0.9% Instead of 6.2%: What Happened When Michigan Employers Paid for Direct Primary Care
Picture a warehouse supervisor with diabetes. It's Saturday. His meter reads 340 and his feet feel strange. Last year he would have spent 4 hours in an emergency room waiting to be told what to do. This year he texts his doctor. She adjusts his insulin over the phone, checks on him Sunday night, and sees him Monday at 8.
Nothing dramatic happened. That's the whole idea. Multiply that Saturday across a whole workforce and 5 years, and you get a number.
Last week SALTA Direct Primary Care, a membership practice with clinics in southeast Michigan, released 5 years of results with the benefits company Ameriflex. Their employer clients paid for workers' memberships through a health reimbursement arrangement, so the flat monthly fee went out in pretax dollars. The regular health plan stayed in place for specialists, hospitals, and surgery.
They reported annual health care cost growth of 0.9%, against an expected trend of 6.2%. Emergency department visits fell 31%. Inpatient admissions fell 71%. Patients came back to the ER at a rate of 23%, compared with 42% for traditional primary care groups. Employers saved $13.84 million over 5 years, a 2.2x return.
For scale, KFF says the average family premium for job-based coverage reached $26,993 in 2025, up 6% in one year. A cost line that grows 0.9% a year is a different kind of business.
Now the honest part, because you deserve it, and so do the employers deciding this month.
Medical Economics covered the release on Monday and listed what it leaves out. Who ran the analysis. How many employers and employees took part. Which years. Where the 6.2% came from. This is a press release, not a peer-reviewed study.
There's a known trap, too. A 2020 Milliman study for the Society of Actuaries found that employees who choose direct care tend to be healthier to begin with, and studies that don't adjust for that can hand DPC credit it didn't earn. After adjusting, Milliman still found DPC members used less emergency and facility care. But the employer's net cost came out an estimated 1.3% higher, within a wide range, partly because the employer paid the fees and also waived the deductible for everyone in the DPC option.
So I won't tell you 71% is a law of nature.
I will tell you the direction keeps showing up. When people can reach their doctor, fewer of them end up in the most expensive building in town. SALTA's own case study says clinic users had a 25% lower rate of hospital stays than members who didn't use the clinics, even though they carried 40% more chronic illness. An ER visit is often a primary care visit that couldn't find an open door.
At AtlasMD we see the same thing from our side of the exam table. Members text and call their doctor. Meds are at cost plus 10%, and the prices are posted. A worried Saturday becomes a phone call instead of a triage bracelet.
It's open enrollment season. Employers are deciding right now how to absorb another year of increases, and the usual answer is a higher deductible and a bigger paycheck deduction. That moves the bill around. It doesn't make it smaller.
Paying for the doctor first is a different bet. Keep insurance for the wreck. Put everyday care up front, at a flat price, where people will actually use it.
I'd love to see SALTA publish the denominator. Everyone in direct care should want better data more than bigger headlines. But if you're an employer staring at a 2027 renewal, ask your broker one question: what happens if my people can just call their doctor?
0.9% isn't a miracle. It's what an open front door looks like on a spreadsheet.
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Sources:
Medical Economics, "Paying for direct primary care through employer HRAs slowed cost growth over five years, data show" (Oct 19, 2026): www.medicaleconomics.com/view/paying-for-direct-primary-care-through-employer-hras-slowed-cost-growth-over-five-years-data-show
Ameriflex and SALTA Direct Primary Care release, Business Wire (Oct 14, 2026): www.businesswire.com/news/home/20261014604123/en/Ameriflex-and-SALTA-Direct-Primary-Care-Announce-Breakthrough-Results-from-HRA-Backed-Healthcare-Model
Accresa, SALTA case study: accresa.com/scaling-direct-primary-care/
KFF 2025 Employer Health Benefits Survey: www.kff.org/health-costs/annual-family-premiums-for-employer-coverage-rise-6-in-2025-nearing-27000-with-workers-paying-6850-toward-premiums-out-of-their-paychecks/
Society of Actuaries / Milliman, Direct Primary Care: Evaluating a New Model of Delivery and Financing (2020): www.soa.org/globalassets/assets/files/resources/research-report/2020/direct-primary-care-eval-model.pdf