An increasing number of providers and patients are participating in direct primary care. It’s not insurance, but rather a business model where patients can purchase a membership, allowing them unlimited access to certain primary care services.
Dr. Kyle Rickner is the co-founder of Primary Health Partners, which is Oklahoma’s largest direct primary care provider. StateImpact’s Jillian Taylor spoke with him about the growing model, which also benefited from President Donald Trump’s 2025 megabill.
TRANSCRIPT:
Jillian Taylor: Dr. Rickner, thank you so much for joining me.
Dr. Kyle Rickner: Well, thank you for having me. I appreciate it.
Taylor: I wanted to start by asking you a little bit about your background. How did you get into this?
Rickner: Well, I'm a family physician by education and training. I was a doctor in the U.S. Army, and then later went into corporate medicine, where I was for 10 years. That's where I was practicing when I learned about the direct primary care model. Literally the day I heard about it, I said, “We have to make this change. We got to go there.”
Taylor: What is direct primary care?
Rickner: Just to keep it simple, let’s just say there's three key tenets of direct primary care. The first tenet is the payment is a flat monthly fee. Think of it like a gym membership, if you will, a medical gym membership. It depends on the region, but roughly the average around the country is about $90 a month. The second tenet is that the physicians have much smaller panels. So typically, we're taking care of about a third to a fourth of the number of patients we did in the traditional model. And then the third, and very important, tenet is the physician is available 24-7 to those patients.
Taylor: What do folks do in the case of specialty and emergent care?
Rickner: Those services are accessed the way they are right now. So those are usually accessed through their payment source, whether that's their insurance or their Medicare. We can certainly refer to anybody and send them for any hospital services that they may need. And so if they need higher levels of care, specialty care, they're able to access that. You're right, the direct primary care model only covers primary care, but it's not a replacement for the insurance or catastrophic coverage. So, the mistake we've made in the U.S. is that insurance is really only meant to be for two things, and that's the unexpected and the costly. And in health care, we've decided it should pay for everything, and that's made it atrociously expensive, and it's driven up the cost of everything. So, if you still have that insurance in place, primary care is neither unexpected nor expensive. So, it really shouldn't play in our space. But when they have to have, unfortunately, that heart surgery or some big procedure, then absolutely, they need that coverage for that.
Taylor: And primarily, what populations are using direct primary care?
Rickner: It's really a diverse group. I think one of the things that has surprised me over the decade of us doing this is currently in our practice, 22% are Medicare. And then about 15% are kids under the age of 18. And we get people from literally every socioeconomic status and area.
Taylor: And so what does the presence of direct primary care look like in Oklahoma?
Rickner: I like to tell people that when we opened in January of 2016, we were doctors number three and four in Oklahoma. Now we're approaching 150 doctors in Oklahoma and literally growing every month.
Taylor: What do you think is driving that?
Rickner: Honestly, the frustration around the current system. It's very broken. It's very frustrating for patients, but it's so frustrating for doctors. And doctors really go through a process of what I refer to as moral injury. It's this, ‘I'm trying to do the right thing by patients, and there are so many external forces fighting me on that,’ that that fight just gets so wearisome. The direct primary care model literally gets rid of 95% of those problems and frustrations and allows doctors and patients to thrive in that doctor-patient relationship again.
Taylor: I do want to ask, because my understanding is there are critics of this model, right? And some of them have said this is concentrated in a certain area, and maybe taking physicians out from people who have traditional insurance. How would you respond to that?
Rickner: We are currently in a critical physician shortage, especially in primary care, all over the United States. Oklahoma is particularly in a bad situation where a large percentage of the physicians are going to retire in the next decade, and leaving people underserved to be looking for a physician. And so people say, ‘Well, if you're taking care of a panel that's a fourth the size of a normal physician, then you're going to make the shortage even worse.’ And I understand where they're coming from on that argument. I know that when I left the system, my panel attributed to me was 3,500 patients. Now, I can't look at you and say I had a great relationship with 3,500 patients. That is just not the case. I could not even say that I was caring for 3,500 patients. So, I would say the number of patients that we get to care for is actually increased. There's a difference between caring for a patient and a patient being a statistic on a panel.
The other two things about addressing the physician shortage that are so important: we had historically seen that, especially primary care doctors, will work well past what we normally accept as retirement age. They sort of accepted it as a calling, it's an identity, it's part of what they do. However, the hassles and frustrations have dictated otherwise. So we have systematically been losing doctors earlier and earlier and earlier, which adds to the shortage. In direct primary care, when you remove so much of the frustration, and stress and workload, the work life can greatly extend.
Secondly, on the front end of it, we have the lowest number ever of medical students who are choosing to go into primary care training. And so now, when we expose them to what it can look like on the direct primary care side, they all of a sudden get excited about going into primary care.
So, we should be able to create over time an infusion of younger doctors wanting to do this, and then the current physicians going longer and actually caring for the people that are in those panels.
Taylor: Well, and there's been a change recently through the One Big Beautiful Bill Act that allows direct primary care membership fees to be covered by health savings accounts. Tell me what's changed and what that means.
Rickner: So, going all the way back to 2015, we actually were aware of this IRS tax code that did not allow for HSA usage on membership fees. So there were about 60 million Americans who were excluded from the direct primary care benefit. Well, what they did in the Big Beautiful Bill was basically obliterate that clause in that IRS tax code so that companies that have an HSA qualifying plan can now pair direct primary with it, which is actually a really good benefit marriage. It's limited to $150 a month for an individual or $300 a month for a family.
Taylor: Well, thank you so much for speaking with me.
Rickner: Thank you for having me. I appreciate it.
This transcript has been edited for clarity and length.
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