Big Bump in Concierge, Direct Primary Care in Recent Years

 

• A study found that the number of concierge and direct primary care practices in the U.S. increased 83.1%, from 1,658 in 2018 to 3,036 in 2023.
• The number of concierge and direct primary care clinicians increased 78.4%, from 3,935 in 2018 to 7,021 in 2023.
• The trend coincides with more advanced practice clinicians and more corporate ownership in these practices.

The number of concierge and direct primary care practices in the U.S. rose sharply in recent years, as did the number of clinicians providing such care, researchers found.

Concierge and direct primary care practices increased 83.1%, from 1,658 in 2018 to 3,036 in 2023, reported Jane Zhu, MD, MPP, MSHP, of Oregon Health & Science University in Portland, and colleagues.

Additionally, concierge and direct primary care clinicians increased 78.4%, from 3,935 in 2018 to 7,021 in 2023, they noted in Health Affairs.

"There has been a reported rise in alternative primary care models that feature small panel sizes and personal attention in exchange for membership or retainer fees, and very little empirical evidence on this trend," Zhu told MedPage Today in an email. This study "gives a first look at a large national sample of concierge and direct primary care practices for future work to build on," she added.

Indeed, recent media attention already points to wider interest in the concierge medicine and direct primary care models.

Traditionally, concierge practices charge patients an annual retainer fee -- which can average several thousand dollars up to tens of thousands of dollars -- and then bill insurance on a fee-for-service basis for visits and procedures, Zhu and colleagues noted. Direct primary care practices operate outside of insurance, and charge patients a monthly or annual fee -- typically less than that charged by concierge care practices -- for predetermined services. There also may be hybrid practices.

"For clinicians, these models of primary care offer more autonomy and control over care decisions, and for patients, they offer greater flexibility, access, and personal attention," Zhu said. "These are great reported benefits that would be important to document with evidence, alongside broader effects of these models on access to care, equity considerations, and workforce implications."

"For example, how will the expansion of these models influence the availability of primary care in traditional settings? Or conversely, do they help to retain clinicians in primary care? Understanding these dynamics is really important as we confront primary care shortages and an evolving landscape across the country," she stressed.

"The growth of these models may benefit participating patients and clinicians, but it's important everyone understands the potential impact these practices have on the healthcare system at large," study co-author Dan Polsky, PhD, of Johns Hopkins University in Baltimore, said in a statement. "We have to consider how the growth of these models may affect access to primary care for the vast majority who can only afford the care covered by their insurance plan."

For their study, Zhu and colleagues used a national online directory to identify concierge and direct primary care clinicians and their locations. They matched clinicians to National Plan and Provider Enumeration System data, linked National Provider Identifiers to IQVIA OneKey data to identify practice and clinician characteristics, and traced clinicians retrospectively through IQVIA data from 2018 through 2023.

The study showed that concierge and direct primary care practices were widely distributed across the U.S., but concentrated in the Northeast and Southeast in particular. In 2023, the states with the most practices were Texas (402), California (387), Florida (352), and Georgia (139), Zhu and colleagues reported.

Regarding physicians as a share of all clinicians in concierge and direct primary care practices, this figure fell from 67.3% in 2018 to 59.7% in 2023, corresponding to a rise in advanced practice clinicians, from 32.7% to 40.3%.

Overall, the majority of these practices had fewer than five clinicians, with just 7% to 9% of practices having more than a handful of clinicians during the study period.

Additionally, the share of practices that were independently owned decreased from 84% to 59.7%, while practices affiliated with corporate owners (i.e., for-profit firms excluding hospitals and health systems) increased from 9.2% to 33.8%.

"We found that these practices, in our sample, have grown substantially over a short period of time, and that they are changing, for instance with more advanced practice clinicians and more corporate ownership," Zhu said. "These findings indicate that these models may be evolving beyond the small practices we think about when we think about concierge and direct primary care, suggesting more heterogeneity."

The study was not a comprehensive census of all concierge and direct primary care practices, however, and the researchers were unable to systematically distinguish between concierge and direct primary care practices, Zhu and colleagues noted.

Disclosures

The study was supported by the Agency for Healthcare Research and Quality, the Commonwealth Fund, and the National Institute for Health Care Management Foundation.

Zhu areported grants from the NIH and the American Psychological Association as well as consulting fees from Cambia.

Co-authors reported grants from the NIH and Arnold Ventures as well as consulting fees from Amazon, Research Triangle Institute, Google Ventures, and VBID Health.

Primary Source

Health Affairs

Source Reference: Zhu JM, et al "Growth in number of practices and clinicians participating in concierge and direct primary care, 2018–23" Health Aff 2025; DOI: 10.1377/hlthaff.2025.00656.

https://www.medpagetoday.com/primarycare/generalprimarycare/119066