National Stats and Other Subscription and Membership-Based Healthcare Delivery Industry Insights
HISTORICAL INSIGHTS AND TIMELINE
This page provides valuable insights from both physicians and C-suite experts, including industry trends, polls, statistics, news releases, and journal articles from Concierge Medicine Today. Media representatives are invited to explore this page prior to submitting any general contact inquiries.© 2007-2025 All rights reserved. Concierge Medicine Today, LLC.
🎙️Cash Healthcare: How Does It Really Work??? Industry Legal Expert 🎙️ Weighs In!
Today our guest is an attorney and an old friend! You probably know him, Jim Eischen, Esq. He’s a talented musician, a motorcycle rider … and more importantly FOR Doctors today, Jim’s an expert in cash healthcare and compliance.
“Once upon a time, the ‘NOW accepting new patients’ sign was the standard signal for patients that their doctor was ‘in the box’ and ‘open for business.’ It was a marathon most doctors would HUMBLY endure in the service of patients and ultimately one day call a career. Though as the years went by more doctors saw that entering the practice felt more like a penalty box than an altruistic calling. And today's healthcare marketplace isn’t giving doctors much choice anymore FOR a long career. HEALTHCARE TODAY is riddled with bureaucracy, ambiguous prices, visits that feel like speed-dating, and unwelcoming environments where both patients and doctors are running on empty. Enter cash-pay, membership, executive, preventative, routine and subscription healthcare (and all of its current iterations, labels and price points). For a few thousand doctors today in the U.S. and abroad, these cash-pay, subscription-based healthcare delivery business/practice models have become one of the few prescriptions and solutions available to both doctors and patients to treat patient and physician burnout in our chaotic, cold, unfriendly and overcomplicated healthcare marketplace. And let’s be honest, healthcare today is more like a maze than a place of refuge or healing. Doctors in these practice models have rediscovered their passion for healthcare – and patients, well, they’re sitting on the other side of these Doctors and rekindling that personal bond with their physician that they honestly thought had gone extinct!”
Editor-in-Chief, Concierge Medicine Today, LLC., industry trade publication, est. 2007.
Disruptively Innovative
~Editor-in-Chief, Concierge Medicine Today
“No matter how one perceives or understands concierge medicine, along with its subscription and membership options today, most people's first reaction to these novel healthcare delivery concepts is typically curiosity. However, it can also be met with preconceived opinions and criticism,” stated the Editor-in-Chief of Concierge Medicine Today to a gathering of physicians in Atlanta last October. “It's no surprise that much of the criticism directed at these business models comes from a small group of entrenched healthcare professionals who overlook a well-known and essential business principle: ‘disruptive innovation.’ This concept, introduced by Clayton Christensen in the 1990s, explains how smaller companies with limited resources can challenge established businesses by creating new markets or transforming existing ones with simpler, more affordable alternatives. These innovations typically emerge in neglected market segments and gradually ascend, displacing established competitors. Examples include Top Golf revolutionizing the driving range and entertainment sector, Netflix disrupting video rental services, and Uber reshaping the taxi industry — all underscoring the importance of adaptability and innovation for maintaining a competitive edge (Christensen, C. M.; 1997; Christensen, C. M., Horn, M. B., & Johnson, C. W.; 2008; Schindler, R. M., & Pelsmacker, P. De.; 2017; Koller, T., & Wutz, A.; 2018; and Teece, D. J.; 2010).
A mentor of mine years ago once shared a thought that has remained with me: ‘Someone is already creating a uniquely better approach, product, environment, or model. There’s someone out there redefining the rules of the current model of whatever it is you do. The aim [he said] isn't necessarily to be the first to create something uniquely better, but rather to be positioned both organizationally and personally to recognize ‘unique’ it when it comes along.’ While I appreciate the altruistic mission of the healthcare field, I observe that much of the criticism aimed at concierge medicine — whether it be the bespoke versions or the more contemporary iterations — originates from within the healthcare system itself. Patients, like myself, generally embrace and appreciate these models. The next generation of patients will require healthcare to innovate as well. While some may dissent ideologically on these models, my experience shows that when the term ‘concierge medicine’ is mentioned, curiosity usually outweighs criticism by both Patients and Physicians. Looking at the bigger picture, I believe we are discouraging more doctors who bring innovative ideas and inadvertently pushing them away when we should be inviting them to the table and expressing interest in their fresh ideas for unique healthcare delivery alternatives. The concept of fairness has not proven effective in healthcare. We must move beyond fairness and actively engage with those waiting on the other side of the exam room or service window today. Ignoring what capable doctors envision for their patient communities benefits no one. The overly complex healthcare marketplace we have today is not truly healthcare; it’s ‘sick care’ and it’s complicated. This ‘sick care’ environment presents numerous reasons for doctors to feel disheartened and potentially leave the medical profession altogether. Concierge medicine (in all of its iterations) has revitalized the careers of many physicians, and to those who argue that it worsens the physician shortage, I would emphasize that five words from my doctor carry immense weight — they are likely one of the most influential voices in my life, second only to my wife and children. It costs little to support a physician's entrepreneurial ideas. When we critique, discourage and fold our arms and stand at the back of the room new ideas in healthcare based solely on fairness regarding shortages, it can come off as simply out of touch and intransigent— so by not listening and failing to encourage innovation in healthcare, we risk losing more physicians to burnout (or worse). Let’s not be in a position where we may overlook the next disruptive innovation, whatever it’s called.”
