A New Era in US Healthcare Payments: The Rise of Concierge, Direct Primary Care, and Pay?First Models

By Hari Prasad, founder and CEO, Yosi Health.

Over the past decade, the US healthcare landscape has witnessed the emergence of alternative payment models designed to realign incentives, improve patient access, and stabilize practice finances. Chief among these innovative models are concierge medicine, Direct Primary Care (DPC), and the pay?first approach.

Although each model operates differently, they share a common goal: reducing administrative burden, enhancing patient engagement, and ensuring predictable revenue streams. Understanding their nuances, benefits, and implementation challenges can help practices decide which path best fits their mission and patient population.

Concierge Medicine, sometimes called “boutique” or “retainer” medicine, typically involves patients paying an annual fee, often several thousand dollars, in exchange for enhanced access to their physician. This can include same?day or next?day appointments, longer visit times, 24/7 phone or text access, and comprehensive annual physicals. For physicians, the concierge model offers a reliable source of revenue detached from traditional insurance reimbursement.

This steady income can reduce reliance on high patient volumes, allowing doctors to maintain smaller patient panels and dedicate more time to individualized care. Patients, in turn, enjoy a white?glove experience: fewer waits, more personal attention, and simplified navigation of preventive care.

Despite its advantages, concierge medicine remains accessible primarily to higher?income patients who can afford the retainer fee. Practices evaluating this model must consider patient demographics and local competition. Physicians must be transparent about which services the retainer covers and which remain subject to traditional insurance billing.

Clear contract terms help prevent confusion when patients seek specialists or hospital care outside the concierge arrangement. Additionally, regulatory and legal frameworks governing retainer practices vary by state, so clinics should seek guidance to ensure compliance with fee?splitting and insurance regulations.

Direct Primary Care (DPC) represents a middle ground between concierge medicine and traditional fee?for?service. In DPC, patients pay a flat monthly or annual subscription—typically ranging from $50 to $100 per person—that covers an agreed?upon suite of primary care services. These may include preventive exams, chronic disease management, basic labs, and unlimited office visits. By removing insurance billing for primary care services, DPC practices eliminate much of the administrative overhead associated with coding, claims submission, and payer denials. The model enables physicians to focus on delivering comprehensive care, often with same?day appointments and enhanced access through telehealth or direct messaging.

Unlike concierge medicine, Direct Primary Care is designed to be affordable for a broader patient base, including those with high?deductible insurance plans or no coverage at all. Patients appreciate the predictability of subscription fees, which can replace unpredictable copays and coinsurance charges. For physicians, DPC creates predictable revenue streams while maintaining the flexibility to bill insurance for services outside the primary care scope, such as specialist referrals, imaging, or hospitalizations. Practices considering DPC should carefully size their patient panels to balance access with financial sustainability, as too many subscribers can strain provider capacity and erode the very benefits that make the model attractive.

The Pay?First Model addresses financial sustainability through a different mechanism: point?of?service collections. At its core, pay?first asks patients to pay their copays, deductibles, or estimated out?of?pocket responsibility when they check in, or even in advance via secure online portals. After insurance adjudication, any remaining balance is automatically charged to a credit card on file. By collecting anticipated patient dues up?front, practices can drastically reduce accounts receivable and bad?debt write?offs. Staff spend less time on billing follow?up and more on patient engagement, while revenue cycles accelerate and cash flow becomes more predictable.

From the patient perspective, pay?first delivers transparency and convenience. When patients understand their financial responsibility before the visit, surprise bills become a thing of the past. Many practices augment this clarity with automated estimates generated from integrated eligibility and benefits platforms, which check coverage in real time. To succeed with pay?first, practices must communicate clearly across multiple channels—phone, text, email, and web—and offer flexible payment options, including online portals, health?savings account payments, or payment plans. Training staff to navigate conversations about costs empathetically is crucial to maintaining trust and minimizing friction.

Although these models each offer compelling advantages, practices must carefully align choice of model with their patient population, specialty, and operational capacity. Smaller primary care clinics in underserved areas may find DPC especially well-suited to populations with high?deductible insurance, as the predictable subscription fee encourages regular preventive visits. Specialty practices with stable, affluent patient bases might lean toward concierge medicine, offering a differentiated, service?rich experience. Multi?specialty groups or larger health systems can pilot pay?first for routine outpatient visits, leveraging their administrative infrastructure and digital engagement tools to reduce billing complexity and improve patient satisfaction.

Regardless of model, technology plays a pivotal role in ensuring success. Practices should invest in integrated EHR platforms that streamline scheduling, billing, and documentation for virtual and in?person visits alike. Automated patient portals and mobile apps facilitate pre?visit questionnaires, consent forms, and payment processing. Telehealth capabilities extend reach beyond the conference room, offering virtual check?ins and chronic disease monitoring that complement subscription? or retainer?based care. Data analytics tools can track key performance indicators such as patient acquisition costs, no?show rates, revenue per visit, and patient satisfaction, which enables continuous optimization.

Looking ahead, the adoption of concierge medicine, Direct Primary Care, and pay?first models reflects a broader shift toward value?based, patient?centric care. These approaches challenge the status quo of volume?driven reimbursements, incentivizing proactive, relationship?driven engagement over transactional encounters. As policymakers and payers increasingly recognize the importance of preventive care and population health, hybrid models may emerge, blending subscription fees with performance?based incentives for quality metrics. Practices that remain agile, invest in digital infrastructure, and prioritize transparent communication will be best positioned to thrive in this evolving landscape.

Ultimately, the future of U.S. healthcare depends on aligning financial incentives with patient outcomes and experience. Emerging payment models, whether through concierge retainers, DPC subscriptions, or pay?first collections, offer practical pathways to reduce administrative overhead, improve access, and build sustainable practices. By thoughtfully selecting and tailoring these models to fit their unique context, healthcare providers can create resilient, patient?focused practices that stand the test of time.