Direct Care: Medicine the Way It Should Be - Integrative Medicine Functional Medicine Membership

John Kim
Apr 22, 2022
9 min read

Updated: Aug 5

How membership-based integrative and functional medicine works — and whether it's right for you

Written and medically reviewed by Yoon Hang Kim, MD, MPH Board-Certified in Preventive Medicine | Integrative & Functional Medicine Physician Based in San Antonio, Texas · Virtual practice serving TX, IA, IL, MO, FL, and GA www.directintegrativecare.com

Last updated: August 2026

Medical Disclaimer: This article is for educational and informational purposes only. It does not constitute medical advice, financial advice, tax advice, or a recommendation to discontinue health insurance coverage. Direct Care is not health insurance. Consult a qualified healthcare professional regarding your medical care and a qualified advisor regarding financial or tax decisions.

What Is Direct Care, in One Paragraph?

Direct Care is a membership model in which you pay your physician a flat monthly fee instead of routing every visit through insurance. That fee covers unhurried appointments, direct phone and text access, and ongoing care — with no copays and no billing surprises. It is not insurance, and it does not replace it: most members keep a high-deductible plan for hospitalization and emergencies. The trade is straightforward. Your physician carries a much smaller patient panel — roughly 400 patients in the average Direct Primary Care practice, versus 2,000 to 2,500 in a traditional one — and in exchange has the time to actually practice medicine.

For integrative and functional medicine specifically, that time is not a luxury. It is the entire point. Root-cause work requires the kind of long, iterative conversations that a seven-minute insurance visit structurally cannot accommodate.

Why Is Traditional Medicine So Rushed?

The answer is billing, not indifference.

In insurance-based practices, the office visit is the unit of transaction. Insurers pay for encounters. Phone consultations are generally not covered. Text messages to your doctor are not covered. A quick email that might save you an unnecessary appointment is not a billable event.

This creates a perverse incentive. Every minute a physician spends answering your question by phone is a minute not generating revenue. The result is schedules packed with 20 to 30 or more patients per day, because that is what keeps the lights on and the staff paid.

The math behind this is worse than most patients realize. Research published in the Journal of General Internal Medicine (Porter et al., 2022) estimated that a primary care physician would need 26.7 hours per day to deliver all guideline-recommended preventive, chronic, and acute care — plus documentation — for a standard panel of 2,500 patients. There are not that many hours in a day. Something has to give, and what gives is time with you.

What Is Driving Patients and Physicians Toward This Model?

Cost. The Kaiser Family Foundation's 2025 Employer Health Benefits Survey found that total annual premiums for employer-sponsored family coverage reached $26,993, with workers contributing an average of $6,850 from their paychecks. Mercer's 2025 survey projects health benefit costs per employee will rise 6.5% in 2026 — the steepest increase since 2010, and closer to 9% without employer cost-cutting. Many families now pay thousands out of pocket before a deductible is met.

Physician burnout. The 2025 Commonwealth Fund International Health Policy Survey found that 43% of U.S. primary care physicians report burnout — the highest of ten developed countries surveyed. Among them, 44% cite administrative tasks as the primary driver and 65% say insurance-related paperwork is a major problem. A 2022 analysis in Mayo Clinic Proceedings estimated that burnout-related primary care turnover costs the system $260 million annually in excess healthcare spending.

When the incentives punish both parties, people look for a different arrangement.

How Does a Direct Care Membership Actually Work?

In exchange for a flat monthly fee, members receive access that insurance-based practices structurally cannot offer:

Unhurried appointments — 30 to 60 minutes, rather than the standard 5 to 10
Direct access — phone, text, email, and telemedicine, not just scheduled office visits
Expanded availability — including evenings and weekends
Smaller panels — the AAFP's 2024 DPC Data Brief puts the average Direct Primary Care panel at 402 patients
Transparent pricing — one monthly fee, no copays, no surprise bills

Your first appointment is typically an extended intake: full health history, current concerns, goals, and often lab work — the foundation for a personalized plan rather than a symptom-by-symptom triage.

The model has scaled considerably. The DPC Coalition reports more than 2,300 DPC practices serving over 300,000 patients, while the DPC Frontier mapper now lists over 3,100 practice locations nationwide. Thirty-four states have passed laws defining DPC as a medical service rather than insurance.

Why Is Direct Care a Natural Fit for Integrative and Functional Medicine?

Because root-cause medicine is time-intensive, and insurance does not pay for time.

Instead of prescribing something for each symptom and moving on, functional medicine asks why. Why is the blood pressure elevated? Why the persistent fatigue? What in your sleep, stress, nutrition, environment, or history is contributing? That detective work cannot be compressed into a rushed visit.

Insurance reimbursement has always been poor for exactly these approaches: extended consultations, advanced functional testing, many integrative procedures. Supplements receive no coverage at all. For patients accustomed to paying à la carte every time a physician's time was involved, the membership model consolidates all of it into one predictable fee.

