The Semi-Concierge Medicine® Model: Innovation That Bridges the Gap Between Fee-for-Service and Concierge Care

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Executive Summary 

The Semi-Concierge Medicine® (SCM) healthcare delivery model represents an innovative, scalable solution that combines concepts derived from Fee-For-Service (FFS) care and Concierge models. It is designed to offer accessible, patient-centered care while maintaining operational sustainability and clinical excellence. 

Traditional FFS models rely on large patient panels and volume-driven reimbursement, often resulting in rushed visits, limited preventive care, and physician burnout (McClafferty et al., 2022). Concierge care offers a more personalized approach; however, cost barriers typically exclude broad access due to its high costs. Direct Primary Care (DPC) has emerged as a membership-based alternative to traditional fee-for-service (FFS) and traditional concierge services, but has limitations on several fronts. 

SCM delivers the benefits of all these models: time-rich care, continuity, and reasonable access without their shortcomings. With panel sizes ranging from 600 to 700 patients and a modest annual membership fee, in addition to insurance billing for visits, SCM restores relationship-based medicine, reduces administrative burden, and preserves access for patients. SCM is particularly well-suited for healthcare system integration. Its prepaid revenue structure supports health system missions by allowing for reinvestment into proper staffing ratios, programmatic improvements, and even underfunded projects within the system, thereby reinforcing public trust and social responsibility (Lucier et al., 2010).

SCM provides strategic diversification of revenue streams for the system or practice, as well as broadening primary care choices for patients. Blending membership revenue with insurance billing and value-based incentives creates a more stable, resilient income model that protects against ever increasing shifts in policy that result in reimbursement reductions. At the system level, SCM can act as a financial stabilizer, supporting underperforming sites and departments, and fostering further innovations in care delivery. 

Validated through two and a half years of successful implementation in a large academic health system, SCM demonstrates that care models do not have to be either high volume or high cost. It is a new approach that delivers consistent, high-quality care to every patient in the panel. The question is no longer whether such a model is viable, but why it cannot be scaled within a system, or grown nationally with proper education. 

Background 

The U.S. healthcare system predominantly relies on two delivery models- FFS and fully concierge medicine. DPC is an emerging model as well. All of these models are hampered by structural and philosophical limitations. In traditional FFS, the largest implemented concept, full schedules and visit-driven reimbursement often result in rushed care, limited preventive services (Nguyen et al., 2024), patient dissatisfaction, and growing provider burnout (Huhtala et al., 2021). 

Conversely, concierge practices limit panel sizes and extend appointment times, allowing for better relationship building and more comprehensive care. However, with annual membership fees that often range from $ 2,000 to $40,000 nationally, concierge models can be inaccessible to most patients. 

DPC’s structural and financial model can create selection pressures that favor healthier, lower-cost patients, while those with greater health needs may be left with fewer primary care options and less reliable continuity of care (Cole, 2018). While Direct Patient Care (DPC) eliminates administrative costs associated with insurance billing, patients are still responsible for maintaining insurance coverage for laboratory tests, radiology services, specialist visits, various therapies, hospitalizations, and other non-primary care services.

Recent policy changes allowing Health Savings Account (HSA) funds to cover Direct Primary Care (DPC) fees may improve affordability for some patients. However, this expanded purchasing capacity can also create a payor expansion effect, potentially driving up DPC membership fees over time (Eskew & Klink, 2015). In some cases, these fees could surpass those of semi-concierge models, even though DPC practices may offer a narrower scope of in-house services and still require patients to maintain separate insurance coverage for labs, imaging, specialist care, and hospital services. 

DPC practices, although likely very medically sound, operate outside of most state and federal insurance regulations, meaning they lack a comprehensive framework for oversight regarding quality metrics, reporting requirements, or cost containment mechanisms (Liaw et al., 2024). Semi-Concierge Medicine (SCM) practices, or concierge practices that accept insurance, still adhere to these standards.

For providers, it is important to consider the growing primary care physician shortage, which underscores the need for an alternative like SCM (Medford-Davis & Malani, 2024). Multiple studies prove that young physicians are deterred by Primary Care's high patient volumes, declining autonomy, and lagging compensation (Hoffer, 2024). While concierge care or DPC may seem more appealing to these physicians, it requires some years of experience in patient interactions and working without a solid safety net. Furthermore, its perceived exclusivity and siloed care may dissuade socially conscious medical graduates from this niche. 

