Smarter Benefits: Pairing ICHRA with Direct Primary Care

After a period of rapid evolution in healthcare strategy, the ICHRA Exclusive Podcast returns with a conversation focused on what employers, brokers, and benefits leaders can do right now to improve access while managing rising costs.

In this episode, we’re joined by Brian Garcia, Vice President of Strategic Alliances at Nexus Health Connect and host of The Nexus Connection Podcast, to explore a more connected approach to healthcare. As traditional models face increasing pressure, the focus is shifting toward practical, scalable solutions.

Brian breaks down what Direct Primary Care is and how it differs from the traditional system, along with how pairing DPC with an ICHRA is becoming a more viable strategy, especially following recent legislative changes. We also explore where DPC makes financial sense, where it may not, and what that means for employers evaluating their options.

The conversation is moving from simply adopting ICHRA to optimizing it. Integrating models like Direct Primary Care is emerging as a key way to deliver more accessible and personalized care while improving outcomes and controlling costs.

If you are navigating rising healthcare costs or rethinking your benefits strategy, this episode offers a clear and practical look at what is possible and what comes next.

Watch or listen to the ICHRA Exclusive podcast

Episode transcript

Brian Garcia: Direct primary care is what healthcare used to be a long time ago, and why? What I mean by that is really just the relationship and the trust that's formed between the provider and the patient. To me, that still is the most important thing.

TJ Witham: Today we're joined by Brian Garcia, Vice President of Strategic Alliances at Nexus Health Connect and the host of the Nexus Connection podcast. Brian helps bring together employers, brokers, physicians, and individuals to access and deliver smarter, data-driven healthcare with direct primary care at the center.

Well, Brian, super excited to have you join us today as our guest for the ICHRA Exclusive Podcast. It feels like spring is here; sunshine's in the background. We were just talking, it's a little cool though, about doing lawn care again, getting the equipment back out of the garage that we haven't touched in a while. Anyway, it's a treat to have you, so thanks for carving out some time this afternoon. Excited to talk all things ICHRA and direct primary care (DPC), as a couple of really innovative solutions that can come together nicely. We thought this was a super relevant topic for our audience of brokers, employers, and those in the insurance industry. So thanks for joining us, man.

Brian Garcia: Happy to be here, and honored, actually. Thanks for having me as a guest. I'm looking forward to the conversation for sure.

TJ Witham: I love it. I know you've got years and years of experience in the healthcare realm. To start off, because we know our listeners might not all know what DPC is, I'd love to have you start with what direct primary care is, and how it's different from the traditional primary care most of us are used to.

Brian Garcia: I always like to start off by saying direct primary care is what healthcare used to be a long time ago. What I mean by that is really just the relationship and the trust that's formed between the provider and the patient, and to me, that still is the most important thing.

I've been in healthcare for quite some time. My dad was a family practitioner, and my mom was an OR nurse, so I've been in healthcare since I was in my mother's womb, I guess. Primary care was a big foundation at that point. My dad was a surgeon, but he also had a primary care practice, and I always got to see him interact with his patients and have great relationships with them. They all trusted him. He was also one of those physicians who wanted his patients to have the opportunity and the options to make choices with their healthcare. Not just, I'm the doctor, you're the patient, you have to do this, but, hey, these are some options. I think that's coming back in the direct primary care space as well. The doctors are able to spend that time, which is very important to develop those relationships and that trust. And within the time being spent with a patient, that provider is finding out things that are more root cause, not just putting a Band-Aid on things.

To answer your question about the definition of direct primary care, the model is set up to be more membership-based. There's a monthly membership fee, basically fairly capitated, so you have expected costs. Whether you're an employer group or an individual, you know what you're going to pay every month for that direct primary care access. Another big thing with direct primary care is the access. You're able to get access to your provider- not just, hey, I've got a pain in my stomach, call and get an appointment, and it's two or three weeks later, but same day or next day potentially. They're able to do that because they have a lot fewer patients on their panel.

TJ Witham: Yeah, 600 to 800 sometimes, which I've heard. I think I've heard an average in the non-DPC model averages a couple thousand up to 3,000.

