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Employers and Membership Medicine: The 2027 Opportunity, Examined
Employer health costs are rising at the fastest pace in 15 years, and the 2025 tax law made direct primary care easier to pair with HSAs. Membership practices are getting calls from employers. The evidence on savings is thinner than the pitch.
Updated October 2026: evidence grades replaced with evidence types; funding disclosed on every source.
Start here: the questions this brief answers
Tap a question for the short answer, then jump to the evidence.
The average family premium reached $26,993 in 2025, and employers expect 2026 costs to rise 6.5% even after plan changes. Seven percent of larger firms already contract directly for primary care. No published study measures employer-sponsored concierge memberships. The most-cited actuarial study involves direct primary care, a different model, and found lower utilization but roughly cost-neutral results for the employer, with wide uncertainty. Employer contracts can stabilize a membership practice, but they change who the customer is. Price them on capacity, measure outcomes, and avoid promising savings you cannot prove.
“An employer contract can steady your revenue or quietly change who your customer is. Before you sign, ask one question: will this make my members' experience better, or just bigger?”
Why are employers interested now?
Costs. KFF found the average family premium hit $26,993 in 2025, up 6%. Mercer found employers expect 2026 costs to rise 6.5% after plan changes, the biggest increase since 2010.
Go to the full answer ↓How many employers contract directly for primary care?
About 7% of firms with 50 or more workers, according to KFF. Thirty percent contract for virtual primary care.
Go to the full answer ↓Is there evidence employers save money?
Not for concierge medicine; no study exists. For direct primary care, a different model, the evidence is limited: a Milliman study for the Society of Actuaries found lower utilization but an employer net cost about 1.3% higher, in a range from 5.2% savings to 7.8% higher.
Go to the full answer ↓Does the HSA change help employer deals?
Yes, for qualifying DPC arrangements: employer-paid fees are excludable from income, and employees can remain HSA-eligible. See Brief No. 27.
Go to the full answer ↓Should a concierge practice pursue employer contracts?
Maybe, with care. Executive health and small-employer contracts can fit. Large contracts can strain capacity and the member experience. Part 4 lists the questions to answer first.
Go to the full answer ↓Employers are looking for anything that bends the curve
Workers carry more of the cost, too. The average worker contribution for family coverage was $6,850 in 2025, and the average single-coverage deductible was $1,886; 34% of covered workers had a deductible of $2,000 or more.1 High deductibles are the opening for membership medicine: predictable primary care cost in front of a plan few employees want to touch.
The savings evidence is thinner than the pitch
No published study measures what employer-sponsored concierge memberships cost or save. The only careful public analysis involves direct primary care, a different model, so it is shown here, walled off, for context.
These figures describe direct primary care (DPC), not concierge medicine. DPC usually operates outside insurance billing at lower monthly fees. They are shown here, separately, for context only and should not be read as concierge data.
The most careful public analysis of an employer DPC arrangement is a 2020 Milliman study commissioned by the Society of Actuaries. It examined one employer offering a DPC option, comparing about 900 DPC enrollees with about 1,100 PPO enrollees over two years. After adjusting for health status, DPC enrollees used fewer services, particularly emergency and facility care. But because the employer paid the DPC fees and waived deductibles, its net cost came out about 1.3% higher, with a plausible range from 5.2% savings to 7.8% higher cost.3 Practice Insight
Lower utilization in one DPC arrangement is a signal, not a concierge result. Savings depend on benefit design, who enrolls, and what the employer pays. A practice that promises an employer a specific savings figure is promising something the published evidence does not support.
How the 2025 tax law changes the employer math
Under IRS Notice 2026-5, employer-paid fees for a qualifying direct primary care arrangement are excludable from the employee's income, and an employee in a qualifying arrangement can keep contributing to an HSA. The fees cannot also be reimbursed from the HSA, and they do not count toward the plan deductible.4,
The definition is narrow: primary care only, from primary care clinicians, paid only through a fixed periodic fee of no more than $150 a month per individual.6 This tax treatment is written for direct primary care, a different model; concierge arrangements that bill insurance or charge more are unlikely to qualify. CMT Brief No. 27 explains the rule in detail.
Before you contract with an employer
Fits well
- Small employers (10 to 200 staff) near the practice
- Executive health benefits for leadership teams
- Employers already offering high-deductible plans
Proceed carefully
- Large contracts that could double the panel
- Employers expecting guaranteed savings
- Contracts with reporting demands the practice cannot meet
Price on capacity
Decide how many employer members your team can serve without changing access for existing members.
Agree on measures
Utilization, member satisfaction and access, measured the same way every year. Not a promised savings number.
Protect the relationship
Members are patients first, employees second. Confidentiality terms must say so.
Employer contracting in concierge practices
CMT could not verify any published data on how many concierge practices hold employer contracts, what they charge employers or how long contracts last. The only platform data on employer contracting describe DPC.
