The DPC Starter Guide

Direct Primary Care is a membership-based primary care model. Patients, families, or employers pay the practice a recurring fee, usually monthly, in exchange for access to most routine primary care services. The practice generally does not bill insurance for the primary care services included in the membership.

A simple explanation patients can understand is: you pay one clear monthly fee for direct access to your primary care doctor, longer visits, simple communication, and transparent pricing.

Before choosing a name, logo, office, or software, define the promise of your practice. Your promise should be short and specific. For example: longer appointments without rushed visits; same-day or next-day access when medically appropriate; direct communication with the practice; no insurance billing for included primary care services; transparent prices for membership and common outside services; a smaller patient panel so the doctor has time to know patients well.

The strongest DPC practices are not just cash-pay clinics. They are relationship-based primary care practices built around access, trust, and simplicity.

2. Choose your DPC structure

Decide what kind of DPC you are launching. The structure affects pricing, staffing, legal review, marketing, and the way you explain the practice.

• Pure DPC: The practice charges a membership fee and does not bill insurance for included primary care services.
• Hybrid transition model: The practice keeps some insurance-based patients while gradually moving toward membership care.
• Employer-focused DPC: Local businesses pay membership fees for employees as a benefit.
• Micropractice DPC: A lean practice with one physician, minimal staff, low overhead, and a smaller panel.
• Family-focused DPC: Built around families, children, preventive care, and convenient access.

For most first-time founders, the simplest starting model is a lean, pure DPC practice with one physician, one support person or virtual assistant, clear pricing, and a defined panel cap. Hybrid models can work, but they often create confusion because the team has to manage two different businesses at the same time.

3. Validate the market before signing a lease

Do not assume people will join just because the model makes sense to you. Validate demand before taking on large fixed costs.

Create a list of at least 100 potential early supporters: current or former patients who value access and relationship-based care; self-employed professionals; families facing high out-of-pocket costs; small business owners; local benefit brokers; gym owners, school leaders, church leaders, and community organisers; patients frustrated by long waits, rushed visits, or confusing bills.

Talk to them directly. Ask what frustrates them most about primary care today, how long they usually wait for appointments, whether they understand their medical bills, whether direct access and longer visits would be worth a monthly membership fee, whether their employer would consider paying for it, and what would make them hesitate to join.

Your goal is not to persuade everyone. It is to identify the first 50 to 100 people who strongly understand the value. Those early members become your proof of demand.

4. Build the financial model first

DPC is a recurring revenue business wrapped around excellent medical care. The formula is simple:

Monthly revenue = active members × average monthly membership fee

A realistic example using an $85 average monthly membership fee and 30% overhead:

The most important numbers are: average monthly membership fee, number of active members, monthly cancellations, overhead percentage, cash reserve, and physician workload.

Do not price the practice so low that you need an oversized panel to survive. The point of DPC is not to recreate volume-based medicine with a different payment method. A strong early target is 300 members. A sustainable single-physician target may be 500 to 700 members depending on patient complexity, visit frequency, staffing, and access promises.

5. Create a pricing model patients can understand quickly

Your pricing should be simple enough to explain in ten seconds. Complicated pricing slows enrolment.

You may also charge a one-time registration fee, but keep it reasonable. Registration fees can help cover onboarding, records review, and initial administrative work, but a high fee creates unnecessary friction.

Publish pricing on the website. Keep family pricing easy to understand. Avoid too many exceptions. Make cancellation terms clear. Do not promise unlimited care in a way that creates unrealistic expectations. Review HSA compatibility and state law before finalising pricing language.

For employer groups, price per employee per month. You can offer tiers based on company size, but avoid creating custom complexity too early.

6. Define exactly what is included and excluded

Your membership agreement and website should clearly explain what the monthly fee covers.

Commonly included: extended primary care visits; annual wellness and preventive visits; acute care visits for common illnesses and injuries; chronic disease management; medication management; direct messaging or phone access during defined hours; basic women's health services, if within scope; paediatric or adolescent care, if offered; simple in-office procedures; care coordination and specialist referral support; wholesale or pass-through lab coordination; basic point-of-care testing, if properly licensed.

Commonly excluded: emergency care; hospital care; specialist care; surgery requiring facility-level support; advanced imaging; outside laboratory, pathology, or imaging fees unless specifically included; medications, unless separately structured and legally reviewed; workers' compensation services; disability evaluations; controlled substance management, if limited by practice policy.