Brian Garcia: Yeah. When my dad had to start morphing into billing insurance and worrying about reimbursements, he ended up with a patient panel of like 4,000. We had 4,000 charts. That's where his frustrations came in, like, how do I take care of all of these patients? There's just no way. So the average is pretty high, and that's why the fee-for-service docs can only spend a few minutes with their patients, because they have to crank through and see as many patients as possible.

I actually have an adopted brother in the primary care space. This was several years ago, but he was bragging, like, hey, Brian, I saw 60 patients today. And I'm like, well, Mark, what kind of impact did you make doing that? And he's like, I don't know. And I'm like, isn't that scary, that that was your answer, I don't know? So direct primary care is giving folks access and giving them access to quality healthcare. It's giving them the time to spend with their doctor, the provider, and not just the provider typing in codes and all that kind of stuff. The provider is able to have a better interaction with you. And then, when you get referred out into the system, because with direct primary care you'll be able to take care of 90% of your healthcare needs with that provider, but they still have to refer out to a specialist, at that point it's not going to be, My buddy down the street, he could take care of your knees. It's, hey, let's look for the best provider for you, that you're comfortable with, that you're going to be able to get into, and that's not just going to be there to bill insurance and get money from you. So the mentality of DPC is reducing unnecessary referrals into the specialty world, reducing unnecessary ER visits, and hopefully wiping out all urgent care visits. Long answer to your question, sorry.

TJ Witham: No, that's great, man. I want to dig in. My primary care brain is going here on a Monday afternoon. So employers have direct primary care as an option; there are also near-site clinics, and then there's a full-blown on-site clinic. For our listeners, we just talked about direct primary care. Near-site clinics typically are a clinic in one location where multiple employers may share the cost. And a true on-site clinic is where an employer is large enough, they've got enough patients in a specific location, that they fully fund the clinic just from that employer. So talk to me about where you find DPC tends to work really well in comparison, especially to a near-site or an on-site clinic model.

Brian Garcia: With the on-site and near-site clinic models, they typically, or initially, were designed for very large employer groups. The pricing model initially started out as a management fee plus cost. Marathon Health was a big one, especially here in town, so putting in a plug for them, I guess. Marathon Health, Premise Health, QuadMed, there are lots of big ones. They charge a management fee, which is basically their profit margin, and everything else is passed through as a cost. So medical supplies, staffing costs, labs, and things like that get passed through to the employer.

What we found when we were in that space was that smaller businesses wanted something like that as well, but didn't have the critical mass to start one on their own. That's where the near-site clinic started, so you can share with different folks. But the pricing is different when it comes to DPC. The care model in those advanced primary care models is very similar, and they're practicing advanced primary care to the top of their licensure, if it's an advanced-level practitioner instead of a doctor. The care is still there, the time is still there, the relationship is still there. They have to be designed that way, because the most important thing, especially with the on-site and near-site clinics, is utilization of those clinics to be able to impact a health plan. Direct primary care fits into there, but you can also think about it as concierge medicine for the masses, not just for the executives, but you still get that access to your provider. It is different than concierge medicine. I shouldn't have opened up that wasp nest. But the comparison to the clinic space, the mindset and mentality is the same thing. It's getting better clinical outcomes for the patients.

TJ Witham: Yep. Love that. So, next question. Obviously you're a leader at Nexus. Talk to me about Nexus's role within the DPC ecosystem, and the type of entities you all serve.

Brian Garcia: When Nexus first started, it was almost a spinoff from folks who left the on-site and near-site world but still wanted to stay in the space. So it was initially to help independent direct primary care providers fill up their patient panel, and to help them market to employer groups, whether direct to the employer or through benefit advisors. That's still a foundation of it, but it's expanded more than that.

The role of Nexus is still to, and this is sometimes a bad term, but to help broker between the benefit advisors, the employers, and the DPC providers. We at Nexus have a relationship with numerous direct primary care providers throughout the country. So instead of the benefit advisor trying to vet out different direct primary care providers, or find them, we're there to help that way and make it very easy for the advisors to provide that type of solution for their employees.

Nexus also gets into some of the care navigation piece. Especially working with employer groups trying to impact different plans, we don't want to just say, okay, here's your direct primary care provider, and that's it. It's, hey, here's your direct primary care provider, and we're also going to work with that provider, communicate with them, and say, this is the solution on your health plan, or this is where you need to go for your surgeries, because your employer has a bundled surgery contract with, whatever, a Wellbridge, that can be navigated better to help impact the health plan.

