Lessons from CRM: Concierge vs. Fee-For-Service is an Oversimplified Choice and It no Longer Reflects the True Landscape

For years, primary care has been framed as a binary or “two-Tier” (a term that I hate). This connotates high-touch concierge care for a few, or high-volume rushed care for everyone else. That framing is outdated. It does not reflect how care is actually being designed today, yet it continues to shape how physicians, health systems, and policymakers talk past one another.

As mentioned previously, “Concierge medicine” has quietly become a catch-all term. It is used to describe everything from boutique, ultra-low panel practices to insurance-participating membership models embedded inside large health systems. When fundamentally different approaches share one label, meaningful discussion breaks down.

What this framing misses is that Membership Medicine exists on a spectrum, not just the two extremes. Traditional fee-for-service sits on one end. Very low panel, high-touch concierge models sit on the other. Between them is a wide and rapidly growing middle ground that blends insurance billing with modest membership structures to support longer visits, better access, and stronger continuity.

These middle-ground approaches are not edge cases. They are where much of the real experimentation and adoption is happening, precisely because they balance personalization with scale and mission. They challenge the idea that relationship-centered care must be either exclusive or inefficient.

If we continue debating primary care as concierge versus fee-for-service, we miss the point. The real shift is toward intentional design of time, access, and continuity. Until we update the frame, we will keep arguing about the edges instead of understanding the actual breath of what is taking place.

One way to think about this is through what I have coined as the PRM Curve. The concept of "Patient Relationship Management" borrows from Customer Relationship Management in the business world, where organizations recognize that relationships must be intentionally managed, and that personalization, scale, and capacity involve trade-offs along a variable continuum. In healthcare, the same reality applies Although with different areas of focus and patient care as the leading concern. We need to recognize that physicians have finite time and relational capacity, and care models continue to diversify based on how those constraints are managed.