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Built to Last? The Sustainability and Drawbacks of Each Concierge and DPC Pathway
Concierge medicine, solo cash-pay direct primary care and employer-sponsored direct primary care are three different businesses. They are paid differently, they grow differently and they fail for different reasons. This brief sets the evidence side by side, pathway by pathway, and is plain about where the evidence stops.
A companion to Research Brief No. 81, the Models and Pricing Map, and Research Brief No. 21, The DPC Question.
By Concierge Medicine Today, Editorial Research · Published November 2026 · Version 1.0 · External review: not yet reviewed · About 12 minutes
The 30-second answer. On the evidence available, the concierge pathway has the longest operating track record and the most layered revenue: a membership fee on top of continued insurance billing, with the largest network reporting member renewals above 90% for more than two decades (company-reported).1,2 Solo cash-pay DPC is younger and leaner: most practices in the largest survey were one to five years old, and 68.4% said their panels were not yet full.3 Employer-sponsored DPC is a different business again, a contract with a buyer rather than a relationship with each patient, with its own concentration risk.4,5 No study has yet compared practice survival across models head to head, so this brief labels CMT's reading as editorial.
Why does CMT see concierge as the more durable pathway?
Two revenue streams, a long track record and high reported renewal. Go to the full answer ↓
What are the real drawbacks of concierge?
Patient loss at conversion, Medicare limits on the fee, higher total spending and access concerns in the research. Go to the full answer ↓
Why is solo cash-pay DPC harder to sustain?
One revenue stream, a price ceiling near $100 a month, a slow build and, often, Medicare opt-out. Go to the full answer ↓
Why is employer DPC "different"?
The customer is the employer, not the patient. Growth comes in blocks, and so does risk. Go to the full answer ↓
How do the ten pathways compare on drawbacks?
See the interactive matrix and pick the drawbacks you can live with. Open the matrix ↓
Written for: Physicians choosing a modelDPC physicians weighing a changeNPs and PAsPractice leadersJournalists
Same word, "membership." Different machines.
Start with first principles: who pays, how often, and what happens to revenue when one patient, or one buyer, leaves.
Concierge
The patient pays an annual fee, usually $2,000 to $5,000 for classic concierge (CMT benchmark), and the practice usually keeps billing insurance, including Medicare, for covered care.6,7
- Two revenue streams
- Panels of several hundred
- Each member renews individually
Solo cash-pay DPC
The patient pays a monthly fee, $98.64 on average in the largest survey, and the practice usually does not bill insurance.3 Most respondents had opted out of Medicare entirely.8
- One revenue stream
- Built one patient at a time
- HSA-eligible only up to $150 a month9
Employer DPC
An employer, union or plan pays the practice per enrolled employee. Hint reports employer rates held at $55 to $65 per member per month for five years, and that employers now fund 60% of active DPC memberships on its platform.4,10
- One buyer, many members
- Grows and shrinks in blocks
- Renews on the benefits calendar
See where all ten pathways sit among every subscription model in health care, from retail memberships to Medicare Advantage, in the interactive family tree below.
The figures in the middle and right columns describe DPC, not concierge medicine, and are shown separately for context. Solo cash-pay DPC and employer DPC share a name but not a customer. CMT treats them as separate pathways throughout this brief.
Why CMT reads concierge as the longer, steadier pathway
CMT editorial reading The points below are CMT's reasoning from the sources cited. They are not the finding of any single study.
1. Two revenue streams instead of one
Most concierge practices keep billing insurance for covered services and add the membership fee for non-covered access and amenities.7,11 A cash-pay DPC practice lives on the fee alone. When fee growth stalls, a concierge practice still has its claims revenue; a DPC practice does not.
2. The math: membership revenue alone, before overhead
Industry Research CMT arithmetic using CMT benchmark ranges and the DPC Alliance average. Illustrative, not a forecast, and excluding concierge insurance billing.