This matters most for the conditions that don't fit neatly into conventional categories — autoimmune disease, chronic fatigue, fibromyalgia, MCAS, mold toxicity, long COVID, and the frustrating experience of being told "your labs are normal" while clearly not feeling well. These are precisely the cases that require time, sequencing, and iteration.

In my own practice, I have capped my panel at 99 patients. That is smaller than the DPC average, and deliberately so. Complex, sensitive patients require a level of responsiveness that a larger panel cannot honestly support.

What Does the Evidence Actually Show?

Honestly: encouraging, but not definitive.

A 2020 Society of Actuaries report prepared by Milliman found that patients enrolled in a DPC option used fewer downstream services, driven mainly by lower emergency department utilization — while also noting that an employer's net costs depend heavily on how the total benefits package is structured. Several employer-sponsored evaluations have reported reductions in ED visits and hospitalizations.

The caveat matters: most of this evidence is observational and drawn from employer-sponsored populations, not randomized trials. Critics reasonably note that healthier patients may self-select into these practices. I think the model is sound and my patients do better under it, but I would rather tell you what the literature supports than oversell it.

Is Direct Care Right for You?

It tends to be a strong fit if you:

Manage a chronic or complex condition requiring ongoing adjustment
Have a high-deductible plan and are already paying out of pocket for primary care
Want integrative or functional medicine and are tired of paying per visit
Value access and continuity over having insurance process every transaction
Have felt dismissed or rushed in conventional settings

It may not be the right fit if you rarely use healthcare and are satisfied with your current arrangement, if a monthly fee on top of insurance premiums is not affordable, or if you need a physician who bills your insurance directly.

Direct Care Is Not Insurance — This Part Matters

Direct Care complements insurance; it does not replace it. Catastrophic coverage remains essential for hospitalization, surgery, cancer treatment, and serious accidents. Most members pair their membership with a high-deductible health plan, which typically carries a lower premium while protecting against major expenses.

A note on Medicare. This is frequently misunderstood. Medicare beneficiaries can join most Direct Care practices. The complication sits on the physician's side: most DPC physicians formally opt out of Medicare, which means Medicare will not reimburse for that physician's services. Your Medicare coverage continues normally for everything else — hospitalizations, imaging, labs, specialists, and prescriptions. Medicare will not pay the membership fee itself. If you are on Medicare, ask any practice directly how they are structured before enrolling.

Can I Use My HSA for a Direct Care Membership in 2026?

Yes — this is new, and it is significant.

Under the One Big Beautiful Bill Act (H.R. 1), signed July 4, 2025 and effective January 1, 2026, Direct Primary Care membership fees are recognized as qualified medical expenses under HSA rules. Pre-tax HSA funds may be used up to $150 per month for individuals and $300 per month for families.

Just as importantly, a qualifying DPC arrangement no longer counts as disqualifying "other coverage," so pairing a membership with an HSA-eligible high-deductible plan no longer jeopardizes your ability to contribute. Consult your tax advisor about your specific situation.

Summary: Direct Care at a Glance

	Traditional Insurance-Based Care	Direct Care Membership
Payment	Fee-for-service billed to insurer	Flat monthly fee paid to physician
Typical panel size	2,000–2,500 patients	~400 patients (99 in my practice)
Visit length	5–15 minutes	30–60 minutes
Access between visits	Limited; often not billable	Phone, text, email, telemedicine
Copays / surprise bills	Common	None for included services
Functional medicine testing	Spotty or no coverage	Discussed openly; transparent pricing
Replaces insurance?	—	No — pair with catastrophic/HDHP
HSA-eligible (2026)	—	Yes, up to $150/mo individual, $300/mo family

Frequently Asked Questions

Is Direct Care the same as concierge medicine? No. Concierge practices typically still bill insurance and charge an additional retainer, often a substantially higher one. Direct Care practices generally do not bill insurance at all, and fees are lower.

Do I still need health insurance? Yes. Direct Care covers primary and ongoing care, not hospitalization, surgery, or catastrophic events. Most members pair membership with a high-deductible plan.

What if I need a specialist or hospital care? Your physician coordinates referrals and works with the specialist. Your insurance covers those services as it normally would. Direct Specialty Care practices are also an emerging option for insurance-free specialist access.

Can I use HSA funds? Yes, as of January 1, 2026, up to $150/month individual or $300/month family.

Can Medicare patients join? Generally yes, though Medicare will not reimburse an opted-out physician's services or the membership fee. Ask each practice how they are structured.

How do I find a Direct Care practice near me? Search the DPC Frontier mapper or DPC Nation. For specialists, use the DSC Alliance directory.

For Physicians: Resources for Starting Your Own Direct Care Practice

If you are a physician considering the transition, the movement is far better supported than it was even five years ago. These are the organizations I recommend:

DPC Frontier — The essential legal and regulatory resource. Their state-by-state guides cover defining legislation and insurance-law considerations, and their guidance on opting out of Medicare is required reading before you structure your practice.