So when you look at DPC from a cost perspective, if you just add DPC onto a group health plan and look at it as, okay, this is going to save me as an employer on primary care visits, yeah, it will, because your members aren't going to have that copay, you have a capitated rate as opposed to whatever the fee-for-service provider is charging. But the savings there is minimal, like 3 to 5% savings on a health plan. The bigger impact is how that direct primary care provider is helping to navigate through the system. So we're there to help with that as well. It's not just putting the onus on a DPC provider and adding more to what they have to do. We're there to help stand in the gap for them on that part.

TJ Witham: It makes total sense. I'm going to geek out here for a minute. My background, prior to coming and joining Remodel Health about two and a half years ago, was working with self-funded employers. I worked for a company called Springbuk doing self-funded analytics, helping an employer look at how the health plan was operating, and using claims data, wellness data, all these different data sets to figure out where they should invest to help better run their health plan and drive better outcomes for their employees and their insured dependents.

Direct primary care, in my past life, made all the sense in the world for an employer to evaluate as a cost containment strategy as well as an added benefit to employees. I think it was both. It was beneficial to employees because they got better access to physicians who could spend more time with them, but it would also ideally reduce gaps in care and lower claims cost over the long haul.

So, shift gears. Now we're here on the ICHRA Exclusive Podcast. You get an employer that, for whatever reason, maybe their self-funded plan is just running so poorly, they had to get out of a traditional group health plan, so they moved to an ICHRA. Now they're out of the defined benefit space, they're in the ICHRA, a defined contribution strategy, where they don't have any more risk or...

Brian Garcia: Data to analyze, right?

TJ Witham: Or data to analyze. No claims data anymore. They've literally moved and said, hey, we're just going to define what contribution we want to give people, and then the carriers in the individual market that people are accessing plans from, that's who bears the risk now of the insured population. So that's a long-winded tee-up to the question I want to ask. As ICHRA continues to accelerate, I've seen it predicted that anywhere from 1 million to 1.5 million insured members will be on the ICHRA chassis by January 1 of 2027. So this thing is starting to get to critical capacity nationwide. Do you see a world where Nexus is actually working with and selling to the individual insurance carriers that have these pockets of insured people in these rating areas, where a DPC could help deliver better primary care?

Brian Garcia: Short answer is yes. I do feel that direct primary care and ICHRA can tie together very well, even though maybe on the surface it doesn't seem like it. It could seem like, here's the cost of the ICHRA, here's the cost of the DPC, so am I double-dipping, for lack of a better term? I'm paying for primary care here, but I'm still getting primary care coverage through the ICHRA. So you have to navigate that a little bit, but tying them together does work.

ICHRA is gaining a lot of traction through Nexus and our folks. We do have some partnerships with cost-share folks, like a Zion or Sedera, and you guys know all about Sedera way back in the day. We would tie that together with DPC, and that works well also. But not everybody qualifies for getting onto a cost-share type of product. So we said, okay, well, how about we have an ICHRA in place over here? As Nexus, we don't resell ICHRA, we're not the administrator or anything like that, but we refer out to somebody who would be able to help take care of all that. So then they have an ICHRA on one side, cost share on the other side, and then something in the middle that helps fund the direct primary care piece they offer to everybody. But again, tying them together.

I might be jumping ahead a little bit, I don't know, but I'll use this example I used with you guys in our prep call. I look at ICHRA as taking care of the catastrophic type events. So you utilize direct primary care for all your day-to-day needs, well, hopefully you're not needing healthcare day-to-day, but always use DPC, and then rely on that DPC to help navigate stuff for you, or Nexus. And then the funding mechanism for that would be the ICHRA side of things. So the ICHRA in this case would be like the financial protection for those catastrophic events, and DPC is your day-to-day stuff.

The example I brought up was kind of like an automobile. You insure your automobile, but you have to buy gas for it, tires for it, change the oil on it. You're paying cash for those day-to-day activities with that vehicle. That's your DPC right there. The auto insurance you have on your cars for the catastrophic events, any accidents you get into, that's the ICHRA and the financial protection on that side.