The Semi-Concierge Medicine® Model

In 2022, we confronted a convergence of pressures: clinical overload, operational strain, and a growing misalignment between our daily practice and our core philosophy. We recognized the need to deliberately redefine our care model. As we explored alternatives, the Semi-Concierge Medicine® concept quickly stood out as the most aligned path forward. Yet despite thorough research, no existing model that occupied the desired middle ground was found. So, we built it. We launched SCM in 2023, introducing a phased membership fee for existing patients to ensure a smooth and equitable transition. 

After two and a half years of real-world application, the question naturally evolves: if the model is working, what would it take to scale it within systems and extend its reach nationally through structured training and support? We have encountered a fair number of challenges, and there is a learning curve for all involved; however, this journey has been well worth it. 

The Semi-Concierge Medicine® (SCM) model is a scalable, patient-centered solution that combines the benefits of high-volume Fee-for-Service (FFS) care and traditional concierge medicine. This is a “Middle ground” approach that offers sustainable, high-quality care while improving access for a broader, somewhat dissatisfied population.

By managing panel sizes of approximately 600-700 patients and collecting modest membership fees in addition to insurance billing, SCM offers a path that maintains workload balance and purpose-driven care without sacrificing equity. This shift could create a renewed interest in primary care as a career choice and improve existing physician satisfaction (Medford-Davis & Malani, 2024). 

This model is not a rejection of traditional systems but a refinement within them. It realigns care delivery with the needs of both patients and providers. With its core structure, SCM frees providers from coding pressures and allows appointments to focus solely on patient needs. 

Advancing The Quadruple Aim with SCM

The Quadruple Aim (enhancing patient experience, improving population health, reducing costs, and supporting provider well-being) serves as a cornerstone for modern healthcare reform. The Semi-Concierge Medicine® (SCM) model directly integrates each of these aims into its core design. 

Enhancing Patient Experience 

SCM replaces episodic, rushed visits with extended appointment times, prompt access, and coordinated communication. Patients are supported by a consistent care team, strengthening trust and continuity (Park et al., 2018). This team-based approach fosters patient satisfaction and engagement. 

Traditional models often push in-person visits for tasks that could be managed by simple, convenient communications. This tendency is driven, at least in part, by a need to generate codable services. In contrast, SCM’s prepaid membership decouples clinical agendas from coding pressures. Each appointment is guided solely by patient needs and medical prudence. 

SCM embeds proactive, unbilled interactions, like secure messaging and phone outreach, directly into its care model. These touchpoints are often underutilized or uncompensated in traditional workflows. By normalizing them, SCM improves outcomes, elevates patient experience (Rylands et al., 2025), increases member retention, and drives organic word-of-mouth advocacy. These factors create long-term value that benefits both patients and systems. 

Improving Population Health 

SCM’s smaller patient panels and proactive care model can enable conversational health maintenance between visits, preventive screenings, efficient referrals, and chronic disease management by default. By fostering early intervention and sustained engagement, models like SCM can reduce avoidable emergency visits and long-term health risks (Jannat-Khah et al., 2021). 

Reducing Costs  

SCM’s emphasis on prevention, early intervention, and reduced acute care utilization contributes to overall cost savings. Its predictable revenue from membership fees lessens reliance on high visit volumes, creating efficiency without compromising quality (Klemes et al., 2012). 

Supporting Provider Well-Being 

Smaller panels, more extended visits, and shared team responsibilities ease provider burden. Clinicians regain time for meaningful patient interactions, improving job satisfaction and reducing burnout (Prasad et al.,2020). The ability to focus on deeper conversations around goals, context, and care decisions restores the human connection often lost in high-volume environments. The shared after-hours call duties amongst several SCM physicians allow for continued non-rushed, patient-centered interactions, while allowing the PCP to have ample "off time" as well. 

Key Success Factors for Adoption 

Leadership Mindset and Buy-in 

Adoption must begin with a fundamental shift in leadership mentality. Leaders must recognize SCM as a transformative care model, one that differs meaningfully from legacy Fee-for-Service (FFS) paradigms. Successful implementation hinges on viewing SCM as an investment in sustainable, relationship-centered care rather than a sidecar experiment to traditional practices. The operational focus of SCM is fundamentally different than that of a legacy FFS division/department. 

