If your workforce is spread across cities like Tampa, Tulsa and Tacoma, you've probably heard that direct primary care (DPC) isn't a realistic option for your company. Traditionally, an employer offers DPC by contracting with a local practice in every market where its employees live. That works for a 200-person company in one city, but across dozens of states it means a separate contract for nearly every location, and no human resources (HR) team has the bandwidth for that.

That's why direct primary care for multi-state employers has been so hard to find. So what would it actually take to make direct primary care work for a distributed workforce?

It takes a program that covers every state under one agreement and runs through the claims process the employer already uses. It also has to apply Internal Revenue Service (IRS) rules automatically for employees on high-deductible plans and reach every employee through a large base of independent practices backed by virtual care. Self-funded employers can get that today through Apaly, a nationwide marketplace of direct primary care practices. The rest of this guide explains why DPC has stayed local, what a nationwide program has to get right and how to evaluate one.

Why is direct primary care typically a local benefit?

Direct primary care is local by design. Most DPC physicians open their practices close to home because they want to be part of the community they serve, and their practices stay small or grow based on demand. When a solo practice attracts more patients than one doctor can care for well, the usual answer is to bring on another physician rather than stretch the schedule.

That discipline is the whole point, and the numbers show why. A 2012 study in the Annals of Family Medicine put the average U.S. primary care panel, meaning the number of patients a doctor is responsible for, at about 2,300 patients. The same study cited an estimate that delivering all of the recommended preventive, chronic and acute care to a panel of 2,500 would take a physician 21.7 hours a day. Put simply, the typical primary care doctor has more patients than one person could ever properly care for. That's why so many appointments feel rushed, why it can take weeks to get in, and why preventive care so often slips through the cracks.

A full DPC panel, by comparison, typically runs 600 to 800 patients per physician, according to DPC physicians interviewed by Medical Economics in 2026. That's roughly a quarter to a third of a typical panel. With fewer patients, a DPC doctor has time for longer visits, same-day appointments and real follow-up, and patients end up with a doctor who actually knows their history. Physicians benefit too. A manageable patient load is a big part of why many of them left fee-for-service medicine, and it's what allows them to keep practicing the way they want to.

That model is good for patients and doctors alike, but it also explains why one practice can't cover a company with employees all over the country. Many small and mid-sized businesses have contracted directly with one or two DPC practices near their office, and it works well for them. Large employers have generally stayed away, and the reasons have little to do with the quality of care.

Why haven't large employers offered direct primary care?

Direct primary care for large employers has been rare for three reasons: contracting doesn't scale, DPC billing sits outside the health plan, and standalone contracts are hard to extend to employees on high-deductible plans. The first barrier is scale. A company with employees in 30 or 40 states would need enough DPC agreements to put a practice within reach of every employee. Each practice comes with its own terms, pricing, enrollment process and invoices. Signing those contracts is only the first step. After that, someone has to manage each agreement, reconcile every practice's bills and answer employee questions in every market. All of that work lands on HR alongside benefits planning and open enrollment.

The second barrier is that direct primary care sits outside the health plan. That's intentional. A true DPC practice doesn't bill insurance at all; according to the American Academy of Family Physicians, DPC practices rely on patient membership fees instead of insurance claims. Getting away from insurance billing frees physicians from much of the paperwork and many of the restrictions that come between them and their patients. Some practices pair membership fees with insurance billing, an approach often described as a hybrid model, but a true DPC practice works outside the claims system entirely.

For an employer, that creates real friction. DPC practices send invoices rather than claims, and many third-party administrators (TPAs) aren't set up to pay invoices, which leaves HR to figure out how each practice gets paid. Because none of that care flows through claims, the employer also loses visibility into how the benefit is being used. For a large employer weighing a new benefit, that combination of extra administration and missing data can make DPC look like more trouble than it's worth.

