
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.
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🎙️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.
Legal Considerations 🎙️ Concierge Medicine is Creating a Splash from the Windy City 💨 to the Sunshine ☀️😎 State: But Remember, It’s Not a One-Size-Fits-All Solution!
Jonna D. Eimer is a health law and corporate attorney and shareholder at Roetzel & Andress in Chicago, Illinois. She represents numerous concierge medicine practices and has extensive experience with other innovative practice models. She also advises her clients – including physicians and physician groups, dentists, behavioral health clinicians, and other health care providers – in forming new practices, selling established practices, and negotiating employment and shareholder agreements, as well as guiding them with respect to regulatory matters.
Why Are There So Many Concierge Medicine Practice Transactions?
Most physician owners of concierge medicine practices do not have experience going through a practice sale or major partnership transaction — here are some helpful and practical recommendations to consider.
“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).
ACROSS THE POND
For more context and additional information and education about concierge medicine and private practice services in the U.K., please see below.
The U.K.’s concierge medicine market has evolved from niche private GP care to a diversified sector with digital hybrids, corporate packages, and luxury health programs.
🕰 Historical Timeline — Concierge Medicine in the U.K.
(For reference and General Information Only - please see disclaimers)
Pre-2000s – Private GP Practices Exist but “Concierge” Term Rare
Private general practice existed for decades, mainly serving executives, diplomats, and private health insurance clients.
Most used pay-per-visit or corporate retainers rather than formal “concierge” branding.
Source: British Medical Association — Private practice in the UK: historical context — https://www.bma.org.uk
Early 2000s – Membership-Style GP Services Emerge
London clinics began offering annual retainers for unlimited GP visits, faster access, and longer consultations.
Example: The London General Practice began corporate and individual memberships.
Source: The London General Practice (Company History) — https://www.thelondongeneralpractice.com/about-the-london-general-practice/
Mid-2000s – U.S. Model Gains Attention
Media coverage introduced “American-style concierge doctors” to U.K. audiences.
2013 – Concierge Medical Practice Ltd Founded
Concierge Medical Practice Ltd incorporated on 20 February 2013.
Companies House confirmation: https://find-and-update.company-information.service.gov.uk/company/08387668
2014 – HealthClic Founded
HealthClic Ltd incorporated on 18 December 2014.
Companies House confirmation: https://find-and-update.company-information.service.gov.uk/company/09892983
2010–2015 – Corporate & International Patient Services Grow
Bupa, HCA Healthcare UK, and others bundle GP access with corporate health plans and executive screening.
Sources:
Bupa UK — https://www.bupa.co.uk/
HCA UK — https://www.hcahealthcare.co.uk
2016–2019 – Digital Concierge & Home Visit Services
Growth of subscription GP services combining home visits and telemedicine.
Examples:
Doctor Care Anywhere — https://www.doctorcareanywhere.com
GPDQ — https://www.gpdq.co.uk
2018 - 2020 - Media Coverage
Press Release - 2018 - (Credit: Concierge Choice Physicians) Concierge Choice Physicians Launches First-of-its-Kind Concierge Medicine Program in the UK -- London area doctors can now offer exclusive, limited-membership model to patients - https://www.prnewswire.com/news-releases/concierge-choice-physicians-launches-first-of-its-kind-concierge-medicine-program-in-the-uk-300727190.html
Article - (2019) - HealthClic Doctors and their team delve into another challenge faced when running a concierge medical service - https://conciergemedicinetoday.org/2019/12/24/healthclic-doctors-and-their-team-delve-into-another-challenge-faced-when-running-a-concierge-medical-service-2/
2020–2022 – COVID-19 Surge in Private GP Memberships
Financial Times - (2020) - Private groups race to meet Covid testing demand from UK companies - https://www.ft.com/content/17c5a06e-7987-415f-ad60-78102535a12f
Financial Times - (2022) - NHS backlog drives steep rise in self-pay healthcare - https://www.ft.com/content/81058c84-9b79-4e4d-927a-a85417b665de
2023–2024 – Luxury & Longevity Positioning
High-end providers integrate concierge GP into wellness and longevity programs.
Examples:
Mayo Clinic Healthcare London — https://www.mayoclinichealthcare.co.uk
Lanserhof at The Arts Club — https://www.lanserhof.com/en/
Financial Times - (2024) - Demand for private healthcare hits record high in UK - https://www.ft.com/content/a4f07a08-b7e9-4330-9915-c2640edf7866
Disclaimer: Some of the information in this publication was gathered with the assistance of generative AI tools. While we strive for accuracy and timeliness, this content may contain errors, omissions, or outdated details. It is provided for informational purposes only and should not be relied upon as medical, legal, or financial advice. Concierge Medicine Today, LLC. makes no representations or warranties regarding its accuracy or completeness and assumes no liability for any loss, injury, or damages arising from its use. We’ve cross-checked each link for accuracy and ensured they are publicly accessible as of today.