Bar scale: $2.5M = full width. Concierge ranges: CMT Annual Industry Report benchmarks, first-party.12 DPC: DPC Alliance.3 Employer: Hint Health, company-reported.4 Overhead, staffing and payer mix differ by model and are not shown.
3. A long, documented track record
Industry Research MDVIP, founded in 2000, reports 1,400+ affiliated physicians, 430,000+ members and a 100-quarter growth streak.1 It has reported annual member renewal at 91% to 92% across many years and "about 90%" today.2,13 These are company figures, not independent audits. A peer-reviewed study of MDVIP Medicare patients with diabetes reported lower hospital use; the study had industry ties.14
4. DPC is still young, and its solo practices are still filling
Practice Insight In the DPC Alliance's survey of 465 physician-owned practices, most were one to five years old, a significant share were under a year, and few had passed ten years. The report itself says the low count of older practices may reflect retirement, transitions out of practice or survey reach.3 68.4% said their panel was not yet full; mature, full panels clustered at 400 to 700.3 A building phase of one to three years is commonly cited.15 Well-known early DPC ventures, including Qliance (2017) and an academic DPC clinic in Houston (2022), closed; the academic clinic cited inflation, the loss of its anchor physician and no employer contracts.16
Since January 1, 2026, DPC fees can be paid from an HSA only if they stay at or under $150 a month for one person ($300 for a family) and cover only primary care.9 That rule helps demand but also anchors price. The DPC Alliance found practices with more than 500 patients averaged $77.74 a month.3
The customer is the employer
Employer DPC can fill a panel quickly, which solves the solo practice's biggest problem.17 But it trades one kind of fragility for another.
- Concentration risk. Advisory Board notes that markets dominated by one large employer pose concentration risk, and fragmented markets often lack the employer density to generate volume.5 Industry Research
- Contract terms you do not set. The AMA's direct-to-employer checklist warns that arrangements can be highly customized by the employer, may shift risk to the physician, and may require coordination with other providers.18 Professional guidance
- A lower, flat price. Hint reports employer rates held at $55 to $65 per member per month for five years.4
- A different relationship. Some DPC physicians describe employer contracts as adding a middleman between doctor and patient.19
CMT editorial reading Employer DPC behaves more like a contracted service line than an independent membership practice. It can be stable when contracts are many and renewals are reliable, and fragile when one buyer is most of the panel.
Every pathway has a cost. Which can you live with?
CMT editorial reading Ratings are CMT's judgment, not measured scores. No study scores these pathways on a common scale. Each cell shows its basis: ✓ fact-based means the reason rests on a cited source; J means CMT judgment from how the pathway is structured, with no direct source. Tap any cell for the reason. Check the drawbacks you most want to avoid, and pathways rated High on any of them fade.
Solid edge: concierge. Dashed edge: direct primary care, a different model. Dotted edge: employer-sponsored DPC. Educational only; your state, payer contracts and market change the picture.
Every way health care is sold by subscription
Start at the root and open a branch. Tap any model for who pays, whether insurance is billed, a sourced example and the reference. Use the buttons to light up models by how they bill. The branches are CMT's editorial taxonomy; the examples and prices are sourced. Naming a company is not an endorsement.
Gray branch: payments that look like subscriptions but are insurance or cost-sharing, not memberships. Executive health programs are usually a one-time annual fee for a single evaluation and sit beside this tree rather than in it (see Brief No. 07). Sources are listed by number in the references of CMT Research Brief No. 81.
The strongest evidence against CMT's reading
- Concierge raises total spending without lowering mortality. The most-cited study, using Medicare claims, found concierge enrollment was associated with a 30% to 50% increase in total health spending and no change in mortality.20 Population Data
- Conversion displaces patients. Patients who cannot or will not pay must find another doctor, often in short-supply markets.21 Population Data (news report)
- Medicare limits the fee. Physicians who stay enrolled may charge the fee only for non-covered services and amenities; federal regulators have pursued cases where fees overlapped covered care.22 Policy and Law
- Independence is shrinking across membership medicine. The independently owned share of membership practices fell from 84% to 60% from 2018 to 2023, concierge and DPC combined.6
- DPC physicians report high satisfaction. 94% of DPC physicians in the AAFP's 2024 survey said they were satisfied, and only 17% in its 2026 survey named income as a reason they chose DPC.23,24 Sustainability can mean a life, not only a balance sheet.