Finally, direct contracts are difficult to extend to employees on a high-deductible health plan (HDHP) paired with a health savings account (HSA). IRS rules limit what HSA-eligible employees can receive before meeting their deductible, and a standalone DPC arrangement doesn't have the claims infrastructure to apply those rules visit by visit. That's a meaningful gap, because these plans cover a substantial share of employees. In the KFF 2026 Employer Health Benefits Survey, 29% of covered workers were enrolled in an HSA-qualified plan.

Why does it matter where your employees live?

Access to primary care varies widely from one market to the next, so a benefit that works well near headquarters may do very little for an employee three states away.

AMN Healthcare's 2025 Survey of Physician Appointment Wait Times found that new patients waited an average of 23.5 days for a physical with a family physician. In Miami and New York, the wait was about 4 days; in Boston, it was 69. The problem extends well beyond a few large cities, too. The Milbank Memorial Fund's 2026 Primary Care Scorecard found that 29.7% of U.S. adults reported having no usual source of care in 2023, the most recent year of data.

For a distributed workforce, that means two employees on the same health plan can have very different experiences when they need to see a doctor. A primary care benefit only delivers on its promise when it works as well for your team in Boston as it does for your team in Miami.

What should you look for in a nationwide direct primary care program?

A nationwide direct primary care program should cover every state under one agreement, run through your existing claims process, include HDHP and HSA members, and keep the small, independent practices that make DPC valuable for patients. Start with where your employees actually live and work backward from there. These questions will help you separate a truly national solution from a local one with national marketing:

• Does one agreement cover every state? You shouldn't have to negotiate practice by practice or market by market.
• How many practices are near my employees? Ask for a GeoAccess report that matches participating practices to your employees' zip codes. It will show where local care is available and where it isn't.
• Are the doctors independent, or employed by one company? The answer shapes how much time doctors have with patients and whose priorities they follow.
• When do we start paying? Find out whether you pay for every eligible employee or only for those who use the benefit.
• Can it run through claims? A program that bills outside of claims means your team handles invoices and loses visibility into utilization. If it doesn't run through claims, ask exactly what program data the vendor will provide and how often, because you'll depend on them to measure whether the benefit is working.
• Can it be offered to HDHP and HSA members, and how is IRS compliance handled? This is one of the most important questions on the list. Offering the benefit to HSA-eligible employees carries real fiduciary responsibility, and mistakes can put employees' HSA eligibility at risk and leave your team with costly corrections. Any partner should have a clear, well-documented answer. The rules have also shifted recently, including IRS Notice 2026-5 on direct primary care and HSAs, so review the answer with your benefits advisor or counsel.
• Can we launch mid-year? If the answer is "only at open enrollment," you could be waiting up to a year.
• What happens in markets with few or no practices? Virtual care should be part of the answer, along with a plan to recruit practices where coverage is thin.

What's the difference between direct primary care and advanced primary care?

Direct primary care describes how a practice is paid: patients, or their employers, pay a recurring membership fee instead of the practice billing insurance for each visit. Advanced primary care describes what high-quality primary care should deliver, regardless of how it's paid. The Purchaser Business Group on Health, a coalition of large employers and public purchasers, describes it as care that puts the patient at the center and focuses on prevention. Providers have time to listen, and they coordinate referrals to high-value specialists. It also calls for in-person and telehealth access, along with integrated services such as behavioral health and chronic disease management.

The two ideas fit together naturally. The DPC model, with its small panels and membership-based payment, is one of the most direct ways to deliver what advanced primary care calls for. Employers evaluating options will see both terms, and it helps to know that one describes the business model while the other describes the standard of care.

Is there a nationwide direct primary care option for large employers?

A self-funded employer can offer direct primary care in every state through a single agreement with Apaly. Apaly is a nationwide marketplace of more than 5,600 independent direct primary care practice locations. Its benefit, Advanced Primary Care Plus (APC+), was built to answer each of the questions above. Apaly already works with Fortune 500 employers that offer APC+ to their employees today, so you don't have to build any of this on your own.