Patients should understand that DPC is not insurance. Many patients should still carry something for emergencies, hospitalisation, specialists, and major procedures outside the membership.

7. Handle legal setup before accepting patients

Before the first patient signs up: professional entity or other state-appropriate structure; EIN; business bank account; accounting system; malpractice coverage; state medical licence in good standing; DEA registration if prescribing controlled substances; NPI, even if not billing insurance; written DPC membership agreement; privacy and medical record policy; employment or contractor agreements; lease or space-use agreement; lab, imaging, and vendor agreements.

Your membership agreement should include a clear statement that DPC is not insurance; the fee and billing cycle; services included and excluded; cancellation and refund terms; communication expectations; after-hours and emergency policy; patient responsibilities; physician termination rights; privacy and records language; employer-sponsored terms if applicable; and Medicare private contracting language if relevant.

Do not copy another practice's contract and assume it works in your state. State DPC laws vary, and some states require specific patient protections or contract language.

8. Decide your Medicare position early

Medicare creates one of the biggest compliance decisions for a DPC founder. Decide before marketing to older adults or accepting Medicare beneficiaries.

• Do not accept Medicare beneficiaries at launch. Operationally simple, but limits your market.
• Opt out of Medicare and use private contracts. May allow private contracting with beneficiaries, but must be done correctly.
• Remain enrolled in Medicare. May limit what you can charge Medicare patients privately for covered services.

If you opt out, Medicare rules generally require an opt-out affidavit and compliant private contracts. A physician generally cannot opt out for some Medicare patients but not others, or for some covered services but not others. Get healthcare legal guidance before including Medicare beneficiaries.

9. Build compliance systems that match a medical practice

DPC reduces insurance billing bureaucracy, but it does not remove healthcare compliance obligations.

HIPAA-aware privacy and security policies; secure EHR and patient communication; business associate agreements with vendors handling protected health information; multifactor authentication; password manager; device encryption; role-based staff access; secure backups; breach response plan; medical record retention policy; OSHA bloodborne pathogens exposure control plan if staff have occupational exposure; CLIA certificate if performing applicable testing; vaccine storage policies if offering vaccines; biohazard and sharps disposal.

Point-of-care testing is often useful in DPC, but do not begin testing without understanding CLIA requirements. Even waived tests may require a CLIA certificate.

10. Choose a lean technology stack

DPC practices need technology that supports membership care, not a bloated insurance billing workflow: a DPC-friendly EHR; recurring membership billing; online enrolment forms; online scheduling; secure messaging; business phone; e-fax or secure document exchange; website and landing page; email newsletter; accounting; payroll if employing staff; secure cloud document storage.

Before choosing software, map the workflow: patient learns about the practice, reviews pricing, enrols online, signs the agreement, payment method collected, new patient paperwork completed, records requested, initial visit scheduled, follow-up plan documented. The fewer manual steps, the easier it is to grow without drowning in administration.

11. Set up the clinic space and operations

Start lean. A beautiful office is nice, but low overhead matters more early.

Minimum space: one to two exam rooms; physician office or consult room; vitals station; phlebotomy or specimen collection area if offered; vaccine refrigerator if offering vaccines; secure medication storage; clean waiting area; ADA-compliant access; bathroom access; sharps and biohazard waste process.

Core supplies: exam tables; blood pressure cuffs and vitals equipment; otoscope and ophthalmoscope; EKG if offered; suture and procedure supplies; cryotherapy supplies if offered; urine and rapid testing supplies if offered; phlebotomy supplies; PPE; AED and emergency kit.

Staffing should stay simple. Many DPC practices can start with one physician and one medical assistant, part-time admin, or virtual assistant. Hire only when the bottleneck is obvious.

12. Build your cash-pay care network

One of the strongest benefits of DPC is helping patients access transparent pricing outside the membership. Build relationships with independent labs, imaging centres, local pharmacies, compounding pharmacies where appropriate, specialists open to cash-pay pricing, physical therapists, mental health clinicians, dietitians and health coaches, and employer benefit brokers.

Your goal is a practical local network. When a patient needs labs or imaging, your team should know where to send them, what the approximate cash price is, and how results will return to the practice. Be transparent about markups. Some practices pass labs through at cost; others charge a small administrative fee. Either can work if the policy is clear and legal in your state.

