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Concierge, DPC, Hybrid and Beyond: The Membership Medicine Models, Compared
Concierge, boutique, retainer, membership, direct primary care, executive health. The labels blur, and the differences matter for your fees, your patients, your Medicare status and your legal exposure. This brief separates the models, shows what the evidence does and does not say about each, and helps you decide which questions to take to your advisors.
New in October 2026. Built on the model framework in CMT's book The Doctor's Guide to Concierge Medicine, checked against current law and research.
Start here: the questions this brief answers
Tap a question for the short answer, then jump to the evidence.
There is no single "concierge model." CMT groups the field into three funding structures: a fee for services insurance does not cover alongside insurance billing, a hybrid that runs a membership practice and an insured practice under one roof, and fee-for-care models that skip insurance, the best known of which is direct primary care (DPC), a different model with its own laws. Executive health programs and add-on lines such as longevity testing and aesthetics sit on top of these. Each structure raises different legal questions, and published, methodology-disclosed data exist for only some of them. Pick the structure that fits the panel you can serve well, then have counsel confirm it.
“It's about being the best doctor FOR the world.”
Are concierge medicine and direct primary care the same thing?
No. Concierge practices commonly charge a membership fee and keep billing insurance and Medicare; DPC usually charges a lower monthly fee and does not bill insurance. Some states regulate DPC under their own statutes. CMT keeps the two separate in every brief.
Go to the full answer ↓What are the main concierge models?
CMT's framework names three structures: the fee for non-covered services (blended) model, the hybrid or segmented model, and fee-for-care models such as cash-only practices and DPC.
Go to the full answer ↓Where do executive health and longevity programs fit?
They are usually service lines or programs layered on a structure, not separate funding models. They carry their own scrutiny, from critics of luxury care to radiology guidance on full-body scans.
Go to the full answer ↓Which model has the most legal risk?
None is safe or unsafe by label. The risk sits in the details: what the fee covers, whether Medicare is billed, how a hybrid separates its two sides, and your state's laws. Part 4 lists the anchor rule for each.
Go to the full answer ↓How many practices use each model?
Nobody knows precisely. The best peer-reviewed count found about 3,036 concierge and DPC practices combined in 2023, roughly 60% concierge, and the authors call it an undercount. CMT's own field estimate is much higher.
Go to the full answer ↓How do I choose?
Start from the panel you can serve well, whether you will keep billing insurance, and what happens to patients who do not join. The model explorer in Part 5 turns those answers into questions for your advisors.
Go to the full answer ↓Six names, at least four different models
Patients, journalists and even physicians use concierge, boutique, retainer, membership, private and direct primary care as if they meant the same thing. CMT's books have documented the confusion for more than a decade, and it has real costs: the wrong label leads to the wrong fee, the wrong Medicare decision and the wrong legal advice.1,
The counting problem follows from the naming problem. The most rigorous recent study, published in Health Affairs, linked practice directories to national clinician records and found membership practices growing fast, while warning that its figures are not a national census and likely undercount the field.3
The Health Affairs team counted practices it could find in web directories and match to clinician records. CMT's field estimate counts more broadly, including practices that never appear in a directory. Neither is wrong; they measure different things. CMT Research Brief No. 28 explains the gap and proposes a transparent counting standard.
The critics deserve a hearing here too. A 2023 study in the Journal of Health Economics found that patients of physicians who converted to concierge practice used more care and that costs rose, without evidence that the change extended lives.5,
Three ways to fund the relationship
In The Doctor's Guide to Concierge Medicine, CMT grouped subscription-based practices into three structures by how they are paid for. The labels a practice uses on its website matter less than which structure sits underneath.1 Practice Insight
| Structure | How it is paid for | Insurance and Medicare | Where it tends to fit | Evidence type |
|---|---|---|---|---|
| Fee for non-covered services (the “blended” concierge model) | An annual or monthly membership fee for services and amenities insurance does not cover, such as an extended preventive visit and direct access | Physician usually keeps billing Medicare and insurance for covered visits | Physicians who want a smaller panel without leaving insurance; the most common concierge structure in CMT's experience1 | Practice Insight |
| Hybrid or segmented | Two businesses under one roof: members pay a fee to see the physician, while other patients stay in an insured practice, often with an NP or PA | Both sides usually bill insurance for covered care; only the membership side pays a fee | Practices that want to keep long-time patients who will not join1 | Practice Insight |
| Fee for care, concierge version (cash-based) | A membership fee, and often visit charges, paid directly; no insurance billing | Physician may opt out of Medicare, which has its own rules7 | Physicians leaving insurance entirely; not every concierge practice bills insurance2 | Practice Insight |
Company examples help show the blended structure at scale: MDVIP, a national concierge network, states that its affiliated physicians continue to participate in Medicare and most commercial insurance.8 Industry Research
In an open CMT online poll that ran through February 2020, 97 self-identified concierge offices answered whether they bill insurance or Medicare. 47 said they were cash only, and 31 said they accepted Medicare and some insurance; the rest gave other answers.9 The poll is not representative and respondents were not verified. It is shown only to illustrate that concierge practices are split on insurance, not to size that split.
