Lifestyle medicine could be direct primary care's next differentiator, whitepaper says

Hint Health, the membership and billing platform used by direct primary care (DPC) practices, has published a whitepaper arguing that DPC physicians should build lifestyle and functional medicine into their care model and sell part of it as an add-on service. The document is anchored in one clinic, Keystone Natural Family Medicine in Mesa, Arizona, and its founder, Kristen Bishop, N.M.D., a naturopathic physician who now runs four locations in the greater Phoenix area.

Of the 465 DPC physicians who answered the most recent national survey of the model, 47.1% reported panels of fewer than 200 patients. More than 30% run with no support staff at all, and 68.4% said their panels are not yet full.

What the whitepaper is selling

Use of complementary health approaches among U.S. adults rose from 19.2% in 2002 to 36.7% in 2022, roughly 122.3 million people, with more than $30.2 billion a year spent on those approaches largely out of pocket, according to federal survey data cited in the whitepaper. Americans have a 43% obesity rate against a 26% average across OECD countries, 69% of U.S. adults take a daily prescription drug and 42% of adults 65 and older take five or more medications, the document says.

A Cleveland Clinic analysis published in JAMA Network Open in October 2019 found 31% of functional medicine patients reported a clinically meaningful improvement in global physical health, outpacing patients in standard primary care. The 58% reduction in type 2 diabetes risk the whitepaper cites comes from the Diabetes Prevention Program trial published in the New England Journal of Medicine in 2002. Its 90% professional satisfaction figure comes from a 2019 survey of 482 American College of Lifestyle Medicine members, physicians already practicing lifestyle medicine.

Bishop's practice sells IV therapy, acupuncture and similar services as add-ons, discounted for DPC members and available to non-members at a higher price, which she describes in the whitepaper as an incentive to join. "You don't have to choose between practicing good medicine and running a sustainable practice," she said.

The practices being pitched

The State of DPC report, published in July 2026 by the Direct Primary Care Alliance's Member Insights Committee and led by Kenneth Qiu, M.D., collected responses from 465 physician-owned practices in October and November 2024. Its denominator, an estimated 3,600 DPC practices nationwide, comes from Hint Health, which also helped distribute the survey through its platform.

Among single-location practices, which were 89.3% of the sample, about 35% employ one staff member and another 20% employ two. Full ownership was reported by 82.4% of respondents, and 80.7% have opted out of Medicare entirely. The national average membership price was $98.46 per member per month, well above the $77 benchmark physicians had cited for more than a decade. Rural practices averaged $81.56 against roughly $110 in urban markets. Practices with panels under 200 charged nearly $106; those above 500 charged about $78.

Emily O'Rourke, M.D., who helped build the survey and owns Fountain Direct Primary Care in Chesapeake, Virginia, opened her practice at $75 a month in 2018 and has since raised it to $100 for new patients, an increase she calculates matches inflation exactly. "The mythological price that was passed around when I was first investigating DPC was that $50 per month was the appropriate — and only — price that you should charge," she said on the Medical Economics podcast Physicians Taking Back Medicine.

Where the time comes from

Six hundred patients at $50 a month across 12 months is $360,000. Josh Umbehr, M.D., co-founder of Atlas MD in Wichita, Kansas, sets that against overhead he puts at 20% to 25%, one staff member per one or two physicians, one or two exam rooms and 700 to 1,000 square feet per doctor. "We spend more on coffee in the waiting room than we spend on EKGs," Umbehr said in an interview with Medical Economics.

A DPC physician spends roughly 5% of the day on administrative work and 95% on patient care, Umbehr said, with no billing department, no MACRA and MIPS reporting and no Medicare rule changes to absorb. He starts new physicians with an EKG machine, a pill counter and a vitals machine, and tells them the rest is optional. That overhead structure is what produces the hour-long visits the whitepaper treats as a precondition for lifestyle medicine.

The pricing trap

Growth of 40 to 50 patients a month puts a practice full and profitable in six months and at a full physician income in 12, Umbehr said. At 10 to 20 a month, the panel does not fill for two to two and a half years, and by his estimate it takes six to eight years to recover the lost revenue.

"It's the practices that charge the least that make the most, and that counterintuitive point is very difficult for doctors," Umbehr said. "We see more growth than we ever have, but we also see more closures than we ever have," he added, attributing part of that to practices trying to reach a full income on 100 or 200 patients.

Does the menu fit the market?

Rebekah Bernard, M.D., who owns Gulf Coast Direct Primary Care in Fort Myers, Florida, counts 60 to 70 concierge practices in Naples, 30 miles south of her, an area of concentrated wealth. Her own market is blue collar, full of small businesses that cannot afford health insurance, and she calls the affordable DPC that works there blue-collar concierge.

"Sometimes doctors talk to me about their dream and their vision of what they want to do, but they haven't thought about what the market will bear," Bernard said at an independent practice panel convened by Medical Economics and Physicians Practice on Oct. 29, 2025.

"That match of model with market becomes the place where an evaluation can get some differentiation," Andrew Swanson, chief revenue officer of the Medical Group Management Association, said at the same panel. Understanding a group's cost of care is the launching point for any decision about viability, he said.

"It's not just enough to grab someone else's pricing," Umbehr said. "How does that relate to the type of medicine you practice?"

What the data can and can't settle

The DPCA survey was distributed through email, DPC Facebook groups and Hint's platform, and 63.8% of respondents were alliance members, a limit the committee flags in the report itself. Hint's own 2026 Direct Primary Care Trends Report, drawn from more than 2,700 clinicians and 1.4 million members on its platform, reports 837% membership growth from 2017 to 2025 and says employers now fund 60% of active memberships.

"We've said for years that if you've seen one DPC practice, you've seen one DPC practice," said Kelsey Smith, M.D., president of the DPCA and owner of Pioneer Direct Primary Care in Stillwater, Oklahoma. "It's not a one-size-fits-all model, and these data support that even further."

"We're in that era of the direct care movement where we want to focus on the fundamentals," Umbehr said.