Fee-based primary care on the rise: 4 notes

Concierge and direct primary care models are rapidly reshaping the U.S. primary care landscape. These membership-based practices, which charge monthly or annual fees for enhanced access and longer visits, have increased in recent years — often operating outside the traditional insurance system.

A research article published in December in Health Affairs by researchers from Baltimore-based Johns Hopkins University, Portland-based Oregon Health & Science University and Boston-based Harvard Medical School found that such practices increased by more than 80% between 2018 and 2023, raising questions about equity, access and the future of the physician workforce.

Here are four key findings:

1. Concierge and direct primary care practices grew 83% in five years.

From 2018 to 2023, the number of fee-based primary care practices nationwide rose from 1,658 to 3,036, according to the study.

2. Clinician participation increased 78%.

The number of individual clinicians working in these models nearly doubled, rising from 3,935 to 7,021. Researchers attributed the shift in part to burnout and administrative burden in traditional practice settings.

3. Corporate ownership of concierge and DPC practices surged 576%.

While many of these direct primary care models started independently, the sharp rise in for-profit ownership may reshape how personalized care is delivered and raise new questions about access and scalability.

4. Researchers warn of growing equity concerns.

While patients in fee-based models may benefit from smaller panels and longer visits, the migration of physicians out of insurance-based systems could exacerbate primary care shortages and limit access for patients who rely on traditional coverage.

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