1900’s
CASH-PAY HEALTHCARE
First Generation Iteration: Some experts trace the roots of this cash-pay healthcare model way back to 1913, with the focus on regular check-ups to keep sickness at bay and where a Doctor would carry a medical bag right into our home. This model however, has probably been cruising around for nearly a hundred years (or more), safeguarded by three federal statutes and a heap of Medicare/OIG guidance that many haven't even heard of.
The root of US cash healthcare was routine exam care, exams/communications detached from medical necessity and delivered on an ongoing basis regardless of condition. The concept can be found in a 1913 US medical practice that touted this as superior prevention/care (it was, still is). In 1920/1921, the same concept was envisioned as a US worker health solution, to increase productivity and better protect employees (Eischen; 2025).
1990’s
ENTER BESPOKE CARE
Second Generation Iteration (Bespoke Concierge Medicine): Bespoke or luxury concierge medicine birthed out of cash-only healthcare in the 1990’s. MD2 was key in starting concierge care by creating a new type of primary care that focuses on personal attention and easy access to doctors. Founded in 1996 by Dr. Geoffrey C. Friesen and Dr. John C. M. R. C. "Chuck" B. Friesen, MD2 offered a way for patients to get more time with their doctors and a variety of services for a yearly fee. This model changed how patients interact with healthcare, allowing them to receive better service and quicker care. It significantly influenced the growth of concierge medicine in today's healthcare system (Avery, A. & Barlow, J.; 2017).
In summary, and according to industry experts and sources over the years, in 1999, the term "concierge" emerged to define a cash healthcare model akin to the executive health model, with added claims of improved time and care coordination, etc — but it was still the same old model under the hood and more or less earned a thumbs-up from HHS in 2002 via public letters (Eischen; 2025).
2000’s-today
THE ORIGINS OF (modern day) ‘CONTEMPORarY CONCIERGE CARE’ or, ‘personal care models’ (PCMs) FOUND TODAY
Third Generation Iteration:
(i.e. Personal Care Models or as some label, a contemporary or modern-day version of more affordable Concierge Care):
This third generation version (as we define it here) often gets tangled in myths misreported by the media and misunderstood by critics; not every provider charges like a five-star hotel (i.e. concierge medicine), and not every doc works for the cost of a hot dog and a handshake!
Roundabout the same time (i.e. late 1990s), the subscription-based economy was at its infancy outside of healthcare — Netflix, Amazon Prime and others were slowly moving into business scene..
While cash-only healthcare got a snazzy new brandname (i.e. concierge medicine or bespoke-luxury concierge care) the ‘opportunity cost’ from our economics classes started to make sense. There was ways to make bespoke concierge care more affordable and unite the hearts and hands of Doctors and patients alike to a new version of subscription-based healthcare delivery.
This version has struggled with labels often getting side eyes from some as being the bespoke version or not ‘affordable enough’ by altruistic PCPs. Nonetheless, it’s become the industry darlin in our POV.
Over the years, more Physicians and healthcare startups considered what patients give up when they make a choice. Early adopters of concierge medicine in the 1990s saw this idea as critically important for the future of healthcare. So, they created more new (yet affordable) business models in this sweet spot they saw in the healthcare space where patients paid a fee a subscription (or membership, whichever you prefer) for routine exams and more personal attentiveness from their Doctors office. This approach eventually allowed more and more doctors to focus on fewer patients, improve service quality, and provide a better overall experience than traditional healthcare (Hewitt, 2006; Chokshi, 2016).