- Both models held up in 2020. An industry survey of about 1,000 independent physicians reported no closures among membership practices (concierge and DPC together) during the pandemic year.28 Industry Research
What would settle it. A study that follows concierge and DPC practices from launch and reports survival, physician income and turnover at five and ten years. CMT has not found one. Until it exists, the durability case rests on track record, revenue structure and company-reported renewal.
Learn
Name the pathway, not just the model. Solo DPC and employer DPC are different businesses.
Build
Stress-test the drawback you rated High: runway for a slow build, a second revenue stream, or more than one anchor contract.
Lead
Plan for patients who will not join. Continuity for them is part of a sustainable practice.
How this brief was built
CMT reviewed peer-reviewed research, association surveys, company reports, professional guidance and federal rules available as of November 10, 2026. Concierge and DPC figures were kept separate; combined figures are labeled. DPC-only data sit in dashed DPC boxes. The pathway definitions and the drawback ratings are CMT editorial judgment. The view that concierge is the more durable pathway is CMT's editorial reading, presented with the strongest evidence on the other side.
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.
| Evidence type | What it covers | Best for |
|---|---|---|
| Clinical Trial Evidence | Randomized trials and systematic reviews | Cause and effect |
| Population Data | Large observational studies and government data | Trends at scale |
| Practice Insight | Surveys, smaller studies and expert consensus | Real-world experience |
| Industry Research | Company-sponsored or company-reported data, not peer-reviewed | Early signals and operating data |
| Policy and Law | Statutes, regulation and official guidance | What is required |
What we don't know
- Five- and ten-year survival rates for concierge or DPC practices.
- Independent, audited renewal rates for any concierge network.
- How many employer DPC contracts are lost at renewal each year.
- Physician income by pathway from a methodology-disclosed survey.
How to cite this brief
Concierge Medicine Today. Built to Last? The Sustainability and Drawbacks of Each Concierge and DPC Pathway. CMT Research Brief No. 82. November 2026.
External review: not yet reviewed. Corrections: CMT corrects errors in the open and notes what changed and why.
Related CMT Research Briefs
References
- MDVIP. Press release: 100 consecutive quarters of growth, February 2026; and 2026 patient satisfaction summary. mdvip.com.Funding: industry (MDVIP)
- MDVIP. COVID's effect on MDVIP practices (91% average retention, 2020 to 2021); earlier releases reporting 91% to 92% annual renewal via Fierce Healthcare. mdvip.com.Funding: industry (MDVIP)
- Direct Primary Care Alliance, Member Insights Committee. State of Direct Primary Care. Data collected Oct. to Nov. 2024; published July 2026. Summary via Hint Health blog. dpcalliance (noviams.com).Funding: not stated (conducted and published by DPC Alliance; distributed with help from Hint Health)
- DPC Insider. Employers now fund more than half of all DPC memberships (on Hint Health's 2026 DPC Trends Report), June 19, 2026. dpcinsider.com.Funding: not stated (news report of company data)
- Advisory Board. Why direct-to-employer contracting rarely drives growth, 2026. advisory.com.Funding: not stated (conducted and published by Advisory Board)
- Zhu JM, et al. Growth of membership medicine practices, 2018 to 2023. Health Affairs, December 2025. Summary via Johns Hopkins Carey Business School. carey.jhu.edu.Funding: not stated
- Medical Economics. Why more physicians will choose concierge medicine in 2026, January 31, 2026 (interview with a concierge conversion firm executive). medicaleconomics.com.Funding: not stated (interviewee's firm converts practices to concierge)
- Medical Economics. Lifestyle medicine could be direct primary care's next differentiator, September 1, 2026 (reporting 80.7% of DPC Alliance respondents had opted out of Medicare). medicaleconomics.com.Funding: not stated (news report)