Apaly calls the benefit advanced primary care because the DPC model is how it delivers the access, time and coordination that advanced primary care calls for. The care relationship is the same one an employee would have with a DPC practice they joined on their own. What changes is everything on the employer's side: one contract instead of hundreds, billing through claims instead of invoices, built-in support for HDHP and HSA members, and reach across every state.

Here's how APC+ works for an employer:

1. One agreement covers the entire workforce. There's no state-by-state or practice-by-practice negotiation.
2. Employees choose their own doctor. Each employer gets a custom landing page that explains the benefit to its employees. From there, employees go to the Apaly marketplace, enter their address, compare local practices and enroll. Many participating practices see both adults and children, so a family can get its care under one roof from a doctor who knows them.
3. Billing begins with the first visit. A member's APC+ membership becomes active after their first appointment, which Apaly calls a Hello Visit, and the employer starts paying for that member only then. Employees who never use the benefit don't add cost.
4. It runs through your existing claims process. APC+ works with most carriers, so there's no carve-out, no new plan and no invoices to manage, and your claims data stays intact.
5. HDHP and HSA members are covered with compliance built in. Apaly's claims logic applies the IRS rules for HDHP and HSA members automatically, so you can offer APC+ to those employees while staying compliant.
6. It can launch at any point in the year. Because APC+ isn't health insurance, it doesn't have to wait for open enrollment.

Every practice and physician goes through a rigorous vetting process before joining the Apaly marketplace. Providers who still operate under a traditional fee-for-service model generally won't qualify, because APC+ is built on the direct primary care approach to care.

When a GeoAccess report shows a market with few or no local practices, employees there can still enroll in APC+ through Apaly's nationwide virtual care partners. Apaly then works to recruit a local practice in that area. Once one joins, employees can switch to in-person care or stay with their virtual provider, whichever they prefer.

What do employees get with APC+?

Employees get a primary care doctor who has the time to know them. Based on the APC+ Scope of Services, here's what that looks like day to day:

• They get in quickly. Same-day or next-day appointments mean a health concern doesn't turn into weeks of waiting.
• They don't feel rushed. Visits typically last 30 to 60 minutes, so there's time to ask every question and actually be heard.
• Their doctor is reachable. Members can contact their doctor by text, email, phone or video when something comes up, often without leaving home.
• The whole family can be seen. Many practices care for adults and children alike, so one doctor gets to know the whole household.
• Someone coordinates their care. When a specialist is needed, their doctor makes the referral to a trusted specialist and stays involved.
• Ongoing conditions get steady attention. Members managing conditions like diabetes or high blood pressure get regular, unhurried follow-up.

Employers that offer APC+ pay the monthly membership fee for eligible employees, spouses and dependents. Every member gets virtual visits and in-person wellness visits for $0. Members on non-HSA plans also get in-person sick visits for $0. Members on an HDHP/HSA plan pay the fair market value for in-person sick visits (around $95 on average) until they meet their annual IRS deductible (Apaly FAQs).

How can you see which practices are near your employees?

The most reliable way to know whether nationwide DPC will work for your company is to look at your own map. Email info@apaly.com to get your own custom GeoAccess report.

Sources

1. Altschuler J, Margolius D, Bodenheimer T, Grumbach K, Estimating a Reasonable Patient Panel Size for Primary Care Physicians With Team-Based Task Delegation, Annals of Family Medicine, 2012
2. Medical Economics, Asked and answered: 7 key questions about direct primary care, August 4, 2026
3. American Academy of Family Physicians, Direct primary care: What to know
4. KevinMD, The smart way to transition to direct care, October 6, 2025
5. KFF, 2026 Employer Health Benefits Survey, October 22, 2026
6. AMN Healthcare, 2025 Survey of Physician Appointment Wait Times, June 2025
7. Milbank Memorial Fund, Primary Care Scorecard, 2026 edition
8. Internal Revenue Service, Notice 2026-5 guidance on direct primary care and HSAs, December 2025
9. Purchaser Business Group on Health, PBGH Advanced Primary Care Overview, 2023
10. Apaly, APC+ Scope of Services
11. Apaly, Frequently Asked Questions