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.
CMT's framework places DPC in the fee-for-care group, but DPC has become a distinct model with its own laws, tax rules and data.1 It usually charges a lower monthly fee and does not bill insurance.
Georgia's statute also requires a written agreement that discloses it is not insurance, and refunds of unearned fees within 30 days when the agreement ends.10 CMT Research Brief No. 21 explains why CMT treats DPC as a separate subject, and No. 27 covers the HSA rule.
Executive health, health-system programs and add-on lines
Not every membership offering is a practice model. Some are programs inside larger institutions, and some are service lines added to an existing practice. Each brings its own scrutiny.
Executive health programs
Comprehensive annual assessments, often at academic medical centers, marketed to executives and employers. A widely cited critique in the Journal of General Internal Medicine argued that some of these programs order extensive testing with little evidence of benefit and widen a two-tier system.13 Practice Insight
CMT’s 2025 book quotes attorney James Eischen, who describes structuring a cash practice to look like the executive health model while following federal law and Medicare guidance.2 That is one attorney’s view, not a legal standard.
Health-system and corporate programs
Membership medicine is no longer mostly independent. In the Health Affairs data, the independently owned share of concierge and DPC practices fell from 84% to 60% between 2018 and 2023, while corporate-affiliated practices grew sharply.3 Population Data
For physicians, that means an employer, not the physician, may set the fee, the panel and the rules. CMT Research Brief No. 22 covers MSOs and outside capital.
Longevity and advanced diagnostics
Many practices now add advanced testing to the membership. The American College of Radiology does not recommend total-body MRI screening for people without symptoms, citing no documented evidence that it prolongs life.14 Practice Insight
CMT Research Brief No. 31 weighs each test against the evidence.
Aesthetics and medical spa lines
Regulators are focusing on medical spas where physician supervision exists on paper but not in practice, and the rules differ sharply by state.15 Practice Insight
Before adding this line, confirm who may perform, delegate, supervise and own it where you practice.
A model is how the relationship is paid for. A program or add-on is what the relationship includes. Confusing the two is where many legal problems start.
Each structure has a different legal anchor
The legal question changes with the structure. These are the anchor rules for each, from official sources. They are a starting point for a conversation with counsel, not legal advice.
A physician who stays in Medicare may charge a membership fee only for services Medicare does not cover; federal regulators warned in 2004 that charging for covered services can violate the assignment agreement.16 The AMA asks retainer practices to explain the arrangement clearly and keep membership charges separate from insured services.17 Note that Medicare now covers an Annual Wellness Visit each year; it is a prevention planning visit, not a full physical exam.18 CMT’s reading: a fee built around an annual exam needs careful drafting so it does not overlap a covered service. CMT’s 2022 book reprints attorney commentary on exactly this issue.1
The Medicare rule above still governs the membership side of a hybrid: the fee may cover only services and amenities Medicare does not cover.16 For patients who decline to join, the AMA asks physicians to help them find other care and to keep caring for them until they do.17 CMT’s reading: a hybrid is only as safe as the line between its two sides.
Opting out of Medicare requires an affidavit and a signed private contract with every Medicare patient, and opt-out periods last two years and renew automatically.7
Converting a practice raises patient abandonment duties, and add-ons such as labs, imaging and aesthetics bring federal self-referral and state rules. CMT’s legal commentary page summarizes each with sources.19
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.
Most legal trouble in membership medicine starts with a mismatch: a practice that calls itself one model but operates as another. Write down which structure you run, then check every contract, consent form and web page against it. That is CMT’s editorial reasoning, not a legal standard.
Which structure fits your practice?
Answer four questions to see which structures fit your goals and what to ask your advisors. This is a discussion tool, not legal, tax or financial advice, and it does not recommend a model.
Model explorer
Name the structure
Write down which of the three structures you run, or plan to, in one sentence. If you cannot, your patients cannot either.
Match the paperwork
Check your membership agreement, consent forms, website and billing against that structure, with counsel.
Explain it plainly
Tell patients, staff and your community what the fee buys and what it does not. Clarity builds trust in every model.
How this brief was built
CMT started from the model framework published in its own book, The Doctor's Guide to Concierge Medicine (Expanded Edition, 2022), Chapter 11, and from Branded: the Concierge Medicine Doctor (2025). Both are labeled CMT original. Older fee and panel figures in those books reflect industry observation at the time of writing and are not reused here as current data. CMT then checked each model against current statutes and official guidance (HHS OIG, CMS, the IRS, a state DPC statute), the AMA Code of Medical Ethics, peer-reviewed research (Health Affairs, Journal of General Internal Medicine, Journal of Health Economics) and published surveys. Every source was opened and confirmed in October 2026.