Long-held tenets of visit volume, charge capture, reactive hiring, schedule fill rates, and exam room utilization need to be cast aside or at least minimized to tertiary concern levels. Visit-generated revenue will account for approximately 25-30% of the operating budget, if implemented correctly. In this model, visits happen organically and based on patient needs rather than the pressures of operational needs. An overt focus on visit revenue could be seen as trivial or contradictory to the membership model in members’ eyes, and this could be counterproductive. It also undermines visit availability, which is an even bigger dissatisfier for members, leading to satisfaction/ retention issues. 

Future reinvestment back into the SCM practice is an ongoing need. Hiring the right personnel (first and foremost), purchasing new equipment, enhancing electronic communication, increasing after-hours features, planning educational offerings are all examples of key investments.  

Perception Management and Cultural Framing 

A critical step in early planning is managing perceptions internally among staff, specialists, and departments, as well as early narratives to the community. SCM must be positioned as an accessible, mission-aligned care model that expands the portfolio of existing primary care offerings and affects the system as a whole, rather than creating an exclusive service for a select few. If the intent is to use a portion of profits to help underfunded ventures, this should be clearly stated. 

Leadership should proactively communicate SCM’s value to stakeholders, emphasizing its alignment with the organization’s commitment to access, quality, and sustainability. Transparent messaging avoids confusion and strengthens adoption across departments. This model will depend on other departments and will need their buy-in for referrals and service to members. 

Operations/ Reporting Structure 

To preserve the unique focus, organizations should separate SCM operations and reporting structures from FFS divisions. This separation allows for accurate benchmarking based on SCM-specific metrics such as patient satisfaction and retention (membership revenue), patient outcomes, and provider retention over daily throughput concerns. It is quite unfair to expect an ambulatory leader to manage both styles of care delivery without bleed-in of confounding concerns that do not apply to the model. 

This organizational suggestion is not just based on our own experiences, but echoed time and time again in many business theorems and frameworks such as Christensen’s Theory of Disruptive Innovation, Mintzberg’s Organizational Structure Theory, Core-Periphery Model, and the Ambidextrous Organization Model. These proven constructs inform us and caution against housing innovations within existing management structures preoccupied with the traditional, longstanding processes of the business. Innovation is meant to be disruptive and not meant to conform to traditional performance metrics and practices. Without separation, integrity, and growth of an SCM practice is severely jeopardized and will not flourish. 

Readiness Assessment and Investment Planning 

Organizations should assess readiness by examining staffing capacity, infrastructure, and financial modeling. Having quality, hospitality-minded individuals with excellent communication skills, from the office staff to the providers, is supremely important. In some instances, new job positions and full descriptions may need to be created. Equity is important in large institutions, but the job descriptions of SCM nurses and office staff are quite different in this model, and compensation may need to reflect that. 

Hiring “ahead of the need” is also a construct that is somewhat foreign to a primary care operation but is critical to ongoing success as a system continues to grow. In this highly service-oriented model, the team needs to be in place for new panels as new members are accepted. 

Initial investments may include hiring or reallocating nursing staff, training of physicians and staff, making EMR changes, creating membership contracts, legal counseling, Concierge/SCM mentorship, and adding supplemental software such as Membership management systems, communication systems, etc.  Consulting with independent experts can reduce the learning curve and help navigate cultural or financial friction points early on. Avoiding missteps and pitfalls in these areas is essential to maintaining clinical integrity and brand trust. 

Implementation and Scaling 

Template Design and First Steps 

SCM implementation requires significant workflow adjustments, including extended visit times, flexible scheduling, and personalized outreach. Phased rollouts (such as launching with a single physician or small team) allow organizations to fine-tune operations before scaling. These pilots offer real-time feedback, increase staff buy-in, and ensure smoother transitions. 

Staffing and Team Structure 

SCM relies on high-touch, team-based care. A significantly higher staff-to-patient ratio is necessary to ensure responsiveness and reduce staff burnout (Helfrich, 2017). Registered Nurses, a membership coordinator, and capable office staff support each physician and each panel of patients. 

Communication and Education 

Educating staff and patients is essential to successful adoption. Staff need training in proactive, preventive care delivery, while patients must understand how SCM differs from traditional and concierge models. Since concierge medicine is a known commodity, tempering of certain expectations around communications with a singular provider is a necessary step. Educational materials, FAQs, videos, and onboarding guides should emphasize accessibility, care coordination, and the tangible value of membership. 

Technology and Infrastructure 

Optimized EHR systems and evolving AI-powered tools are crucial to SCM efficiency. Technology should support personalized care planning, automate scheduling and reminders, and facilitate secure, two-way communication. HIPAA-compliant portals allow patients to actively engage with their care, improving outcomes and satisfaction. 

