An Urgent Care Chain Is Selling Houston Employers Direct Primary Care. The Two Definitions Everyone Quotes Don't Rule It Out.

Houston Business Journal readers got a clean argument for direct primary care this morning. Employer health plans are built around coverage, the article said, so workers “technically ‘have insurance’” and still wait weeks to be seen. DPC starts from access instead of claims processing, and the piece listed the employer complaints it answers: long delays for a primary care appointment, emergency rooms used for non-emergencies, missed workdays, rising downstream claims.

The argument holds up fine. According to Douglas Farrago, MD, the company behind the article runs 45 urgent care clinics across Texas.

Farrago wrote it up at DPC News the same day, saying the chain “sponsored/wrote” the piece, and filed it under a label he applies himself. DINO. DPC In Name Only. The Houston Business Journal article sits behind a paywall that blocks automated retrieval, so the sponsorship label rests on Farrago’s reporting rather than on anything DPC Insider could confirm at the source. His verdict on Next Level Urgent Care and its employer product, Next Level Prime: “An expanded urgent care is not the same thing. It is not even close.”

He’s right about what Prime is. The harder problem is that neither of the two definitions the field actually quotes clearly rules Prime out.

What Next Level Prime sells

Next Level introduced Prime in January 2021 as an employer-paid benefit giving workers access to primary care and urgent care at every Next Level clinic, plus 24/7 telemedicine and a care navigator. The company is physician-founded, led by Juliet Breeze, MD.

The current product page describes a flat monthly fee with no copays, no deductibles, and no per-visit charges. Members get routine visits and annual physicals, preventive screening, labs and X-rays at full-service locations, referral coordination, and wellness coaching and behavioral counseling. The page states no session limits; Farrago puts both at 12 visits a year, and puts the employer price at $30 to $60 per member per month.

What the page does not describe is a doctor.

Next Level says a flat fee buys “access to a network of highly qualified healthcare providers” and does not break out physicians from nurse practitioners and physician assistants. Farrago went digging and reports that NPs and PAs make up a substantial share of day-to-day staffing. Nothing on the page indicates a member is assigned anyone in particular, and nothing on it promises that a patient who comes in three times would see the same person.

One detail is checkable and worth putting on the record. The 2021 launch release doesn’t use the phrase “direct primary care” anywhere. It calls Prime “a primary care program offered direct to employers.” The DPC label came later, once the term started carrying weight.

The definitions everyone quotes don’t rule this out

The article is the small problem. This is the large one.

DPC Frontier, the reference site that tracks DPC statutes state by state, defines the model by three characteristics: a periodic fee covering a defined set of primary care services, no third-party billing on a fee-for-service basis for what that fee covers, and per-visit charges below the monthly equivalent of the fee. The AAFP’s description is looser, calling DPC an alternative to fee-for-service billing that charges a monthly, quarterly, or annual fee covering most primary care.

Now run Prime against those. Flat monthly fee, yes. A defined set of primary care services covered by that fee, yes. Per-visit charges below the monthly equivalent, yes, on the technicality that there are no per-visit charges at all. The third-party billing criterion is the one nobody can check from outside. The product page says members pay no copays, deductibles, or per-visit fees, but that describes what the member pays, not what gets billed to a health plan. Next Level runs insurance-accepting urgent care clinics, and the same page describes helping members navigate their traditional insurance. Nothing published states whether Prime services are billed to third parties on a fee-for-service basis, which is what the criterion actually asks.

Continuity with a physician who knows you appears in neither definition. Neither one sets a panel size, though the AAFP page does report an average panel of 413. And DPC Frontier’s three criteria say nothing at all about who delivers the care, so nothing in them requires that a physician be the person who sees you. The AAFP writes its description around family physicians, which comes closer to the point, but a description is not a test anyone applies to a product.

That silence cost nothing when the only people using the term were solo docs with 500 patients and a personal cell number. It costs something now.

The buyer is the one who can’t tell

Picture the HR director at a 400-person Houston company with two proposals in front of her. Both say direct primary care at the top. One runs $30 to $60 per member with 45 locations, round-the-clock telemedicine, and a single contract to sign. The other runs closer to $98.64, the average membership fee in the DPC Alliance’s State of DPC report, published in July 2026 but drawn from 465 physician-owned practices surveyed in October and November 2024. It comes from a practice with one doctor and a waiting list.

Nothing in her training or in either sales packet teaches her what separates them.

Farrago raised the same worry from the patient side, asking whether employees signed up this way will understand DPC at all. He had trouble explaining it to companies with fewer than ten employees. A benefits manager staring at a spreadsheet is not going to reconstruct it from a brochure.

Employers now fund the majority of DPC memberships, 60 percent of active memberships, according to Hint Health’s 2026 Trends Report. That number is the whole reason a chain with 45 clinics wants the label on its product.

What This Means

If you run a DPC practice and you’re bidding on employer contracts in a metro where a chain like Next Level operates, you’re competing against something that shares your name and, at $30 to $60 per member, prices between a third and two-thirds of that reported national average. You won’t win that on cost. You might win it by making continuity legible before anyone asks: name the physician, name the panel size, state what happens at 9pm on a Sunday, and put it in writing next to their proposal that can’t.

If you’re a resident weighing this model, watch the definitional fight rather than the growth charts. Employer money arrived. Companies that were never in primary care are building products to catch it, and most of them will be staffed the way those companies already know how to staff. Some will be good. The label won’t tell you which.

And for the people who built this movement, the gap between the definition and the practice has turned into a strategic problem. DPC Frontier’s three criteria describe a payment arrangement, not a standard of care. Whatever they were written to do, they were never written to keep anyone out of DPC.

Farrago closed by offering to be corrected if Next Level wants to make its case. That offer is open. The question underneath it is who has standing to answer, and whether a standard nobody can enforce is doing any work at all.