The PRM Curve™: Rethinking the Design of Physician-Patient Relationships

In a my previous blog, I argued that primary care is too often framed as a choice between high-volume fee-for-service and high-touch concierge care.

That binary framing no longer reflects reality. The language of “two-tier medicine” is increasingly outdated.

Across the country, membership-based care now spans a wide range of structures. These include small direct primary care and independent concierge practices, as well as insurance-participating membership models embedded within larger health systems. The real shift is not simply between two extremes, but toward more intentional operational design of time, access, continuity, and revenue.

To better understand this evolution, I developed what I call the PRM Curve™, a way of visualizing the dynamics of Patient Relationship Management in primary care.

The idea is loosely informed by CRM (Customer Relationship Management) concepts in business. But PRM emphasizes something different. It focuses on the design of the clinical relationship itself, not simply the management of transactions or logistics. In healthcare, relationships are not incidental. They are structured by operational choices, and those choices create inevitable trade-offs between personalization, scale, and physician capacity.

Every primary care model sits somewhere along this curve.

Many patients would prefer to find themselves toward the lower-right portion of the curve, where relationships are deeper and access is more personalized. In reality, the constraints of time, workforce, and cost make that impossible for the entire population.

One important question is whether the curve can be flattened. How can a greater percentage of patients experience higher-relationship care without creating unintended consequences for patients, physicians, or health systems?

Primary care physicians have finite time and relational bandwidth. Panel size, visit structure, access design, staffing models, and payment structure all shape the depth and continuity of the physician–patient relationship.

If the long-term goal is progress toward the Quadruple Aim (better patient experience, improved population health, sustainable physician practice, and more efficient use of resources), then these structural questions matter.

The answers are not yet clear. They are likely multifactorial and will probably involve adaptation of existing models rather than a single new solution.

But asking the right structural questions about relationship design in primary care is an important place to start.