Listen to the podcast here: Preparing for Growth in 2026
Summary: The hosts explain how new Medicaid cuts and reduced insurance subsidies will cause premium hikes, pushing some families away from DPC practices while attracting more who need affordable care. They advise focusing on outreach to new patients rather than retention. The episode encourages DPC practices to highlight their value and use social media to share their services. Overall, these changes are seen as a chance for growth and to help more families.
Welcome to DPC Pediatrician. We’re Dr. Phil Boucher and Dr. Marina Capella, two DPC Pediatricians who are on a mission to share our love of direct primary care with you.
Welcome everyone to another episode of DPC Pediatricians. Phil and I today are… Going to have an interesting conversation about a few things that might be on the horizon that may be affecting all of us in the DPC community. So as we know, a couple of months ago, Congress passed the One Big Beautiful Bill Act.
And in that was rolled in a lot of cuts to Medicaid. There were some DPC provisions that were actually beneficial for us DPC doctors. But also there’s going to be a loss of subsidies to a lot of marketplace plans, health insurance plans that a lot of families rely on. And so it is anticipated that health insurance rates,
especially through the marketplace, are going to take a big jump next year. So a lot of families are going to be looking at And they’re going to be trying to make the decision. Is it worth it to keep paying for health insurance if my premium is going to jump so much or can I do without?
And also other families who really do need that insurance and they’re having to fork out a couple extra hundred dollars a month for their plan, they’re going to be looking at their budgets and they’re going to be having to make hard decisions. If they already are members of a DPC practice, they might be saying,
is it worth it to continue paying our DPC membership? So, Phil… I’m interested to hear your thoughts on how do you think these things are potentially going to affect us as DPC pediatricians and what can we do to kind of anticipate those possible changes?
I was thinking about this and I think it’s a double-edged sword. As you said, on the one side, like a lot of people are going to see a huge increase in their insurance premiums. And if they’re in the marketplace, that means that they’re not getting it from their employer,
which means they have to send that check in themselves and they can just stop doing that if the rates are high and then go without. And so then they might be the ones that say, hey, We don’t have a way to make sure our two month old is growing well and we can’t
afford a doubling of the price of our marketplace plan. So let’s find a cost effective opportunity like direct primary care. And so that will be the opportunity then to say, hey, we help families that are uninsured, underinsured, have really high deductibles to get affordable health care.
and to have all the fringe benefits of the direct primary care practice that you never got to experience in the fee for service model anyways. And it’s this price per month. I think that will be the driver for most DPC practices. On the flip side, like you said,
there may be families that are already in the marketplace that then say, well, we have to have insurance. and we need to cut costs. And so we’re going to abandon the DPC that we love and go to the fee-for-service practice that we will have to tolerate because our healthcare jumped so high. Obviously those are two separate buckets,
but I think the bucket full of more people joining the pool of potential DPC practices will outweigh the small number in your own individual practice that are gonna say we have to cut costs. And so my time would be focused on finding more of those new families that are
going to be wanting something different rather than trying to spend a lot of time and mental energy figuring out how to help those that are going to see the insurance premium hikes that force them to look closely at their budget. And so I think in the big picture,
I’d be focused on how can I grow more versus how can I prevent churn? Because frankly, if their healthcare costs are going to double, then you as a DPC practice are going to be a very small blip in the cost of their, their premiums.
And that’s either going to mean that they’re not going to see that it’s valuable enough compared to paying $2,100 more per month versus 22 and a half more total that that’s not going to be as big of a blip or there’s going to be so much that
there’s nothing that you could do to keep them in your practice. Does that make sense?
Absolutely. Yeah. And I agree. I think it becomes really difficult to try to figure out ways of keeping people who have already decided to leave. Right. That’s not to say that you can’t do anything. Well, this last year I had upped my prices and I sent emails to families and Saying, hey, these are the price increases.