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).
TERMINOLOGY
For more context and additional information and education about terminology used in this space and attributions, please see below.
Disclaimers: However, please be aware that some of the information in this publication was gathered with the assistance of generative AI tools. While we strive for accuracy and timeliness, this content may contain errors, omissions, or outdated details. It is provided for informational purposes only and should not be relied upon as medical, legal, or financial advice. Concierge Medicine Today, LLC. makes no representations or warranties regarding its accuracy or completeness and assumes no liability for any loss, injury, or damages arising from its use. We’ve cross-checked each link for accuracy and ensured they are publicly accessible as of today.*
Timeline — Origins of Key Healthcare Terms IN THIS INDUSTRY OVER THE YEARS
1990s — “Concierge Medicine”
Widely credited to Dr. Howard Maron and Scott Hall of Seattle, WA, who founded MD² (MD Squared) in 1996, offering an upscale, retainer-based model for fewer patients and personalized care.
Early media coverage (1999 Seattle Times, 2000 New York Times) popularized the phrase “concierge medicine” in the U.S.
Sources:Maron, H. MD² official site: https://www.md2.com
McClure, R. “Seattle doctor starts upscale practice,” Seattle Times, Oct. 11, 1999.
Late 1990s — “Membership Medicine”
Used in marketing by early boutique medical practices to frame the retainer fee as a “membership.”
Term appears in Physician Executive journal (1999) to describe annual-fee primary care models.
Sources:Sager, A. & Socolar, D. Physician Executive, “The Boutique Medicine Phenomenon,” 1999.
2001–2003 — “Personalized Medicine”
Academic and policy use of “personalized medicine” grew after completion of the Human Genome Project (2003).
Term is often attributed to Dr. Leroy Hood (systems biology pioneer) who advocated genomics-based personalization in healthcare.
Sources:Hood, L. & Friend, S.H. “Predictive, Personalized, Preventive, Participatory (P4) Medicine,” Nature, 2004.
National Human Genome Research Institute: https://www.genome.gov
Mid-2000s — “Subscription-Based Healthcare Delivery”
Business and policy analysts began using this phrase to describe recurring-fee healthcare models, paralleling the “subscription economy” trend in other industries.
Earliest healthcare use appears in Health Affairs blog posts and consultancy white papers (2005–2008).
Sources:Deloitte Center for Health Solutions, “The Emergence of Subscription-Based Healthcare,” 2008.
2007–2010 — “Direct Primary Care”
Popularized by the Direct Primary Care Coalition and early DPC practices such as Qliance (founded 2007, Dr. Garrison Bliss, Seattle) and AtlasMD (Dr. Josh Umbehr, Wichita).
The term “direct primary care” appeared in Washington State legislation in 2007 and in national policy discussions by 2010.
Sources:Bliss, G. Qliance Media Kit, 2009.
WA State SB 5958 (2007), “Direct Patient-Provider Primary Care Practice.”
Direct Primary Care Coalition: https://www.dpcare.org
2010s — “Longevity Medicine”
Emerged in anti-aging and preventive medicine circles as precision health, biomarkers, and geroscience research matured.
Term used in Nature Aging and The Lancet Healthy Longevity in the early 2020s to describe physician-led interventions aiming to extend healthspan.
Sources:Zhavoronkov, A. “Longevity Medicine: from Bench to Bedside,” Nature Aging, 2021.
The Longevity Medicine Foundation: https://longevitymedicine.io
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.
The term "Direct Primary Care" (DPC) does not have a single universally agreed-upon “inventor,” but the historical trail points to:
Earliest Roots
In the early 2000s, several small physician groups in the U.S. began using the term “direct care” or “direct primary care” to distinguish their monthly-fee, non-insurance model from “concierge medicine.”
Qliance in Seattle, founded in 2007 by Dr. Garrison Bliss and Dr. Erika Bliss, is widely credited with popularizingthe term “Direct Primary Care” in the press and policy discussions. They were among the first to lobby for explicit legal recognition of the term.
Before Qliance, some pioneering practices (e.g., Bliss MD in 1997, and a few early 2000s family practices) used “direct care” or “direct practice” in marketing, but the “primary care” modifier became more consistent by the mid-2000s.
Key Milestones
2007: Qliance launches and explicitly brands itself as a “Direct Primary Care” company.
2008: The Washington State Legislature passes a law defining and legalizing “Direct Patient Care” arrangements, influenced by Qliance’s lobbying.
2010: National media (e.g., The New York Times, Wall Street Journal) begins using “Direct Primary Care” in articles describing low-cost, membership-based alternatives to traditional insurance.
2014 onward: The DPC Alliance, DPC Frontier, and other advocacy groups cement “Direct Primary Care” as the industry-standard term.