GRAND ROUNDS

Why Subscription Medicine Is Taking Over

Subscription medicine is set to dominate the healthcare conversation over the next decade. In just the past two weeks, several Huddlers—including a few family members—have reached out asking for my take on concierge medicine and other direct care models. I happily pointed them to my previous pieces, “Subscription Health: The Rise of Direct Primary Care” and “Healthcare’s VIP Experience: Inside the Concierge Model.”

But after those conversations, I felt it was time to revisit and update my thoughts on these rapidly evolving models.

In this article, I’ll dive into two of the most talked-about direct care models, explore the trends driving their growth, and even share why I’m seriously considering direct pulmonary care for my future.

Background

Direct care models are a departure from the conventional fee-for-service and insurance-based healthcare models. Traditionally, health insurance is intended to cover unpredictable and expensive medical events, providing financial protection against catastrophic health issues. However, routine care services, such as check-ups, vaccinations, and preventive care, often do not align with the original purpose of insurance, which is to mitigate high, unexpected costs.

Direct care models cut out insurance and instead operate on a membership or subscription basis, where patients pay a flat monthly fee directly to physicians. Below, I describe two popular models.

Direct Primary Care

Direct Primary Care is similar to concierge medicine but generally more affordable, with a straightforward fee structure. The retainer fee covers all or most primary care services, including clinical, laboratory, consultative services, and care coordination, without additional per-visit charges. DPC practices do not typically accept health insurance, which reduces the overhead and complexity of billing and allows physicians to focus more on patient care.

Here’s a graphic showing the flow of money and care in direct primary care.

Concierge Medicine

Concierge medicine is a retainer-based healthcare model that prioritizes personalized, accessible care for patients willing to pay a premium. Patients pay an annual or monthly fee, often ranging from hundreds to thousands of dollars, in exchange for services like same-day appointments, longer visits, and 24/7 direct communication with their physician. This model allows physicians to reduce patient panel sizes, spend more time with each patient, and avoid the constraints of traditional insurance reimbursement systems.

#Trending

I’ve written plenty on direct primary care and concierge medicine, so I’ll sum up some of the trends.

There are around 2,100 DPC practices in the U.S., largely composed of single family practice physicians. This represents ~1.5% of all family practice physicians! Note, DPC is a relatively new model, and around 75% of DPC practices are three to five years old. If you want to stay up to date on DPC, follow Paulius Mui and Kenneth Qiu.

As for concierge medicine, there’s no robust data regarding how many physicians are in a concierge model. Still, the latest data suggests the number is around 6% (this was 11 years ago, so the proportion is probably much greater today). Yet, the market is growing. The U.S. concierge medicine market hit $6.7 billion in 2023 and is projected to grow at a CAGR of 10.37% by 2030.

The concierge market is typically made of solo physicians. However, other companies and non-profit hospitals have significant leverage in the concierge market. I cover them all in a prior Huddle #Trends article here.

Dashevsky’s Dissection

As I envision my future in pulmonary/critical care medicine, I’ve been thinking a lot about how these direct care models could align with my goals. Here’s the vision:

First, I love the ICU. It’s intense, complex, relies heavily on teamwork, and remarkably efficient (you know I love efficiency). Outpatient care is meh to me right now. It’s too inefficient and too bureaucratic. That said, I could see myself building a small, focused direct pulmonary care side practice as a complement to my ICU work.

Here’s how it would work: a direct pulmonary practice centered on asthma, COPD, and OSA care, with a patient panel capped at around 100 members. It would operate largely virtually, eliminating overhead and leveraging digital tools for efficiency. The setup could include:

• Digital health tools to streamline telehealth operations and patient management.

• Fintech platforms like Stripe for subscription payments.

• AI-powered triage systems, such as the work being done by my closest friend at Aidify, to handle patient messages and inquiries.

• Cost Plus Drugs for affordable, transparent access to essential asthma and COPD medications. Or other direct-access drug markets (LillyDirect) for GLP-1s for OSA.

Of course, there are valid critiques of direct care models. The model I envision is on the boutique-end of care, which will likely attract wealthier patients, raising questions about equity. By focusing exclusively on asthma/COPD and OSA, I’d likely avoid the sickest, most complex pulmonary cases—like those with pulmonary hypertension or interstitial lung disease—who could benefit the most from personalized care. But I see a potential balance here: my critical care work in the ICU would keep me engaged with the most critically ill patients, serving individuals from all socioeconomic and ethnic backgrounds.

This vision isn’t fully fleshed out, but it’s an exciting framework for combining my passion for pulmonary medicine with the autonomy and innovation of direct care.

In summary, subscription-based direct care models like Direct Primary Care and concierge medicine are changing the way healthcare is delivered. These models reflect broader trends toward patient-centered care, transparency, and efficiency, but they also raise questions about equity and scalability. For me, the idea of integrating a direct pulmonary care practice alongside critical care work represents an opportunity to blend innovation with meaningful patient impact. As these models continue to grow, they’ll undoubtedly play a larger role in shaping the future of medicine.

COMMUNITY SPOTLIGHT

Community Content

If you’re part of The Huddle community, share with me content that you’ve written, and I’ll post it here!

Healthcare Happenings

Every week in The Huddle community, I take a quick 15 minutes to go live and recap what I’m seeing in healthcare for the week, from fundraising to policy.

Check out the latest episode HERE.

Become a Community member to watch live every week.
Already part of the community? Access it here.

INSIDE THE HUDDLE

Healthcare Huddle
Sunday Newsletter

CMS Reveals 15 Drugs for Medicare Negotiation, Including Ozempic

Huddle+
Inefficiency Insights

Ouch! Reducing Unnecessary Fingerstick Glucose Tests in Hospitals

Huddle+
Huddle #Trends

Consumerism Conundrum: How Innovation is Reshaping Healthcare Access and Equity

Healthcare Providers
Residency Reflections

Why “Working Hard” Isn’t Enough in Residency

Huddle+
Huddle University
Available for purchase without a Huddle+ membership.

A 7-step Framework for Problem-solving in Healthcare
Healthcare Huddle Masterclass: Decoding My Writing Process

Check out more exclusive coverage with a Huddle+ subscription.

Read personalized, high-quality content that helps healthcare providers lead in digital health, policy, and business. Become a Huddle+ member here.