TJ Witham: I love that illustration. I like any illustration like that in insurance. It's not perfect, but that one's pretty doggone good. Very similar to the illustration I tell every single day, that the move from a group plan to an ICHRA is like the move from a pension plan in retirement benefits to a 401(k). Same concept. But I like that illustration of the day-to-day, weekly, or monthly maintenance being like DPC, versus anytime you have to actually file a claim for your car that runs through your car insurance company, because those are bigger-ticket items and there's a bit more financial protection for those things you can't budget for.

Brian Garcia: And even to add on to that example, you're changing the oil, changing the transmission fluid, because why? That's maintenance, right? It's preventative maintenance, so your engine won't blow up. DPC is not just for sick care. It's not just, man, I don't feel well, I need to go to the doctor. Utilize DPC for preventative stuff, even more so than sick care. Utilize it for your healthcare. Just like you have to maintain your car to keep it running, maintain your body to keep yourself running, and DPC can do that. Some of that preventative and maintenance stuff is looking at root causes of things, and those providers have the time to do that. So they're not just going to be like, here's an Allegra because you can't stop sneezing. It's, hey, what have you got going on at your house? You have like 15 cats, a couple of dogs, do you not vacuum? Why are your allergies really happening? It's a simplistic example, but it's the same thing. They're digging into why something's happening instead of just putting a Band-Aid or a medication on top of it.

TJ Witham: One of the other things I wanted to pick your brain on, that gets me excited for how ICHRA and DPC work together in the future, is the legislative change that rolled out January 1 of 2026, where now, for the first time, individuals can use HSA dollars to pay for DPC costs.

Brian Garcia: So finally. It took us way longer than we had hoped.

TJ Witham: Yeah. Even in my family, I'm married, and I've got two sons. We're Remodel, we like to say we drink our own champagne, so we offer and administer our own ICHRA plan for our 200-plus employees. We're all on ICHRA ourselves. For our family, it made sense. This year we actually bought a bronze-level plan, an individual plan with a higher out-of-pocket maximum and higher deductible, and we max out our HSA contribution. One of the ways we choose to use our HSA is, my wife values a DPC subscription, so she's got DPC for her. I've decided at this stage that I don't need that, so it doesn't even have to be for an entire family. Me and my boys don't elect to subscribe to DPC, but my wife does. And maybe she's smarter; actually, I know she's smarter than me. She's investing more in the maintenance. That's why we should go on DPC too. I should consider it. I'll try to consider it in the next year.

But it's this whole idea of choice, like true choice. What I love that you said earlier is that DPC is advanced primary care for the masses. I think the ICHRA framework and the new HSA legislation is hopefully going to open up DPC for more and more people. So I'd love for you to share, what does growth look like at Nexus, even after this initial ruling where HSA dollars can be used for DPC?

Brian Garcia: Yeah, that was exciting news, obviously. It was a step in the right direction, and finally, it makes sense. It's a no-brainer that you should be able to utilize your HSA dollars for that. I also think the Medicare space really needs to open up and let Medicare folks utilize direct primary care without being penalized in some way.

Growth-wise, as a company, at Nexus, we try to make sure everything is focused around direct primary care, direct care in general, so cash pay, whatever, on the front end. Our growth is going to be more along the lines of still helping DPCs fill out their patient panels, but not relying solely on, whatever you want to call it, a spread between what we charge per member per month and whatever discount we got from a DPC. It's more along the lines of helping those DPCs but not messing with their per-member-per-month pricing, and we add that navigation layer and other advisory-type layers on top of that.

I think the legislature can probably do even more when it comes to DPC. I mentioned the Medicare stuff. I think states should really get into looking at the capitated payments. Look at the Medicare and Medicaid crisis we have going, even in the state of Indiana, not a crisis, but it's getting tight, funding is getting tight. There's a term being used nowadays: waste, fraud, and abuse. Whether you think it's there or not, there is definitely waste, maybe not the fraud or abuse, but definitely waste in how things can be paid for that way. So growth, not just for Nexus but for the industry as a whole, might be in that space as well.

I also think, from the ICHRA standpoint, everybody was hoping the legislation in the big beautiful bill would have been a lot more friendly. There were a lot of things in there that...

