Concierge Medicine’s Rise: Balancing Growth, Medicare, and Patient Needs

Author: Originally published by PartBNews.com on February 17, 2025

Though recent statistics show very few physicians opting out of Medicare, boosters of self-pay medical practice models —concierge, direct primary care and hybrid — still believe those models will advance in years to come, partly due to the interest of physicians, and partly due to the interest of investors.

Many providers and provider associations have argued that the steady drop in Medicare reimbursement under the physician fee schedule in recent years is making the practice of medicine difficult and, for some, unsustainable (PBN11/11/24). The suggestion is that a substantial number of providers will forsake Medicare. In an article published Jan. 23,2025, the AMA’s Tanya Albert Henry writes, “physician practices are forced to make hard choices to survive É Do they only take a certain number of Medicare patients — or none at all?”

But a Jan. 11 analysis of CMS data from the Kaiser Family Foundation shows that the percentage of Medicare non-pediatric physicians who opted out of the program in 2024 hovered around 1% — hardly an exodus (see resources, below). They further report that 98% of non-pediatric physicians in the U.S. participate in the Medicare program. Most of the opt-outs are psychiatrists, KFF reports.

This extremely small loss may suggest a limited growth opportunity for models that circumvent Medicare and other healthcare insurances, such as concierge practices. However, Terrence L. Bauer, CEO of Specialdocs Consultants, a concierge medicine consultancy based in Highland Park, Ill., says that depends on how you define concierge.

“We advise our physician clients to remain in-network with Medicare as well as private insurance mainly because it is a convenience for the patient — or as we like to say, frictionless,” Bauer says. “People over 65 have paid Medicare premiums for over 40 years and would like to use that benefit. And those under 65 are usually provided with employer-sponsored health insurance.”

Many people think of concierge as strictly self-pay, but Bauer says there’s a “bright line between concierge medicine and direct primary care (DPC),” the latter of which usually doesn’t involve insurance at all and covers patient health on a membership or other self-pay basis (PBN 11/20/23).

It should be mentioned that DPC is itself a fungible term and some companies, such as Yakima, Wash.-based Assurance, talk about how DPC “works with insurance.” And while some would consider Bauer’s definition of concierge to be “hybrid” practice, his definition of that term is “a multi-physician group where some physicians practice under the concierge model, and one or more doctors or nurse practitioners practice in the traditional fee-for-service model” — due, for example, to a patient base that has a mix of payment preferences.

Markets like it

The concierge difference, as Bauer describes it, is “highly personalized care” in addition to what insurance covers, including “same-day or next-day appointments; longer, more comprehensive office visits, health and wellness education, and a focus on prevention. Additionally, these may include health coaching, nutrition and lifestyle medicine.”

However it’s defined, concierge remains a hot commodity. Global Market Insights’ most recent report on the U.S. concierge market, published in March 2024, shows the U.S. market value at $6.7 billion in 2023, and expects it to reach$15.1 billion by 2032. They attribute this growth to “growing public awareness regarding perks of concierge medicine, increased affordability to obtain such expensive and private medical care, and digitization and adoption of telehealth services in the U.S.”

Another motivator may be profit — not on the part of the doctors so much as on companies that like to acquire financially promising medical properties. Big firms continue to snap up subscription providers, hoping for the next Oak Street Health(PBN 3/6/23). Concierge company Sollis Health recently added $33 million in Series B Funding. Sollis is rather on the high end, though — its memberships start at $3,500 a year. Memberships at One Medical, the primary care service Amazon bought for $3.9 billion in 2023, start at $199 a year.

Bauer warns, however, that even massive investment doesn’t necessarily mean success in the model. He points to Forward, the concierge primary care startup that pushed “Care Pods” for efficient, tech-forward treatment but shut down late last year.

Forward spent a small fortune to build new clinics around the country “and used many kinds of new technology to attract patient members,” Bauer says. But “ultimately, they closed their doors because people are attracted to and follow their physician, not the technology.”

Less tech than high-touch

Dan Carlin, M.D., founder of World Clinic, a telehealth-intensive national concierge service, believes that while “the total number of Medicare opt-outs may remain small, the demand for personalized, membership-based health care continues to rise, creating expansion opportunities for concierge models without requiring a large-scale shift in Medicare participation.”

Also, whether the patients are millionaires getting “executive physicals” in high-end private practices or employees getting extra services on top of their E/M visits, Carlin says “this trend is less about Medicare opt-out rates and more about the increasing patient demand for high-touch, accessible care — an area where the concierge medicine model continues to thrive.”

Resources

• AMA News Wire, “With Medicare cut after cut, even big medical groups at risk,” Jan. 23, 2025
• Kaiser Family Foundation, “How Many Physicians Have Opted Out of the Medicare Program?”
• Assurance Healthcare and Counseling Center, “How Direct Primary Care Works With Insurance,” Oct. 1, 2021
• Press release, “Sollis Health Completes $33 Million Series B Funding Round Led by Foresite Capital to SupportGrowing Demand for Personalized, High-Touch Healthcare,” Dec. 5, 2025