Direct Primary Care Alliance (DPCA) — The national 501(c)(6) focused solely on DPC physicians: education, mentorship, masterminds, group purchasing, and malpractice discounts. See membership benefits.

Direct Specialty Care Alliance (DSC Alliance) — Founded in 2020 for specialists building insurance-free practices. Contracts, templates, and a structured starter course built for the specific challenges specialists face.

DPC Coalition (DPCC) — The leading policy and advocacy organization, and the group behind the HSA legislative win.

Free Market Medical Association (FMMA) — Broader price-transparency movement connecting physicians, patients, and self-funded employers. The San Antonio chapter is worth knowing for Texas physicians.

DPC Nation — Patient-facing community and Facebook group.

I have written a practical, unglamorous guide to the startup process — costs, entity formation, SEO, and the mistakes I made — here: So Doctor, Would You Like to Create Your Own Direct Primary Care Practice?

The Bottom Line

Direct Care is not a miracle or a movement requiring belief. It is a rearrangement of incentives. When a physician is paid to keep you well rather than to process encounters, prevention beats crisis management, patients come in early instead of waiting, and the adversarial triangle between patient, physician, and insurer collapses into an actual relationship.

For integrative and functional medicine — where the work is slow, iterative, and deeply personal — that rearrangement is not a nicety. It is what makes the medicine possible at all.

If you are managing a complex condition and want to discuss whether this approach fits your situation, you can learn more or reach out at directintegrativecare.com.

https://youtu.be/qNxc1mc9yA8?si=_DWhngyXQ_nnEdHD

About Dr. Kim

Yoon Hang "John" Kim, MD, MPH, is board-certified in Preventive Medicine and is an Integrative & Functional Medicine physician with over 20 years of clinical experience. He completed his integrative medicine fellowship at the University of Arizona's Andrew Weil Center for Integrative Medicine and holds certifications in preventive medicine, medical acupuncture, and integrative and holistic medicine. Dr. Kim specializes in low dose naltrexone (LDN), autoimmune conditions, chronic pain, integrative oncology, fibromyalgia, chronic fatigue syndrome, mast cell activation syndrome (MCAS), and mold toxicity. He is the author of 3 books and over 20 published articles, and has helped establish integrative medicine programs at institutions nationwide.

Yoon Hang Kim, MD, MPH Integrative & Functional Medicine Physician Based in San Antonio, Texas · Virtual practice serving TX, IA, IL, MO, FL, and GA www.yoonhangkim.com | www.directintegrativecare.com

References

Kaiser Family Foundation. 2025 Employer Health Benefits Survey. October 2025. https://www.kff.org/health-costs/2025-employer-health-benefits-survey/

Mercer. Employers Prepare for the Highest Health Benefit Cost Increase in 15 Years. September 2025. https://www.mercer.com/en-us/insights/us-health-news/employers-prepare-for-the-highest-health-benefit-cost-increase-in-15-years/

Gunja MZ, et al. The Causes and Impacts of Burnout Among Primary Care Physicians in 10 Countries. Commonwealth Fund, November 2025. https://www.commonwealthfund.org/publications/surveys/2025/nov/causes-impacts-burnout-primary-care-physicians-10-countries

Porter J, Boyd C, Skandari MR, Laiteerapong N. Revisiting the time needed to provide adult primary care. J Gen Intern Med. 2023;38(1):147–155. doi:10.1007/s11606-022-07707-x. PMID: 35776372.

Sinsky CA, Shanafelt TD, Dyrbye LN, Sabety AH, Carlasare LE, West CP. Health care expenditures attributable to primary care physician overall and burnout-related turnover: a cross-sectional analysis. Mayo Clin Proc. 2022;97(4):693–702. doi:10.1016/j.mayocp.2021.09.013. PMID: 35339279.

Society of Actuaries / Milliman. Direct Primary Care: Evaluating a New Model of Delivery and Financing. May 2020. https://www.milliman.com/en/insight/what-our-study-says-about-direct-primary-care

American Academy of Family Physicians. Answers to six common questions about direct primary care (citing the AAFP 2024 DPC Data Brief; average panel size 402). https://www.aafp.org/pubs/fpm/blogs/inpractice/entry/dpc-faqs.html

One Big Beautiful Bill Act (H.R. 1). Signed July 4, 2025; HSA/DPC provisions effective January 1, 2026. See IRS Revenue Procedure 2026-24 and IRS Notice 2026-05.

DPC Frontier. Opting Out of Medicare. https://www.dpcfrontier.com/opting-out-of-medicare

Direct Primary Care Coalition. https://www.dpcare.org/

Direct Primary Care Alliance. https://www.dpcalliance.org/

Direct Specialty Care Alliance. https://dscalliance.org/

Free Market Medical Association. https://fmma.org/