TJ Witham: Didn't make its way through.

Brian Garcia: Didn't make their way through, and I wish some of them would have. That's the scary thing I look at from the ICHRA standpoint: that one or two presidential elections can really send this thing upside down.

TJ Witham: They can, but here's the thing I always say. It's really bipartisan, because this is one of the few things both sides agree on, so they'll do something about it. And I think they have, just maybe not as fast as you or I would have liked. But in general, both the left and the right, wherever you're at politically, I think both sides agree that this idea of giving more choice to the consumer is a good thing. Now, the exact mechanics of how both sides would have it rolled out, maybe they don't see eye to eye on that. But ICHRA has been the best middle ground that both the left and the right agree upon, like, hey man, this thing's here to stay. The employer adoption of ICHRA has accelerated. In general, I think both sides agree it's a great thing. So I'm not worried about ICHRA going away. But getting further, making it so we can smooth out the edges of how ICHRAs get rolled out.

Now you're going to get me on my soapbox. Things like COBRA. Why in the world does COBRA even have to be administered when an employer offers an ICHRA? Because these plans are individually owned and portable. So if an employee is no longer employed by their employer, they lose their ICHRA contribution, but they can just take over making the full payment of their plan themselves. You shouldn't have to administer COBRA, because no one in their right mind would want to pay 100% of the plan plus a 2% COBRA fee. But you still have to administer COBRA when you offer an ICHRA. So it's some of those little details that I think we'll work through and smooth out. But that was a huge win, that HSA dollars can now be utilized.

I think we're just at, to use a baseball analogy, the bottom of the first or the top of the second inning for how, especially brokers, are going to think about DPC and ICHRA together. I'd also say, as ICHRA moves upmarket, we've seen the amount of employers we serve that are truly middle market, 500, 1,000. We've got an employer now that's almost 5,000 eligible that we administer an ICHRA for. The more upmarket this moves, you've got employers that have made advanced primary care a part of their health plan strategy for years. They're not going to just rip that out from people. But a near-site or an on-site clinic, if they move to an ICHRA, might not make as much financial sense. DPC is such a nice alternative, where you can still make that available to people who value it, but maybe you don't have to fully fund an on-site clinic where it doesn't make as much financial sense when you move away from self-funding. So I get really excited about it. I think DPC is such an incredible strategic lever that the best consultants and HR leaders can think about as part of their overall benefit strategy.

Brian Garcia: Yeah, and even outside of the benefit strategy, just an HR strategy in general as a whole. You went over it a little earlier, but providing that type of benefit to your employees, number one, like you said, if you yank it away from them, it's going to be a mutiny, right? They're used to it, they love it, they want to use it. If you take it away, it's not going to be great. But that benefit can also be utilized as a recruiting and retention tool. From a cost perspective, you guys hire people all the time, you know how much it takes just to recruit, train, and hire somebody. So if you can start eliminating some of those costs, that helps out.

TJ Witham: It is interesting, though, I don't know if you've seen, I just saw it this week. Lockton, one of the biggest national brokers, just published their 2026 benefits survey that over 1,700 administrators complete. It showed, over time, whether admins value retention of their benefits plan more, or cost savings. And it's like this giant X. When you looked at 2018, 2019, 2020, it was almost all attraction and retention. Well, that's now shifted, where 54% of the people they surveyed said cost containment is now the number one priority, and attraction and retention for employees has dipped significantly below cost containment. So I feel like we're in this weird moment in American health insurance and healthcare where it's like, enough's enough, and people are finally being super honest about what's most important to them. You still want to offer benefits that are highly valuable, but I feel like people are starting to be honest and say, no, my number one most important thing is I've got to keep the lights on on my health plan, and cost containment is critically important.

Brian Garcia: Yeah, and that's the perfect mentality to implement ICHRA, right? Because you've got at least a capitated payment, or a payment you can budget for. It's not random costs here and there, and not all of a sudden some kind of cancer or heart event, a catastrophic event that you're going to have to worry about and jump in your health plan. ICHRA takes the business completely out of the insurance business, or the insurance world, and that's definitely helpful for a lot of folks. One thing you mentioned about the ICHRA being portable, direct primary care would also be portable, right, with that ICHRA product.