And there was a paragraph in there that said, if you’re experiencing financial hardship for whatever reason, you really want to stay on as a member, please reach out to me and we will try to figure out a way to make it work. Right. We are all human. We want to be like. Right.
We really love, I would say, all of our families, if not most of them, right? And so we want to keep them in general. And so it’s up to you as the business owner to say, oh, I can extend a discount to this family who’s been really loyal, who maybe doesn’t have that many needs,
is not a high utilizer. If you want to cut their rate to help them out, that’s up to you, right? But you can spend a lot of emotional energy and time trying to desperately hold on to families. And that may not be the best investment of your time when there are going to be all
of these new families that are ripe and ready for what you have to offer. And so I agree with your message, Phil, of like, hey, let’s try to see how can we funnel some energy into capturing those families who are going to be ready for us, right?
And who we’re going to be able to help in this new way that they’ve never experienced before. Right.
Totally. And it’s not like I mean, we’re like ready and raring to go. We know how to provide more cost effective health care than you’ve experienced before. And so like it’s the model for them and it’s going to be really attractive to them.
You’re not going to have to be trying to sell yourself or like all these little things of am I good enough for them or how can I sweeten the deal? They’re going to say, holy moly. You’re telling me that now my family that doesn’t have insurance,
that I was worried about going into the checkup because I know they told me that it would be $400 per checkup at the office that I was at before because that’s what they bill insurance. Now it’s going to be $100 and something per month for all the visits, sick visits and well visits.
That’s going to be super attractive to them when they… move from that place of insurance to uninsured or cutting back on their insurance coverage or having a super high deductible those sorts of things it’s going to make it like they’re going to you’re going to be the godsend for them when they’re going
through this difficult time of health care insurance transitions
Yeah, and I will use this as an opportunity to remind, especially those who are new, relatively new in the DPC community, your job is not to convince people who are never going to be convinced about DPC to join. Like your job is to just put messages out there, whether it’s through your website, through a newsletter.
through social media, which is easy to use and free, that you are there as an option. Right. So just putting a few posts out there on your social media says, hey, I’m so sorry that a lot of I know that based on national news, like premiums are going to jump X percent next year.
That’s going to leave a lot of families in a difficult position. Um, just so I’m here and I offer these services for a fixed monthly fee, blah, blah, blah. Right. However you want to frame that message, just put the message out there so that the people who are looking for something
like what you have to offer are going to find you. That doesn’t mean you’re going to try to convince people who are anti DPC to join a DPC practice because that’s just wasting your breath and your energy. That’s just giving families who are ready opportunities to find you essentially.
Yeah. And I think that if you were to take your panel, because in pediatrics, unlike family practice or internal medicine, almost all of our patients are insured. And they are employer insured by and large. Some of them are on the marketplace, but compared to the number that are employer-based insurances, it’s a small number.
So that’s why that gives me peace of mind that like the majority of our patients are not marketplace. And so they’re going to be less affected by the insurance premium hikes than those that are in marketplace. It’s going to be a small percentage anyways, but
There are going to be a lot in the community that are not currently our patients that are then going to be looking for healthcare options. So I think of it more, at least at this point, based on what all the national news and things that we’ve seen as an opportunity to
get out there and share more about the model. rather than worry that your current patients are all going to be cutting their healthcare budgets all of a sudden. Some will, but some will no matter what happens because life changes and all of those sorts of things.
We know that churn is just an inevitable part of being a practice owner and that people make their decisions. You can’t convince them to join. You can’t convince them to stay. And it’s not worth your time or energy to try and do that or cut them deals or those sorts of things.
But you do have the opportunity right now to really share what your practice is about, how it works, and how it helps families that are budget conscious when it comes to their child’s healthcare and just the convenience factor and all the other things that DPC offers that a fee-for-service practice can’t compete against.
