TRIBUTARY
ADVISORY GROUP
DEFINING MEMBERSHIP MEDICINE
Membership medicine isn't one thing. It's a spectrum
Most conversations about primary care reform collapse into a false choice: stay in traditional fee-for-service, or go full concierge. That framing misses the most important territory — the range of models in between. Membership medicine is not a single product. It's a spectrum of approaches that vary by panel size, fee structure, and the role of insurance. Understanding that spectrum is the first step to deciding what, if anything, fits your system.
The range, end to end
At one end sits traditional fee-for-service: large panels, high volume, little time per patient. At the other, full concierge and direct primary care: small panels funded by retainer, often outside insurance entirely. Between them lies a set of middle-ground models — including Semi-Concierge Medicine® — that keep insurance in play while reducing panel size enough to restore time and relationship. Most health systems assume they have two options. In reality, they have a portfolio.
WHERE MEMBERSHIP MODELS MAY FIT
Membership-based care is best understood as a spectrum of practice structures rather than a single model. One useful way to understand this spectrum is through the Patient Relationship Management (PRM) Curve, a concept coined by Dr. James Lawlor to illustrate the structural relationship between patient panel size and the depth of the physician–patient relationship.
The PRM Curve highlights an important reality in primary care design. As patient panel sizes grow, practices can provide access to larger populations, but the time available for individualized care naturally becomes more limited. As panel sizes decrease, physicians are able to spend more time with patients, deepen continuity, and deliver a more personalized care experience.Traditional fee-for-service primary care generally sits on the higher-panel portion of the PRM Curve. These practices provide broad access to large patient populations but often operate under significant time pressure due to panel sizes and administrative demands.
At the opposite end of the curve are fully concierge practices. These models typically maintain much smaller patient panels and are designed to deliver a highly personalized care experience with enhanced physician availability and continuity. Concierge medicine has demonstrated that when panel sizes are intentionally reduced, both patient experience and physician satisfaction can improve meaningfully.
Between these two ends of the curve lie a range of middle-ground membership models. These approaches combine insurance-based care with a modest membership structure and moderately reduced panel sizes. By moving slightly down the PRM Curve, these models can create more time for physician–patient relationships while still preserving meaningful access and scale within larger health systems.
For many organizations, the goal is not to replace one model with another but to understand where different approaches sit along the PRM Curve and how they may work together within a diversified primary care portfolio.
SUPPORTING THE QUADRUPLE AIM
Health systems across the country are working to balance the goals of the Quadruple Aim: improving patient experience, enhancing population health, controlling costs, and supporting clinician well-being. These objectives are widely accepted as the guiding framework for modern healthcare. Achieving all four simultaneously within traditional primary care structures, however, has become increasingly challenging.
Traditional fee-for-service primary care was designed around high patient volumes. Physicians often manage panels of 1,800 to 2,500 patients, with visit schedules driven by throughput and administrative demands that continue to grow. In this environment, time with patients becomes compressed, access can become strained, and the depth of the physician–patient relationship may suffer. At the same time, clinicians frequently experience increasing workload and burnout pressures.
Membership-based care models have emerged as one response to these structural tensions. In these models, patients pay a recurring membership fee to support enhanced access, expanded services, and a more personalized relationship with their physician.
Fully concierge practices represent one end of this spectrum. These models typically operate with smaller patient panels and emphasize a highly personalized care experience with significant physician availability.Concierge medicine has demonstrated that when panel sizes are reduced and relationships are prioritized, both patient experience and physician satisfaction can improve meaningfully.
Between traditional fee-for-service primary care and fully concierge practices, a range of middle-ground membership models has also developed. These approaches combine insurance-based care with a more modest membership structure and moderately reduced panel sizes. By maintaining compatibility with traditional insurance while introducing additional time and resources for patient care, these models aim to balance personalization, access, and financial sustainability within larger health systems.
When thoughtfully designed, membership-based approaches across this spectrum can help organizations advance the goals of the Quadruple Aim. Patients may experience improved access, longer visits, and stronger continuity with their physician. Clinicians can benefit from more manageable panel sizes and the ability to practice in a more relationship-centered environment. Health systems may gain additional revenue alignment that supports the sustainability of primary care while preserving broader access across the system.
Membership medicine should not be viewed as a single model but rather as a spectrum of approaches that can complement traditional primary care. Tributary Advisory Group works with health systems and physician organizations to evaluate where different membership-based structures, including concierge and middle-ground models, may fit within their broader primary care strategy while supporting the goals of the Quadruple Aim.