TJ Witham: Yep. I love that, 100%. So, the last major question I've got for you today. I always try to give people something to sink their teeth into. To frame this question: if you're talking with an employer, or meeting with a broker partner, that's trying to really grasp DPC and Nexus, what are some criteria you would say, hey, if you have a group that has X, Y, and Z, they'd be great to evaluate DPC? And then the other side of the coin, what are the types of things, maybe based on where an employer has people located, that might not be a great DPC candidate? I'd love for you to share with our audience what to look for, and maybe even more importantly, what not to look for, as a consultant or employer leader evaluates where DPC works and where it doesn't.

Brian Garcia: Yeah. So the biggest things are, well, our lens of success at Nexus is, anytime we can get one person utilizing direct primary care, that's a success milestone for us, because that leads to, if it's a big employer group, word of mouth. So other people are going to start utilizing it, or at least be interested in it. And again, we're there to help out with that member experience.

The good candidates for DPC really are, I mean, anybody. Anybody and everybody needs access to good primary care, no matter who you are. And again, it's not just because of sick care, it's because of that healthcare. So we want to help create better clinical and health outcomes for folks, not just get them access, but help keep them healthy. So candidates for direct primary care, advanced primary care, really are anybody out there who wants a healthcare product. And again, tying that with the health insurance of an ICHRA. Benefit advisors looking at different, spread-out employer groups can still have access. Working through Nexus, you don't have to sit there and try to source out one provider. We can have, even in Indianapolis, 10 different direct primary care providers with one company, so that DPC is closer to that person's home and not just closer to their work. So it's not just a one-or-nothing thing.

TJ Witham: Talk to me about some pockets in the country where, I would almost call it, the DPC network isn't as strong, where those can be trickier.

Brian Garcia: Yeah, perfect, thanks for teeing that up. There are DPC deserts, I guess, is what we call them, where there are no bricks-and-mortar physical clinics anywhere. There's a lot of reasoning for that. Maybe there's just not the critical mass, or maybe just no providers at all whatsoever, and people have to drive for their care. There are companies out there trying to alleviate that, that have a direct primary care type of model or product, but they're going to visit or go to a person's house to do their primary care visit.

TJ Witham: Traveling DPC. I didn't even know that was a thing.

Brian Garcia: Am I allowed to say names?

TJ Witham: Oh, yeah.

Brian Garcia: Okay. So if you look at Nice Healthcare, they're actually coming into Indiana now, I believe they've put a footprint in Indiana, but it's virtual, virtual first. Then if you need a physical visit, the doctor or provider would go and visit that person and take care of them. There are other companies like that sprouting up as well. Now, Nexus has a sister company to help alleviate that. If we run into an employer group in Rockport or Rockford, Indiana, I think, where there are no DPCs around there whatsoever, we're proposing that they utilize our virtual direct primary care product. It's virtual only, so we won't go on-site anywhere, but it's virtual urgent care and virtual primary care. That can be their choice. If the employee wants to choose that, they can. Or we could say, we do have a DPC provider that's 45 minutes away, not 25, are you okay with that? And if they say yeah, then we'll get them set up with that type of clinic. So DPC, we feel, is for everybody, but it may not be accessible to everybody in the country.

TJ Witham: Which is very similar to how I talk about ICHRA. The reality of ICHRA is, ICHRA is only as strong as the individual insurance market and where your employees live. So, and this is not a perfect example because we have Chicagoland clients, but Chicago, for example, is a very tough ICHRA market. You've got fragmented networks in the Chicago area, and prices of individual plans are really high in comparison to other areas. So I tell consultants I'm working with in Chicagoland, it's a tougher ICHRA ecosystem. Versus other areas, just north of Chicago, you get into most of Wisconsin, most of Minnesota, incredible ICHRA markets in most of those areas. So it's very much pocket to pocket. I think there's some truth to that in DPC, but it's being further developed every month that goes by as DPC continues to grow. I think the same is true for ICHRA. You've got more and more individual carriers that see these markets have a need for better product, and they're trying to bring more and more solutions and options to the individuals looking for better insurance plans in some of the pockets that maybe aren't great right now.

