After deducting HC2U's program fee, estimated net deflected costs were between $3 and $24 per patient per month (PMPM) across the low, average, and high-risk cohorts, representing between 0.6% to 3.4% of total employer paid claims costs.
• For the average risk cohort, net deflected cost was $18 PMPM—approximately 3.1% of total employer costs—resulting in a hypothetical return on investment of 1.4 to 1.
• Across all three risk cohorts, cost deflection PMPM was higher for member subsets having at least one focus condition, and lower for subsets with no focus conditions.
• Estimated net deflected costs for members with at least one focus condition were between $23 to $54 PMPM, representing between 3.2% to 4.4% of total paid costs.
• For members with no focus conditions, there were no savings. Rather, employer costs are estimated to be $6 to $17 PMPM higher through the HC2U program than costs through traditional healthcare providers.

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