Yeah. And even with the loss of the healthcare subsidies aside and the loss of Medicaid aside, healthcare premiums in the U.S. continue to jump. every year they are just continue to rise and rise and rise and so even for employers it’s becoming harder and harder to find the funds to offer good health
care to their employees and so something i think is happening more slowly is that more employers are going with are offering high deductible plans and that also pairs well with with DPC, right? Because I, well, I remember even when I was employed by a big health system a few years ago,
we kind of had a few choices of healthcare plans. And one of them was high deductible plan that was less expensive as far as my contribution per month, but also paired together with an HSA card that I could put money into. And that pairs beautifully with DPC. So Even among employed families,
they’re having to make those decisions because if they want to stay with that low deductible plan, it’s very likely that they’re going to have a higher and higher contribution on their part every year because the employer has to come up with that money somewhere. Right. And so we might see that trend continue as well.
Yeah, I think DPC is well poised when the cost of the other side keeps going up. And so it should be challenging for everybody, period, to deal with this, but also an opportunity to share more about the model and grow that model as more and more families.
are looking at the bottom lines and having to make tough decisions and figure out how to make sure that their kids get good healthcare. Because most people want their kids to get a regular checkup and to get the thumbs up that everything’s good and have the opportunity to ask all those questions.
And so we stand really well positioned to be like, yeah, we can do all of that. We make it super easy and it’s price transparency and affordability when the other side, it just keeps getting more expensive and less opportunity. So yeah, Yeah, I think my bottom line is that it’s an opportunity to increase your practice’s
reach and continue to grow your practice despite the financial winds changing.
Absolutely. Yeah. And that’s not to say that we’re like trying to profit off of an unfortunate thing that we’re just trying to respond to the larger ecosystem of healthcare in our community. We’ve already made the decision for our own reasons, right? To jump into the world of DPC and how we’re asking here,
how is it that we can help people who are going to need what we have to offer and So don’t be shy about making your services known, making sure you have videos on your website that or really good copyright that explains how you can help these families with high deductible plans or with no insurance. Right.
And don’t be shy about posting on social media. If you don’t like being in front of the camera, like Phil says, you can do other you can do other types of posts. They don’t have to be you talking in front of a camera.
Yeah. I don’t look at it as an opportunity to like make a bunch more money off the difficulties that people are facing. It’s much more the opportunity to serve more and to have your model be what fills the gap that has been created because of all the things that are way outside of our control. Okay.
Well, yeah, that sucks. And I can help and I can serve and I can care for your family because we’re not tied to all of the insurance stuff that makes it really hard to keep costs affordable. So I think it’s just an opportunity that you might have more people looking at than you’re able to serve.
Absolutely. And I really do believe that one of the draws to enter the world of DPC for me was just having more time to spend with families. And I really believe that a good primary care physician, us pediatricians included, can help with 90% plus of our patients’ needs, right? It’s going to be like maybe…
the few exceptions of kids in our panels that are truly going to need subspecialty care. But because we have that extra time, we truly can help address even more than 90% of the needs of our patients. I feel like I’m able to address 95% of the needs of my patients, honestly. I do very few referrals,
very few referrals even for imaging because I have that time to dig deeper, to ask the questions, to choose my lab work and my imaging really carefully, right? And to really selectively… send to subspecialists. There are e-consulting platforms that we can use in the world of DPC.
So sometimes if a family really can’t afford the $500 to go see a dermatologist for five minutes, then we can do a consult, a peer-to-peer consult for $50 to $100 and get the input of a dermatologist. and help them in that way.
So there are so many ways that I think we can be creative in the world of DPC that helps our patients to get the care they need and to save money in the big scheme of things as well.
Amen. And I think that that is really what it’s all about when we start our practice and want to grow. It’s like, how can we provide really good care without all the hassles? And a big hassle is the finances. So…
Absolutely. Well, thanks everyone for listening. If you have any other ideas on how we can address these looming changes in our country, we’d love to hear from you. Thanks for listening and until next time.
