Compare practice models.

Concierge

Retainer + insurance · $1,500 - $45,000+/yr · Panel under 100 to 600

The concierge model adds a recurring annual retainer on top of traditional insurance billing. The retainer buys enhanced access, same-day appointments, longer visits, 24/7 physician availability, expanded annual physicals, while the practice continues to bill insurance for covered services delivered during those visits.

The category is broader than most physicians realize. The 2026 Macbach concierge benchmark separates the field into four operating tiers, each with its own retainer band and panel ceiling:

• Classic concierge (entry). $2,000 - $3,500/yr retainer, panel of 350 - 500. The most common entry profile for a practice transitioning from insurance.
• Classic concierge (established). $3,500 - $5,000/yr retainer, panel of 400 - 600. A mature concierge practice operating at steady-state.
• Luxury concierge. $6,000 - $12,000/yr retainer, panel of 150 - 300. Substantially deeper access and house-call/travel availability.
• Ultra-premium concierge. $15,000 - $45,000+/yr retainer, panel under 100 to 150. Bespoke care including longevity-medicine workups, on-call clinical-coordination teams, and integrated specialist orchestration.

The financial mechanics are clearer than the insurance model's: predictable retainer revenue creates a stable revenue floor, and insurance billing layered on top provides the second revenue stream. Overhead typically runs 40-50%, lower than insurance-only because the practice has fewer claims to chase and process. Recurring-revenue share across these tiers runs 75-90% of total practice revenue.

The model fits when: the local market has the disposable income for the retainer fee; the physician values the deeper patient relationship and is comfortable charging directly for access; the practice has 12-24 months of runway to fill the panel. The model is harder when: the existing patient panel cannot afford the retainer; the local market is already saturated with concierge offerings; the physician prefers the variety and pace of an insurance-paneled practice.

Direct Primary Care (DPC)

Subscription only · Monthly patient fee · Panel 600-1,000

DPC eliminates insurance billing entirely. Patients pay a flat monthly fee directly to the practice for all primary care services, visits, basic in-office labs and procedures, communication. Patients use insurance for what their primary care does not cover: specialty care, hospitalization, imaging, prescriptions outside the practice's negotiated rates.

The operational footprint of a DPC practice is dramatically different from either insurance or concierge. No claims, no coding, no prior authorization. Most practices run with substantially smaller administrative teams, sometimes 1 admin per 400-500 patients versus 1 per 200 in concierge. Overhead can run as low as 30%.

The model fits physicians who want to maximize the direct financial relationship with the patient and minimize the structural complexity of running a practice. Panel sizes are typically larger than concierge (600-1,000 patients per physician) because the monthly fee is lower and the practice needs more volume to clear similar revenue.

The model fits when: the local market is fee-sensitive but values the predictability of subscription pricing; the physician is comfortable not billing insurance; the practice can operate without the revenue cycle infrastructure that supports traditional billing. The model is harder when: the physician serves a patient population that strongly prefers an insurance-mediated relationship; the local payer mix would make the insurance revenue from a concierge model substantially exceed the lost coverage cost.

Hybrid

Concierge tier within insurance practice · $1,500-2,500/yr retainer · Panel 600-1,200

The hybrid model splits the practice's panel. A subset of patients pays a retainer for the concierge-tier experience; the remainder continues to receive traditional insurance-mediated care. Some practices operate this as a formal two-tier system; others as a gradual transition where the concierge tier grows over time as the insurance tier attrites or is intentionally wound down.

This is the most common transition path from a traditional insurance practice to a membership-based one. Physicians who have an established patient base they value cannot easily flip the entire practice to membership without losing patients who cannot or will not pay the retainer. The hybrid model lets the transition happen at a manageable pace.

Operationally, the hybrid model is the most complex of the three. The practice runs two parallel revenue cycles, insurance claims for the traditional tier, retainer billing for the concierge tier, and the scheduling system has to handle two service levels. Most practices that run hybrid successfully have invested in operational systems that handle the tier distinction cleanly; practices that try to run hybrid informally often struggle.

The model fits when: the physician has an established practice they're transitioning rather than launching new; the local market has demand for both service levels; the operational team can manage two-tier complexity. The model is harder when: the practice tries to run hybrid without operational structure; the local market won't support the price point of the concierge tier; the physician finds the two-tier service standard ethically uncomfortable.

Insurance-only (the baseline)

Traditional · Per-encounter revenue · Panel 2,000-3,500

The traditional insurance-mediated primary care model is the baseline against which the membership models are measured. The practice bills payers per encounter; revenue scales with patient volume; panels are large because the per-patient revenue is low.

This model is the dominant structure in American primary care and has been for decades. It is also the model that has been most aggressively consolidated by hospital systems and private equity over the past five years. The economic pressure on solo and small-group insurance practices is the primary reason most concierge and DPC practices exist, they are escape paths from a model the field has decided is no longer working for either physicians or patients.

The model still works for physicians who: practice in a market or specialty where membership economics don't apply; want the breadth of patient population that a 2,000+ panel allows; are comfortable with the operational and financial pressure that the per-encounter revenue model creates; have a path to ownership consolidation (joining a larger group or selling to a system) they're comfortable with.

For physicians considering a transition to one of the three membership models, the most important question is honest: do you want to keep working in the insurance model as it continues to consolidate, or do you want to rebuild the practice around a different financial structure? The answer determines which of the three above is your actual next step.