Strengthening the Broker - Client Relationship Through Direct Primary Care
Insurance brokers hold a uniquely trusted seat at the table with self-insured employers. Year after year, clients rely on their broker not just to place coverage, but to guide them through an increasingly complicated landscape of cost containment and benefits strategy. That trust is a broker's most valuable asset — and it is built, renewal after renewal, by consistently bringing forward solutions that are grounded in evidence, operationally sound, and demonstrably effective.
In a market where close to 65% of covered workers are enrolled in self-insured plans, employers bear direct financial responsibility for their members' healthcare costs. This creates both urgency and opportunity: self-insured employers have a stronger incentive to manage costs proactively, and they look to their brokers for guidance on how to do so. The broker who can bring a well-vetted, evidence-backed solution to the table — rather than a theoretical one — deepens that trust and cements their role as an indispensable strategic advisor.
Direct Primary Care delivered through onsite and near-site clinics is one such solution. It gives self-insured employers a more direct, measurable lever for managing healthcare spend, at a time when many employers are looking for alternatives to generalized wellness programs and insurer-run virtual care benefits, which can be harder to track and quantify. The model is gaining traction: among U.S. employers with more than 5,000 employees, 31% now operate on- or near-site clinics providing primary care. Nationally, direct primary care and concierge practice sites grew by 83.1% between 2018 and 2023, with the number of participating clinicians increasing by 78.4% over the same period.
Where the Model Can Deliver for Clients — and Their Advisors
When an onsite or near-site clinic is designed and executed well, paired with the right pharmacy benefit manager and a best-value provider network, the published evidence points to meaningful, measurable outcomes:
Lower total healthcare spending. In a matched-cohort study of over 23,500 commercially insured employees and dependents, individuals who used employer-sponsored on-site or near-site primary care for most of their care had 45% lower total spending per member per month compared to matched controls (cost difference: −$167 PMPM; 95% CI, −$204 to −$130; p .001). A separate study of public-school teachers found that worksite clinic users had annual healthcare costs $745 lower than community-based clinic users ($4,298 vs. $5,043), a difference of $62 per teacher per month.
Fewer emergency department visits and hospitalizations. The same employer-sponsored model showed 33% lower ED spending and 16% lower hospital spending among primary clinic users (Basu et al., 2020). Among teachers, worksite clinic use was associated with significantly lower inpatient admissions — 31 per 1,000 teacher years compared to 53 per 1,000 for community-based clinic users.
Better chronic disease management. Diabetic employees using worksite health and wellness clinics demonstrated significantly lower HbA1c levels compared to matched non-users (7.42% vs. 8.53%; p .001).
Improved access and continuity of care. Employer-sponsored primary care models are built on the medical home principles of accessible, coordinated, and longitudinal care — attributes that have been independently associated with reduced ED use and fewer hospitalizations.
Stronger recruitment and retention. Employers increasingly view accessible primary care as a strategic tool for facilitating employee well-being and associated retention, encouraging preventive care, and potentially controlling delivery costs. Studies have reported decreased absenteeism, improved productivity, and positive reception by both employees and employers.
For a broker, these are concrete, reportable outcomes to bring back to a client's leadership team — the kind of results that reinforce the broker's credibility and justify the client's continued trust in their advisory relationship.
A Value Add for Clients and Their Teams
The appeal of this model is that it works on two levels simultaneously. Employers get a more direct, trackable approach to cost containment. Employees and their dependents get accessible, whole-person primary care delivered through a dedicated clinic — not routed through a generalized benefit or an impersonal virtual platform.
Research shows that employees perceive convenience and a sense of belonging as key benefits of onsite clinics, and that these clinics can serve as effective primary care homes when trust and communication are prioritized. When employees and their families experience genuinely accessible, high-quality care provided by their employer, it endears the company to the team member in a way that a standard insurance card simply cannot. The employer becomes not just a place to work, but a place that invests in the health and well-being of its people and their families.
For brokers, this dual value proposition — cost containment for the employer, meaningful care for the employee — is a powerful story to bring to a client. It positions the broker as someone who understands that the best benefits strategies serve the whole organization, not just the balance sheet.
The Importance of Utilization Strategy and Program Design
Results vary widely, however, and the evidence underscores why. A study of an employer-provided primary care medical home found that employees and dependents who were "casual users" of the clinic had the highest claims costs — $482 higher annually for employees and $598 higher for dependents compared to major users. This finding highlights a critical insight: inconsistent or casual utilization is associated with the highest costs, while consistent, engaged use of the clinic as a primary care home drives the savings.
Return on investment has been shown to increase significantly with clinic penetration rate, number of employees served, and clinic age over a 10-year period. Published benchmarks suggest an ROI of 1.5:1 or higher for well-run on-site clinics. What separates a high-performing clinic from an underperforming one comes down to vendor selection, program design, utilization strategy, and integration with the broader health plan.
Augmenting, Not Replacing, the Broker Relationship – The Vantage Perspective
This is where a specialized advisory partner can add value without stepping on the broker's role. When a broker brings in the right clinical and operational expertise to support a DPC recommendation, the broker is not outsourcing their advisory function — they are strengthening it. The client sees a broker who has done the diligence, assembled the right team, and brought a solution built on direct operational experience rather than theory alone. That is the kind of move that builds lasting trust.
Vantage Clinical Partners works alongside brokers to bring the clinical and operational depth needed to evaluate and procure complex clinic solutions — designing RFPs aligned to each employer's specific needs, co-managing vendor evaluation and procurement, and providing longitudinal performance monitoring to track and sustain results.
Vantage's principals bring decades of hands-on operational leadership across primary care, employer-based clinics, urgent care, and large-scale clinical operations. For a broker, that means bringing a client a partner with direct experience building and running these programs — one that can help the client avoid common pitfalls in clinic design and procurement and position the program for durable, measurable ROI.
For brokers evaluating how to bring more value to self-insured clients, Direct Primary Care — supported by the right advisory expertise — offers a model with a growing and substantive evidence base behind it. It is a way to bring clients a solution that delivers measurable financial outcomes, improves the health and experience of their workforce, and reinforces the broker's position as the trusted advisor their clients cannot afford to be without.
Beth Papetti, MBA FHM
Principal & Chief Operating Officer
References
Basu, S., Zhang, T., Gilmore, A., Datta, E., & Kim, E. Y. (2020). Utilization and cost of an employer-sponsored comprehensive primary care delivery model. JAMA Network Open, 3(4), e203803. https://doi.org/10.1001/jamanetworkopen.2020.3803
Cohen, C. C., Hollands, S., & Liu, H. H. (2021). Impact of primary care worksite health and wellness clinics on HbA1c level among prediabetic or diabetic employees. American Journal of Health Promotion, 35(1), 13–19. https://doi.org/10.1177/0890117120927307
Conover, C., Namenek Brouwer, R., Adcock, G., Olaleye, D., Shipway, J., & Østbye, T. (2015). Worksite medical home: Health services use and claim costs. The American Journal of Managed Care, 21(7), e422–e429.
Engberg, J. B., Harris-Shapiro, J., Hines, D., McCarver, P., & Liu, H. H. (2018). The impact of worksite clinics on teacher health care utilization and cost, self-reported health status, and student academic achievement growth in a public school district. Journal of Occupational and Environmental Medicine, 60(8), e397–e405. https://doi.org/10.1097/JOM.0000000000001373
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