Concierge and DPC were kept separate throughout. Combined counts are labeled “concierge and DPC combined.” DPC descriptions and figures appear only inside walled-off DPC boxes. CMT reader poll results appear only as raw counts in a Reader Pulse box because the sample is under 100. The model explorer in Part 5 offers discussion questions, not legal, tax or financial advice.
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 practices use each concierge structure (blended, hybrid, cash-only). No public dataset separates them.
- Outcomes by model: no study CMT found compares patient outcomes, retention or physician wellbeing across concierge structures.
- The size of executive health and health-system concierge programs nationally; institutions rarely publish enrollment.
- How state laws on DPC, medical spas and the corporate practice of medicine will change in 2027.
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
- Concierge Medicine Today (Tetreault M, Sykes C). The Doctor's Guide to Concierge Medicine, Expanded Edition (hardcover). Chapter 11, Choosing a Model: the three most common business models in subscription-based medicine. Concierge Medicine Today, LLC. 2022. CMT original framework. conciergemedicinetoday.netFunding: Concierge Medicine Today (self-published book; no outside funder) CMT original
- Tetreault M. Branded: the Concierge Medicine Doctor. Concierge Medicine Today, LLC. 2025. Includes commentary by attorney James Eischen (2025). CMT original. conciergemedicinetoday.netFunding: Concierge Medicine Today (self-published book; no outside funder) CMT original
- Zhu JM, Marsh T, Huntington A, Polsky D, Song Z. Growth in number of practices and clinicians participating in concierge and direct primary care, 2018-23. Health Affairs. December 2025. doi:10.1377/hlthaff.2025.00656. www.healthaffairs.orgFunding: mixed: federal (Agency for Healthcare Research and Quality, R01HS029467) and foundation (Commonwealth Fund; NIHCM Foundation)
- Concierge Medicine Today. CMT field estimate, 2026: 8,000 to 12,000 concierge and membership-based practices in the U.S., and fewer than 2% of professionally active U.S. physicians (KFF physician count with CMT estimates). Published on the CMT Media Desk. Method not published. conciergemedicinetoday.netFunding: Concierge Medicine Today (self-conducted; no outside funder) CMT original
- Leive A, David G, Candon M. On resource allocation in health care: the case of concierge medicine. Journal of Health Economics. 2023;90:102776. doi:10.1016/j.jhealeco.2023.102776. ideas.repec.orgFunding: not stated
- Hinckley J. Concierge medicine drives higher health costs without extending lives. Penn Leonard Davis Institute of Health Economics. September 18, 2023. ldi.upenn.eduFunding: not stated (research summary by Penn LDI)
- Noridian Healthcare Solutions (Medicare Administrative Contractor). Opt-out period, renewal, and cancellation. med.noridianmedicare.comFunding: federal (Medicare Administrative Contractor guidance issued under contract with CMS)
- MDVIP. How MDVIP is different from other concierge medicine (company website). Accessed October 2026. www.mdvip.comFunding: industry (MDVIP company website)
- Concierge Medicine Today, LLC. Poll: Does your concierge medicine office accept and/or bill insurance and/or Medicare? 97 votes, through February 2020. Open online poll (CrowdSignal). Not representative; respondents not verified.Funding: Concierge Medicine Today (self-conducted; no outside funder) CMT original
- Official Code of Georgia Annotated, section 33-7-2.1: Direct primary care agreements. Via Justia (2024 code). law.justia.comFunding: not stated (state statute)
- 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)
- Direct Primary Care Alliance. State of Direct Primary Care report (2024 survey, 465 respondents), as reported by Medical Economics, July 29, 2026. www.medicaleconomics.comFunding: not stated (conducted and published by the Direct Primary Care Alliance)
- Donohoe MT. Luxury primary care, academic medical centers, and the erosion of science and professional ethics. Journal of General Internal Medicine. 2004;19(1):90-94. link.springer.comFunding: not stated
- American College of Radiology. ACR statement on screening total body MRI. April 17, 2023. www.acr.orgFunding: not stated (American College of Radiology statement)
- Elliott B, Rai K. Medical spa compliance under the microscope. Holland & Knight. August 5, 2026. www.hklaw.comFunding: not stated (law firm analysis)
- HHS Office of Inspector General. OIG Alert: charging Medicare beneficiaries for services that are covered (assignment violations). March 31, 2004. www.hhs.govFunding: federal (HHS Office of Inspector General publication)
- American Medical Association. Code of Medical Ethics Opinion 11.2.5: Retainer Practices. code-medical-ethics.ama-assn.orgFunding: not stated (American Medical Association ethics policy)
- Centers for Medicare & Medicaid Services. Annual Wellness Visit (Medicare preventive services). Last modified April 9, 2026. www.cms.govFunding: federal (Centers for Medicare & Medicaid Services publication)
- Concierge Medicine Today. Legal Experts' Commentary: the rules differ by model, and by what you add (CMT editorial summary of public sources). October 2026. conciergemedicinetoday.netFunding: Concierge Medicine Today (self-published; no outside funder) CMT original
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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