- Internal Revenue Service. Notice 2026-5. irs.gov.Funding: federal (IRS)
- Hint Health. Press release: 2026 Direct Primary Care Trends Report, April 2026. finance.yahoo.com.Funding: industry (Hint Health)
- KFF Health News. Hospitals cash in on a private equity-backed trend: concierge physician care, March 29, 2024. kffhealthnews.org.Funding: not stated (news report; KFF is an independent nonprofit)
- Concierge Medicine Today. Annual Industry Report, panel-size and fee benchmark observations, 2024 and 2025 editions; cross-checked with Macbach, 2026 Concierge Medicine Benchmark Report (agency client data). conciergemedicinetoday.net.Funding: Concierge Medicine Today (self-conducted; no outside funder); Macbach: industry (marketing agency)
- MDVIP. For physicians (90% patient retention year after year). mdvip.com.Funding: industry (MDVIP)
- Morefield B, et al. MDVIP and Medicare fee-for-service beneficiaries with diabetes. American Journal of Managed Care, 2020. ajmc.com.Funding: industry (MDVIP-related study; see article disclosures)
- Sermo. Direct primary care pros and cons for physicians, May 2026. sermo.com.Funding: not stated (physician network publication)
- KevinMD. Direct primary care: what physicians say, in their own words, 2026 (on Qliance and the University of Houston clinic closures). kevinmd.com.Funding: not stated (commentary compilation)
- Elation Health. Recap: employers and direct primary care. elationhealth.com.Funding: industry (Elation Health, EHR vendor)
- American Medical Association. Direct-to-employer arrangements: model checklist, 2019. ama-assn.org.Funding: not stated (conducted and published by AMA)
- Cooke M. Are we trading one master for another? Employer contracts in direct primary care. DPC News. dpcnews.com.Funding: not stated (physician commentary)
- Leive A, David G, Candon M. Journal of Health Economics, 2023; as reported by KFF Health News. kffhealthnews.org.Funding: not stated (see journal article disclosures)
- KFF Health News. The concierge catch: better access for a few patients disrupts care for many, 2024. kffhealthnews.org.Funding: not stated (news report)
- HHS Office of Inspector General. Alert on charging Medicare beneficiaries for covered services, 2004. hhs.gov.Funding: federal (HHS OIG)
- American Academy of Family Physicians. 2024 DPC Data Brief, as reported by Sermo (94% satisfied). sermo.com.Funding: not stated (conducted and published by AAFP)
- American Academy of Family Physicians. 2026 DPC Data Brief. aafp.org.Funding: not stated (conducted and published by AAFP)
- American Medical Association. Pondering direct primary care? 10 potential benefits and drawbacks. ama-assn.org.Funding: not stated (conducted and published by AMA)
- Colwell J. Successfully switching to concierge care in California. Physicians Practice, February 2016 (one physician's account). physicianspractice.com.Funding: not stated (trade publication)
- Fullscript. Corporate concierge medicine networks: governance, autonomy and economics, 2026 (revenue sharing in affiliation models). fullscript.com.Funding: industry (Fullscript, vendor publication)
- Medical Economics. Survey shows zero percent pandemic closure rate for membership-based medical practices (OvationLab / VirtualPractices.org survey). medicaleconomics.com.Funding: industry (OvationLab, a consulting firm)
This brief is educational and informational only. It is not medical, legal, tax, financial or accounting advice. Revenue figures are illustrative arithmetic, not projections or guarantees. Consult qualified professionals about your situation.
Concierge Medicine Today is independent. No one pays for favorable coverage, and funding is disclosed for every source. CMT covers every membership model; where this brief states a view, it is labeled as CMT's editorial reading. CMT does not vet or endorse any practice, network, sponsor, vendor or company named here.
This brief reflects sources available at publication and is not without possible error or omission. © 2007-2026 Concierge Medicine Today, LLC.