MDVIP was soon born as well in 2000 from an idea that started in the minds of forward-thinking primary care doctors in the 1990’s who felt the healthcare system was losing its way. They knew there was a better way to practice medicine and provide the level of care and attention their patients deserved (MDVIP; April 2025).
In 2002 HHS/OIG tested MDVIP openly in public letter exchanges between Congressman Henry Waxman and HHS Secretary Tommy Thompson, and Mr. Thompson openly confirmed in a public letter (Eischen; 2025) that charging cash for services not covered by Medicare was lawful (validating the MDVIP model openly as Medicare compliant). MDVIP practices remain in Medicare, and bill plans, and charge cash for an annual routine exam, a follow-up consult, and marketing claims of extra time with/access to the physician (Eischen; 2025).
of note
DPC, CONSIDERED TO BE A DISTANT RELATIVE YET NOT TO BE CONFUSED WITH ‘BESPOKE’ nOR MORE ‘CONTEMPORARY’ VERSIONS OF CONCIERGE CARE NOR CONSIDERED CONCIERGE-STYLE ‘Personal CARE MODELS’ IN THE MARKETPLACE TODAY
Like a Fourth Generation Iteration (A distant cousin if you will): Not to be confused with bespoke-luxury concierge medicine practice models, nor present-day versions of membership-driven contemporary personal care models (PCMs) nor a contemporary iteration of concierge subscription healthcare practices, DPC is a modern-day, cash-only, no insurance, no Medicare, self-pay, reboot (or budget-friendly) subscription spin on the original 90’s luxury or bespoke concierge medicine subscription model that catered primarily to the affluent clientele years ago.
“In contrast, DPC arose as a response to insurance limitations for lower-income populations, focusing on lobbying for legal changes instead of adapting to existing regulations, often leading to violations. Steer clear of marketing and branding, that, while quite prevalent in the marketplace, is frustrating your patient fees achieving qualified medical expense status. For example, you may dearly love the DPC or concierge [as terms or] brands, but, the IRS is convinced that neither brand’s patient fees are qualified medical expenses. Why debate the IRS? Neither brand is likely to fully explain YOUR medical or healthcare philosophy, and neither brand assists with qualified medical expense status so both brands frustrate HSA/FSA/HRA/MSA funding absent changes in tax laws and IRS regulations.” (Eischen; 2025)
Typically (but not always which is why industry jargon can be confusing) DPC docs often urge their curious colleagues to ditch Medicare and kick insurance headaches to the curb and offer a more affordable fee. They champion a cash-only subscription model for primary care or family health services and those fees can range (typically, but not always) $50 to $150 per month per patient. This may (but not always) cover services like check-ups and preventive care (Baus, C. (2022). Baird, A. (2021); Peterson, J. (2021); Tew, J. (2020))
As of recent estimates (2025), there are about 1,200 to 1,500 Direct Primary Care (DPC) practices in the U.S., accounting for some closures. DPC is expected to grow at a rate of 10-20% annually, driven by increasing demand for personalized healthcare, excluding concierge medicine programs. ("The Future of Direct Primary Care" by the American Academy of Family Physicians; "Direct Primary Care" by the American College of Physicians; Articles in *Health Affairs* regarding DPC trends.)
How Concierge Medicine and Direct Primary Care Differ
Direct primary care (DPC) is like concierge medicine in the sense that practices charge a flat fee to patients and offer members greater access to in-person and virtual care. However, there are two key differences. (Eastwood; 2022)
One is that, as the name implies, DPC is solely for primary care, while concierge medicine may also cover specialty care. This tends to make DPC less expensive than concierge medicine but also less comprehensive in the services it can offer. (Eastwood; 2022)
The other is that DPC practices don’t accept insurance, while the American Academy of Private Physicians estimates that 75 percent of concierge medicine practices do. (Generally, concierge practices that don’t accept insurance tend to charge higher membership fees, according to AARP.)
For patients, insurance covers care that’s not included in the membership fee. For practices, insurance reimbursement provides an additional revenue stream; Jorgensen says MDVIP gets about 20 percent of revenue from insurance, which is roughly an even mix of Medicare and commercial plans. (Eastwood; 2022)
In summary, while DPC shares some distant genetic traits to other subscription healthcare delivery ancestors, DPC is essentially just a distant relative (as an example) of subscription healthcare delivery option trying to build its own sand castle on the beach with the some of other subscription options in the healthcare marketplace.