Integration and Alignment 

Maintaining SCM’s structural independence during implementation is essential (see “Operations/ Reporting Structure” section). Practices should ensure that the distinct reporting lines, governance, and performance metrics established during planning remain in place as operations scale. 

Scalability and Growth Planning 

SCM supports growth through controlled, formulaic expansion. Care teams are fully onboarded before enrollment begins, ensuring a smooth launch. This measured approach minimizes disruption, builds staff confidence, and establishes a strong foundation for growth. Proactive investment in staffing and infrastructure ahead of demand protects care quality and reduces the risk of provider burnout with panel expansion and as new panels and teams are added. 

Revenue, Sustainability, and Strategic Alignment 

The Semi-Concierge Medicine® (SCM) model provides a financially resilient framework that supports high-quality, patient-centered care. By moving away from volume-based reimbursement toward membership-derived income, SCM creates a more stable economic foundation—enabling enhancements such as extended visit times, expanded staffing, and personalized patient engagement. Over time, its membership-to-FFS revenue ratio protects the enterprise against demand variability and policy-driven reimbursement shifts. This stability empowers organizations to take calculated risks, pilot new services, and adapt confidently to the changing reimbursement landscape. 

SCM’s emphasis on sustainability and value makes it a powerful tool for not-for-profit systems navigating financial pressures, community expectations, and care offering diversification. Excess program revenue can be reinvested back into other initiatives such as community screening programs, behavioral health, and other socially impactful services. These initiatives reinforce both resilience and social impact (Jannat-Khah et al., 2021). When these reinvestment goals are clearly defined up front, SCM becomes not just a care model, but a vehicle for advancing equity and institutional values. 

Conclusion 

Semi-Concierge Medicine® is more than an alternative; it is a strategic evolution of primary care. In an environment strained by clinician shortages, unsustainable visit volumes, and inequitable access, SCM redefines what sustainable, mission-aligned care can look like. 

This model allows health systems and practices to prioritize relationship-based care without sacrificing financial performance. Its prepaid membership model supports predictability, its team-based structure ensures continuity, and its flexibility enables integration across a portfolio of service lines. 

Importantly, SCM offers a mechanism for revenue diversification and a buffer against financial instability. When applied within a broader system, it stabilizes performance across service lines, funds under-resourced sites, and fuels innovation. Its compatibility with not-for-profit values also allows for reinvestment in programs that support vulnerable populations, building goodwill and advancing institutional trust. 

As healthcare continues to evolve, models like SCM are essential. They embody the principles of patient-centeredness, preventive care, and provider sustainability while remaining operationally viable and socially responsible. The success to date shows that with the right training, infrastructure, and leadership mindset, SCM can scale nationally and usher in a new era of primary care. 

Acknowledgements

Generative AI use 

Select portions of this white paper were developed with the assistance of generative AI tools, specifically OpenAI’s ChatGPT and OpenEvidence. These tools were used to support information gathering, the synthesis of Semi-Concierge Medicine® (SCM) data (original concepts and content created solely by the author), and to enhance the clarity, syntax, and flow of the text. All material has been reviewed, edited, and finalized by the author to ensure accuracy and to reflect the author’s voice and intent. 

Trademark and Intellectual Property 

The views expressed are solely those of the author and do not represent the views of The Ohio State University. The SCM model represents an original, independently developed synthesis of clinical operations, staffing design, revenue strategy, and patient engagement- all informed by publicly available concepts and frontline healthcare experience. 

While the Semi-Concierge Medicine® trademark is registered to the Ohio State Innovation Foundation, the underlying intellectual framework presented here reflects the author's independent work. No proprietary data, institutional trade secrets, or confidential materials were used in its development. 

About the Author 

James Lawlor, DO, MBA, FACOI is a practicing Internal Medicine physician, healthcare leader, and an innovator in care delivery design. Three years ago, during his tenure as the Executive Health Medical Director at The Ohio State University Wexner Medical Center, he developed the Semi-Concierge Medicine® (SCM) model to address existing operational challenges and structural limitations in both traditional Fee-for-Service and full concierge care models. 

James.Lawlor@osumc.edu | www.linkedin.com/in/jim-lawlor/ 

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© 2025 James Lawlor. This white paper may be cited and excerpted for educational and non-commercial purposes with appropriate attribution. All other rights reserved. This preprint research paper has not been peer reviewed. Electronic copy available at: https://ssrn.com/abstract=5362443