Employer Contracts Guide¶

Quick Summary: Employer contracts can accelerate panel growth and provide stable revenue. Expect 10-25% discounts from individual rates, longer sales cycles, and more administrative complexity. Start with small local businesses where relationships matter.

Table of Contents¶

• Why Employers Choose DPC
• Types of Employer Arrangements
• Pricing for Employers
• Finding Employer Clients
• The Sales Process
• Contract Essentials
• Operations and Administration
• Common Challenges

Why Employers Choose DPC¶

Employer Motivations¶

Cost savings: - Reduce insurance claims through better primary care - Decrease ER and urgent care utilization - Lower pharmacy costs - Potential insurance premium reductions

Employee satisfaction: - Better access to care - No copays or deductibles for primary care - Less time away from work for appointments - Healthier, more productive employees

Competitive advantage: - Attract and retain employees - Differentiate benefits package - Show investment in employee health

The Employer Value Proposition¶

Frame DPC as: - An investment in employee health and productivity - A benefit that employees actually use and value - A complement to (not replacement for) health insurance - A way to reduce total healthcare spending

Types of Employer Arrangements¶

Full Panel Membership¶

Employer pays for all employees to have DPC membership.

Pros: - Simple administration - High utilization - Predictable revenue

Cons: - Larger financial commitment - Some employees may not use it - Employer bears all cost

Voluntary/Subsidized¶

Employer subsidizes membership; employees pay difference or opt in.

Pros: - Lower employer cost - Employees who join are motivated - Flexibility

Cons: - Lower participation - More admin complexity - Adverse selection possible

Hybrid Arrangements¶

Combination approaches: - Full coverage for employee, subsidized for dependents - Tiered employer contribution - Wellness incentives tied to participation

Pricing for Employers¶

Typical Discounts¶

Pricing Structures¶

Per Employee Per Month (PEPM): Most common structure. Employer pays X dollars per enrolled employee monthly.

Example: - Individual rate: $99/month - Employer PEPM: $85/month (14% discount)

Family considerations: - Employee only: Base PEPM - Employee + spouse: Higher PEPM - Employee + children: Higher PEPM - Employee + family: Highest PEPM

What to Include¶

Standard: - All services included in individual membership - Same access and availability - Same scope of care

Consider adding: - On-site visits (if feasible) - Health screenings - Basic occupational health - Health education sessions

What to Charge Extra¶

• Pre-employment physicals
• Workers' comp visits (may have separate requirements)
• DOT physicals
• Drug testing
• Other occupational health services

Finding Employer Clients¶

Ideal First Clients¶

Start with: - Small local businesses (10-50 employees) - Business owners you know personally - Companies frustrated with health insurance costs - Businesses that value employee wellness

Why small first: - Decisions made by owner, not committee - Faster sales cycle - Personal relationships matter - Good reference for larger clients

Prospecting Approaches¶

Network-based: - Your existing patients who are business owners - Chamber of Commerce connections - Local business associations - Professional networks

Direct outreach: - Identify target companies - Research decision-makers - Personalized introduction - Offer to present

Referrals: - Ask satisfied employer clients for introductions - Insurance brokers (some are DPC-friendly) - HR consultants - Benefits advisors

Who Makes the Decision¶

The Sales Process¶

Initial Conversation¶

Discover their pain: - What's frustrating about current benefits? - What do employees complain about? - What's happening with insurance costs? - Have they heard of DPC?

Educate: - Brief DPC explanation - How it complements insurance - Local success stories if available

Don't sell yet. Listen first.

Proposal Development¶

Gather information: - Number of employees - Location(s) - Current benefits structure - Budget considerations - Timeline

Proposal elements: - Executive summary - DPC explanation - Proposed pricing - Implementation timeline - ROI considerations (if appropriate)

The Presentation¶

To decision-makers: - Focus on business value - Address their specific concerns - Share patient/employer testimonials - Be clear on pricing and terms

To employees (if invited): - Focus on access and convenience - Address common questions - Make it relatable

Closing¶

Common objections: - "We already have insurance" — DPC complements, doesn't replace - "How do we know it works?" — Offer pilot, references - "Employees won't use it" — Discuss engagement strategies - "Too expensive" — Discuss ROI, total healthcare costs

Trial arrangements: - 3-6 month pilot with subset of employees - Early termination clause - Clear success metrics

Contract Essentials¶

Key Terms¶

Duration: - 12-month contracts typical - Auto-renewal with notice period - Termination provisions

Pricing: - PEPM rate by coverage tier - Annual adjustment mechanism - What's included/excluded

Enrollment: - Who's eligible - How employees enroll - Effective dates - Open enrollment vs. ongoing

Administration: - Who provides employee data - How changes are communicated - Billing and payment terms

Termination: - Notice period (typically 60-90 days) - Proration of fees - Continuation options for employees

Sample Contract Sections¶

Services description:

Provider will make available to Enrolled Employees all primary care services offered under Provider's standard DPC membership, including office visits, telehealth, secure messaging, and [other services].

Enrollment:

Eligible employees may enroll during annual open enrollment or within 30 days of qualifying life events. Employer will provide updated roster monthly.

Payment:

Employer will pay Provider [rate] per enrolled employee per month, due by the 15^th of each month for that month's coverage.

Termination:

Either party may terminate with 90 days written notice. Upon termination, enrolled employees may continue membership at individual rates.

Legal Review¶

Have a healthcare attorney review your employer contract template before use.

Operations and Administration¶

Onboarding¶

For the employer: - Contract signing - Payment setup - Employee communication materials - Enrollment process

For employees: - Welcome communication - Enrollment instructions - Schedule first appointments - Access setup (portal, messaging)

Ongoing Administration¶

Monthly: - Roster reconciliation - Invoicing - Payment processing - New enrollee onboarding

Periodically: - Utilization reports (if requested) - Employee satisfaction check - Relationship management - Contract renewal discussions

Reporting¶

Employers may request: - Aggregate utilization data - Participation rates - Satisfaction scores - Health outcomes (be careful with PHI)

Important: Never share individual PHI with employers without employee authorization.

Common Challenges¶

Low Utilization¶

Problem: Employees have membership but don't use it.

Solutions: - Better onboarding - Employer communication support - On-site presence (if feasible) - Regular engagement reminders

Administrative Burden¶

Problem: Roster changes, billing issues, HR coordination.

Solutions: - Clear processes - Designated employer contact - Simple enrollment systems - Automate where possible

Contract Negotiations¶

Problem: Large employers want extensive contract modifications.

Solutions: - Know your non-negotiables - Standard contract for small employers - Flexibility for large accounts - Walk away if terms don't work

Employee Turnover¶

Problem: High turnover means constant enrollment changes.

Solutions: - Monthly roster reconciliation - Prorated billing - Simple add/drop process

Checklist¶

Before Pursuing Employers¶

• Stable individual panel (don't neglect core patients)
• Capacity for additional patients
• Administrative systems in place
• Employer contract template (attorney-reviewed)

For Each Employer Client¶

• Understand their needs
• Propose appropriate pricing
• Negotiate contract terms
• Plan employee onboarding
• Set up billing and administration
• Schedule relationship check-ins

Related Resources¶

• Pricing Your Practice
• Membership Agreement Essentials
• Community Outreach Strategies

Employer contracts can grow your practice and stabilize revenue. Start small, deliver excellent care, and let satisfied clients become your best marketing.