These figures describe direct primary care (DPC), not concierge medicine. DPC usually operates outside insurance billing at lower monthly fees. They are shown here, separately, for context only and should not be read as concierge data.
Contracts are concentrating: 58% of employer sponsors had fewer than 10 members enrolled, and practices with 21 or more sponsors had 54% of their panels sponsored.7 In Hint's 2026 data, employers fund 60% of active DPC memberships.8
These are company-reported figures from one DPC software platform.Know the evidence
Lower utilization: likely. Net employer savings: unproven.
Design the contract
Capacity limits, data rules and exit terms first; price second.
Report results
Share de-identified outcomes with employers every year. Evidence wins renewals.
How this brief was built
CMT reviewed the KFF 2025 Employer Health Benefits Survey, Mercer's 2025 national employer survey (as reported), IRS guidance on direct primary care and HSAs, and the Milliman analysis commissioned by the Society of Actuaries. Vendor and practice case studies reporting employer savings were excluded because their methods are rarely disclosed. Concierge medicine and DPC are treated as different models: the Milliman study and Hint Health's 2025 and 2026 platform data (company-reported) describe DPC and appear only in separate, labeled DPC boxes.
How to read the evidence types
Every key finding is labeled by evidence type. Labels describe the type of evidence, not its value. Each type answers different questions. Funding is disclosed on every source.
Randomized trials and systematic reviews.Best for cause and effect.
Large observational studies and government data.Best for trends at scale.
Surveys, smaller studies and expert consensus.Best for real-world experience.
Company-sponsored or company-reported data that is not peer-reviewed.Best for early signals and operating data.
Statutes, regulation and official guidance.Best for what is required.
What we don't know
- How many concierge (as opposed to DPC) practices hold employer contracts, and what share of revenue they provide.
- Independent, multi-employer evidence on total cost and outcomes of employer-sponsored DPC or concierge benefits.
- Whether employer demand for HSA-paired DPC grows in 2027 as the new rules take hold.
How to cite this brief
External review: this brief has not yet been reviewed by an outside expert. When review is complete, the reviewer is credited by name above with any conflicts of interest, and the version number is updated. Reviewers check accuracy and fairness; CMT is responsible for the final content.
Corrections policy: when an error is identified, CMT corrects it in the open and updates the version number above. Send corrections to the editor through conciergemedicinetoday.net.
Related CMT Research Briefs
References
- KFF. 2025 Employer Health Benefits Survey. October 22, 2025. www.kff.orgFunding: not stated (conducted and published by KFF)
- Healthcare Finance News. Employers brace for biggest health cost increase in 15 years (Mercer National Survey of Employer-Sponsored Health Plans 2025). September 8, 2025. www.healthcarefinancenews.comFunding: not stated (conducted and published by Mercer)
- Milliman. What our study says about direct primary care (research commissioned by the Society of Actuaries). May 2020. www.milliman.comFunding: professional society (Society of Actuaries Research Expanding Boundaries Pool, commissioned)
- Current Federal Tax Developments. Notice 2026-5: Expansion of HSA availability and eligibility under the OBBBA (analysis). December 10, 2025. www.currentfederaltaxdevelopments.comFunding: not stated (tax commentary)
- Internal Revenue Service. Notice 2026-5: Expansion of health savings account availability and eligibility under the One, Big, Beautiful Bill Act. December 9, 2025. www.irs.govFunding: federal (Internal Revenue Service publication)
- Louisiana Academy of Family Physicians (source: American Academy of Family Physicians). Guidance released on allowing HSA funds to be used for DPC arrangements. December 17, 2025. lafp.orgFunding: not stated (association news item)
- Hint Health. Employer Trends in Direct Primary Care 2025 (de-identified Hint platform data: 2,400+ DPC clinicians, 1.2 million members, 7,200 employer sponsors, January 2017 to December 2024). 2025. www.hint.comFunding: industry (Hint Health; company-reported platform data)
- Hint Health. Hint Health releases 2026 Direct Primary Care Trends Report (platform data from 2,700+ DPC clinicians and 1.4 million members). Press release via Cision. April 23, 2026. digital-release.nwahomepage.comFunding: industry (Hint Health; company-reported platform data)
Educational and informational only. This CMT Research Brief does not constitute medical, legal, tax, financial, accounting or other professional advice, and it does not create a professional relationship of any kind. Statements about laws, regulations, tax rules and payer policies are general, may not reflect the rules in your state, and can change after publication. Consult a qualified attorney, accountant, tax adviser, compliance professional or licensed clinician before acting on anything here.
Independence. Concierge Medicine Today is an independent publication. It does not accept payment for favorable coverage, and it does not favor one practice model over another. Company names and products are mentioned for context only and are not endorsements. Funding is disclosed for every source in the reference list.
Accuracy. CMT verifies figures against their original or best available sources at the time of publication. Where a figure is an estimate, an inference or a company-reported number, the brief says so. This content is not without possible error or omission.
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