Brian Garcia: On the DPC front too, you do have providers out there who want to get out of the system. They want to get out of the fee-for-service world, they just don't know how. And there are companies out there that can help do that and guide them. One big thing is the financial hurdle, like, okay, I'm going to lose all this fee-for-service income, what am I going to do to make any income until I build up my patient panel? So there are mechanisms out there that help front-load the financing as well. It's getting easier and easier for providers to get out of the fee-for-service world, get out from under whoever owns them, if that's the case, and become independent again, and do it from a direct primary care space.

And one thing that always gets brought up to us sometimes is, well, there's a DPC right here and there's a DPC right here, right next to each other, aren't they competitors? It's almost like yes and no. I guess maybe they're competing for some patients, but they're going to cap their patient panel.

TJ Witham: Right. They've got a capacity. Once they're there, they're there.

Brian Garcia: Yeah. So they're not going to sit there and go after as many patients as possible. They're not going to poach the DPC down the street, they're going to support the DPC down the street. The industry as a whole is rising.

TJ Witham: Yep.

Brian Garcia: And the ICHRA space as well, right? You guys are rising and getting more and more prominent. Education's getting out there, and podcasts like this are great to get that word out as well.

TJ Witham: So I love it, man. It's been awesome. Last question I've got, I ask every guest this. So put on your future-thinking, future-facing hat. If anything could change in the next, call it five years, specific to ICHRA, what would you love to see changed? I know there's a lot.

Brian Garcia: Yeah, there is a lot. I was trying to go back to something you said earlier, TJ, about setting it up and designing it to be like someone's 401(k), but even funding it, having a funding mechanism, something like that for ICHRA, even making it easier to get into that space for folks. Education, I brought it up before, just making sure people know this is something that's out there. And I'd mentioned it might go away with a presidential election, just because of the executive order or whatever. You don't feel that way, which is awesome. But if it does get somehow codified into something, then the market will explode big time. And I really think there are situations, obviously, where an ICHRA probably won't work, but there are a lot of situations where it's just great. It's a definitely good product. Like I said earlier, it gets the company out of being in the insurance business as their secondary business, and gets them out of that risk as well. And even the fiduciary liabilities that come with all of that too.

TJ Witham: Yep, 100%. Plus one to all of that. And I think, too, the more ICHRA accelerates, we've had major acceleration in knowledge of brokers, also knowledge for employer leaders and HR staff who know about ICHRA more and more. What I want to see next, the next layer, is the everyday employees knowing that ICHRA is an option. Because I think the more employees go to their benefits leaders and say, hey, why are we not considering an ICHRA for our health plan, it would open up so much more choice for me. That's the next layer. The more and more I can just walk on the street and survey random people and say, hey, do you know what an ICHRA is? My dream is that in three to five years, I'd survey people on the street and they'd be like, oh yeah, I know what an ICHRA is, it would give me pre-tax dollars and I can go pick the plan that works for me and my family. And once we hit that, I feel like it's just going to accelerate all the more. But insurance is complicated. We've had some major steps forward in a short amount of time, because this is the start of the sixth year of ICHRA being a thing. So we want to keep driving and pressing for growth, but we've had a lot of growth over the last five or six years too.

Brian Garcia: Along with what you were saying, just being able to get that choice. Even benefit advisors, as they develop group health plans, it's always the case that a group health plan is not going to be right for somebody, or several people, in the company, and it could eliminate that as well. So, again, the education for people to know that. And you also mentioned you went with a bronze plan with your ICHRA. Tying a bronze plan to DPC is fantastic.

TJ Witham: Yep, 100% agree. And if you've never seen, if you like The Office and you're a listener and you've never seen the Office health insurance episode, go watch it. You'll thank me later, you'll be rolling laughing. It literally hits on, this was The Office years and years ago, the problem that ICHRA solves, where the office employees had to try to pick a health plan for everybody. So you just made me think through Michael Scott and all the office actors acting that out, because it's just hilarious.

Brian Garcia: I've got to go watch that episode.

TJ Witham: Yeah, go check it out. Anyway, Brian, appreciate you being our guest, man. This was such a treat.

Brian Garcia: Great to be here. Take care, man.

TJ Witham: All right, appreciate it.