It's All About the Access, 'Til It's Not

The term "bespoke" is more familiar to European audiences than North American ones, though that's changing quickly. In its original context, bespoke referred to custom-tailored clothing: a suit cut to the exact measurements of one individual, with no standard template applied. In healthcare, the word has been adopted to describe something similar: care designed not for the median patient, but for the specific individual in front of the physician.

According to the Advisory Board's Solomon Banjo and Nick Hula, who explored the concept on the Radio Advisory podcast, bespoke care represents a model where treatment is customized to a patient's unique biological, behavioral, and personal characteristics, integrating medical needs with individual preference. Their key insight: healthcare has historically been designed to treat a hypothetical "median patient." Bespoke care challenges that assumption entirely.¹

We're not prepared now, but we can absolutely develop the infrastructure in clinical education, health literacy, all across from payment to clinical decision-making to make this a reality.

Solomon Banjo, Advisory Board, Radio Advisory podcast

This is worth pausing on. Bespoke care, as defined by leading healthcare researchers, is less a business model and more a clinical philosophy, one that demands precision medicine, advanced diagnostics, genetic insight, and a willingness to treat each patient as a population of one. It is ambitious, expensive in the short term, and largely aspirational at scale.

Concierge medicine, also known as retainer medicine, boutique medicine, or membership medicine, emerged in the mid-1990s as a response to a strained system. In 1996, Dr. Howard Maron and Dr. Scott Hall founded MD² International in Seattle, offering dramatically reduced patient panels, roughly 50 families per physician, and charging annual retainers of $13,200 to $20,000 per family.² MDVIP followed in 2000, founded by Dr. Robert Colton and Bernard Kaminetsky in Boca Raton, FL, scaling the model across hundreds of practices nationwide.³

The core proposition of concierge medicine is structural: it improves the physician-patient relationship by reducing panel size, increasing time per visit, and guaranteeing access. Where a traditional primary care physician may carry 2,500 to 3,000 patients and see 20 to 25 per day, a concierge physician typically carries 300 to 600 patients and sees 6 to 8.⁴ The math changes everything.

Bespoke care, by contrast, is a clinical and technological aspiration. It is about what happens inside the appointment, the depth of genomic profiling, the precision of diagnostics, the integration of behavioral and environmental data into a treatment plan that is truly singular. As the Georgia Tech Center for MedTech Excellence describes it, bespoke care "revolves around the idea that one size does not fit all," leveraging genomic sequencing, biomarker analysis, wearables, and telemedicine to deliver interventions matched to the individual at a molecular level.⁵

In plain terms: concierge medicine gives you more time with your doctor. Bespoke care gives you a treatment plan built around your biology. They are related, and the best concierge practices incorporate bespoke elements, but they are not the same thing. Conflating them doesn't serve physicians, and it certainly doesn't serve patients trying to understand what they're signing up for.

Over the past 20 years, a proliferation of terms has emerged to describe the evolving relationship between primary care and subscription-based models.⁶ Understanding the differences is not academic, it shapes patient expectations, physician positioning, and regulatory treatment.

Let's focus on substance, not labels.

Healthcare attorney, American Academy of Private Physicians conference, Phoenix, April 2015

Access is the headline promise of every tier in this space, but access at $50,000 a year and access at $50 a month are not the same product, and conflating them is where the "luxury" criticism gets its traction. Based on CMT's ongoing industry observation, the market breaks roughly into three tiers.

New products and services routinely enter a market at higher price points before becoming accessible to broader populations as competition increases and technology evolves. This is true of telemedicine, urgent care, and community health clinics, all of which began as premium or niche offerings before expanding access. Membership medicine, across all three tiers, appears to be on the same trajectory.

Author and leadership speaker Carey Nieuwhoff uses the term "insideritis" to describe a condition that healthcare has contracted in epidemic proportions: the tendency of organizations to view themselves exclusively through an internal lens, assuming that patients, the customers, understand the jargon, the acronyms, and the distinctions that insiders take for granted.

Perhaps the insiders know what you're talking about, but I don't. Nor does anyone new or not yet embedded in your culture.

Carey Nieuwhoff

This is not a small problem. Research analyzing recorded standardized patient encounters found that medical jargon is used on average more than once every four minutes, and only about half of those terms are ever explained.⁷ The consequences are real: poor health communication has been associated with medication non-adherence, missed diagnoses, reduced patient engagement, and lower satisfaction scores.

When a patient hears "concierge," "DPC," "bespoke," "retainer," and "membership" used interchangeably, sometimes within the same marketing brochure, they don't parse the nuances. They get confused. And confused patients don't enroll. Or worse, they enroll in the wrong model and feel misled. This is not only a marketing problem. It is a trust problem. And in healthcare, trust is the product.

There is a growing body of evidence, imperfect but directionally clear, that membership-based medicine improves outcomes when implemented well. A 2012 study published in the American Journal of Managed Care found that MDVIP-affiliated concierge patients were 42% to 62% less likely to be hospitalized than matched non-members. A follow-up study in Population Health Management (2016) showed MDVIP members had 20% to 24% fewer emergency room visits than matched controls over a three-year period.⁸ More recently, a 2025 systematic review in the American Journal of Medicine analyzed 49 studies from the prior decade and confirmed that concierge models are associated with increased patient and physician satisfaction, along with reduced hospital admissions.⁹

It's worth remembering that even the most foundational concepts in medicine were once unfamiliar and contested. Evidence-based medicine, today a cornerstone of clinical practice, was first formally defined in the early 1990s. The landmark 1996 paper in the BMJ articulated what it was and, crucially, what it was not: not a cookbook, not a replacement for clinical judgment, but a systematic integration of the best available research with individual clinical expertise and patient values.¹⁰ It was debated, mischaracterized, and resisted before it was accepted. Today's membership medicine terminology is experiencing a similar moment.

Price transparency has become a legal requirement in healthcare for a reason. Terminology transparency deserves the same seriousness. Bespoke and concierge are not the same. Neither is inherently better. But knowing the difference, and communicating it clearly, is how this industry earns the trust it keeps insisting it deserves.