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Differences & Similarities Between Direct Primary Care (DPC) and Concierge Medicine Models

As the healthcare landscape continually evolves, physicians are increasingly exploring alternative options to allow them to practice medicine on their terms outside of the traditional insurance-based system. Two models which are gaining popularity amongst members of our online physician community are direct primary care (DPC) and concierge medicine (and alongside them direct specialty care). While both models are similar in that they are membership based and involve cash pay fees to the practice, the overall philosophy can be quite different, with varying costs and relationships with insurance companies. As this can be confusing, we cover the similarities and differences between direct primary care and concierge medicine below to help you choose which model best fits your goals and patient population.


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Similarities and differences between direct primary care (DPC) and concierge medicine models for private medical practices


What is the direct primary care (DPC) model?


Direct primary care is a membership based subscription model where the patient pays a membership fee to have access to their physicians. This fee is typically a monthly fee without a long-term commitment. The direct part of DPC comes from cutting out the middleman of insurance payers. Physicians are paid for services provided directly through the membership fees charged. Direct primary care practices do not bill insurance. These practices typically try to be affordable to most patients, and therefore rates tend to be lower than concierge practices. They also tend to emphasize transparency in pricing and often offer or negotiate with partners for discounted rates on labs and tests. 


Learn more with our introduction to direct primary care.



What is concierge medicine?


Concierge medicine is another healthcare option for patients and practices that is growing in popularity. Similar to DPC, it also works under a subscription based model, but unlike DPC practices, they do bill insurance companies and are seen as offering add on services and special perks relative to typical insurance based care. A patient in a concierge practice will still have their labs and tests billed through insurance as well. Concierge practices typically charge an annual membership fee under a one-year agreement, although some offer monthly memberships. Concierge services focus on enhanced access to physicians and highly personalized and advanced care; therefore, this is typically perceived as a more luxurious model of healthcare.



Similarities between direct primary care and concierge medicine


Direct primary care and concierge medicine share common traits.


  • Smaller panels, allowing more time with each patient. Physicians and patients alike are often frustrated with the limited amount of time available for patient encounters under the traditional insurance model, making it difficult to provide the standard of care desired. By charging monthly or annual fees, both models provide a reliable income stream for a practice, which can allow physicians to reduce their panel size and spend more time with each patient.


  • Provides easier, more direct, access to care. Concierge and direct primary care practices often offer 24/7 access to a care team, typically via text or call. With smaller panel sizes, patients can get care sooner, often with same or next-day appointments.


  • Strives to improve the doctor-patient relationship. Smaller panel sizes and more time with each patient allows doctors to build a more personal relationship with each patient, which can enhance the level of patient trust in care and creates a better overall relationship for both parties.


  • Can provide less stress and help reduce burnout. We unfortunately see so many instances of burnout in our communities of overworked doctors in the traditional insurance model who are considering leaving clinical practice. We always recommend considering other approaches to your current clinical work before considering leaving clinical practice entirely. Both DPC and concierge models can offer an opportunity to lower the amount of administrative burden and demand to see more patients to meet performance benchmarks, reducing stress and creating higher job satisfaction and longevity.



What is the difference between direct primary care and concierge medicine practices?


While these two models share common features, they are unique in several ways.


  • Acceptance of insurance. With direct primary care, appointments are covered under the membership fee a patient pays. DPC practices are typically cash pay and generate revenue through the membership dues. They generally do not contract for any reimbursement through payers. Concierge practices, however, often charge a membership fee for access and the more luxury features, but also bill insurance payers for visits and treatments. Navigating the cash pay and payer reimbursement relationship can get a little tricky, which is why some concierge practices may opt to work with a company that helps set up and manage the practice.


  • Membership fees. Direct primary care practices focus on affordable care for patients, and typically have much lower membership fees than concierge practices. While fees can vary significantly, DPC fees are usually in the ~ $50-$150/month range, while annual fees for concierge medicine can range anywhere from $1,500-$10,000/year.


  • Membership structure. Direct primary care practices typically charge a monthly membership fee, often without requiring a long-term commitment, while concierge practices typically charge an annual fee under an annual contract and may have termination fees. Obviously, exceptions to each exist, but these are general trends.


  • Patient populations. Given the more expensive costs for concierge medicine, this model usually attracts higher-income patients, while DPC focuses on offering affordable care to a broader patient population.


  • Focus of care. Direct primary care practices focus on providing general healthcare (although they may certainly have niche areas of expertise), while concierge medicine focuses on providing higher level of service care that would justify members paying both for insurance based care as well as an additional fee.


  • Services provided. Direct primary care membership fees typically cover select services for general healthcare, such as physical exams, preventative screenings, chronic disease management, acute care, and basic in-office diagnostics. Concierge practices may provide advanced screenings and wellness programs, and even house calls. There can be overlap in these, however, as many direct primary care practices may also offer niche services or accessibility.


  • Panel size. Given the differences in costs and focus of care, it’s likely no surprise that direct primary care practices typically have larger patient panels than concierge practices. DPC panels usually range from ~400-800 patients, while concierge practices are usually around 200-300 patients.



DPC vs concierge: which model is right for my practice?


When assessing which model might be the best fit, it’s important to consider how you want to practice medicine, what type of patient experience you want to offer, and what your patients can realistically afford. 


  • Direct primary care works well for physicians who want to focus on affordable access to healthcare while escaping the headaches that can often arise when dealing with payers and reimbursements. This can be a great fit for practices with patient populations that are typically uninsured or have high-deductible plans, and/or are frustrated with long wait times at traditional practices. There are challenges associated with treating Medicare patients, which we will cover separately, but if this is your patient population, this may not be a model that is ideal for you.


  • Concierge medicine can be a great fit for physicians seeking a smaller panel size to provide a higher level of care for each patient, and who don’t mind the administrative side of navigating insurance reimbursement. This can be a great fit for practices with more affluent patient population demographics who can afford the annual membership fees and have insurance for covered services.



Conclusion


Both direct primary care and concierge medicine can provide alternatives for physicians interested in continuing in clinical practice but looking to shift away from the traditional insurance-based system. Understanding the differences between the two models can help doctors explore which option best fits their patients and their ultimate goals with their practice.



Additional private practice resources for physicians


Explore related PSG resources:


We offer a free private practice educational series for physicians interested in virtual events to help you start and manage your practice. Sign up for our PSG weekly newsletter for alerts on upcoming events and registration links.


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