13. Design the patient experience

The patient experience is the product. Patients should feel the difference from the first interaction.

New patient visit: 45 to 90 minutes. Routine visit: 30 to 60 minutes. Same-day or next-day acute access when medically appropriate. Clear response-time expectations for messages. Annual care plan for each patient. Follow-up reminders for chronic conditions. Medication refill workflow. Lab result communication workflow. Referral tracking. After-hours boundaries.

Do not promise 24/7 unlimited access unless you truly have the staffing and lifestyle tolerance to support it. Clear boundaries protect the practice and the physician. The best DPC practices feel calm, personal, and organised. Patients should not wonder how to reach you, what they owe, or what happens next.

14. Launch marketing 90 days before opening

90 days out: announce the practice; launch a simple website; publish the DPC explanation and pricing; start collecting email addresses; meet local business owners; contact benefit brokers; post educational content.

60 days out: open founding member enrolment; host small webinars or lunch-and-learns; share patient-friendly FAQs; ask early supporters for referrals; begin employer conversations.

30 days out: schedule first visits; collect signed agreements and payment methods; send onboarding emails; request records; confirm workflows and supplies; test phones, messaging, scheduling, and billing.

Do not sell DPC as cheap care. Sell it as better access, better relationships, and clearer pricing.

15. Add employer memberships

Employer groups can help a DPC practice grow faster, especially small businesses that struggle with healthcare costs and access. The pitch is simple: we provide your employees with direct primary care access for a predictable monthly fee.

Package by size: 5 to 20 employees, 21 to 50, 51 to 100, custom above that. Employer materials should include a one-page explanation, pricing per employee per month, what is included and excluded, how employees enrol, a privacy statement explaining that employers do not receive individual medical information, and simple de-identified utilisation reporting if offered.

Protect patient privacy. Employers may receive aggregate, de-identified reports, never individual medical details.

16. Track the numbers every month

Track active members, new members, cancelled members, net growth, average revenue per member, monthly recurring revenue, revenue by individual/family/employer, visit volume, message volume, no-show rate, panel complexity, overhead percentage, cash reserve, patient satisfaction, and physician workload.

The most important question is whether the practice is becoming more sustainable while preserving the doctor's quality of life and the patient experience. If revenue is growing but the physician is becoming overloaded, adjust panel size, pricing, staffing, visit boundaries, or workflows.

17. Launch checklist

Business entity formed · business bank account opened · accounting system active · malpractice coverage active · DPC agreement reviewed by a healthcare attorney · Medicare position decided · HIPAA and security policies drafted · EHR selected and tested · billing system tested · website live · pricing published · CLIA certificate obtained if testing · OSHA exposure control plan created if applicable · lab and imaging relationships established · phone and messaging live · new patient forms complete · employer one-pager ready · first 100 prospects contacted · founding member campaign launched · first month of appointments scheduled.

18. First-year operating rhythm

Monthly: review membership growth and cancellations; review cash flow and overhead; audit response times and access; ask happy members for referrals; publish educational content; meet at least five potential referral partners or employers.

Quarterly: review pricing; review workload and panel capacity; review vendor performance; update patient FAQs; evaluate staffing; review compliance tasks.

Annually: review the membership agreement; renew malpractice and business policies; review privacy and security policies; update pricing if needed; revisit panel cap and growth strategy; survey patients.

Do not rush to scale before the model is stable. A calm, profitable 300-member practice is better than a chaotic 700-member practice that burns out the doctor.

Final advice

A successful DPC practice is simple, but it is not casual. The model works because the incentives are cleaner: patients pay directly for access to primary care, and the physician has more time to deliver thoughtful, relationship-based medicine.

The practices that win are disciplined about five things: clear pricing, low overhead, a strong legal and compliance foundation, an excellent patient experience, and consistent local marketing.

You don't have to build all of this alone. CoreMed exists to make the hard parts of launching a direct primary care practice easier. For most founders, the biggest early risk is an empty schedule. CoreMed helps fill it by connecting your new practice with members in your community who are already looking for exactly this kind of care, so you can open your doors with patients instead of starting from zero. You stay independent and run your own practice. We're simply the neighbour down the road helping you grow.

If you've even thought about making the leap to your own DPC practice, reach out. We'd love to help you build it, and we have members ready to sign up.

Sources and reference notes

Use these as starting points for legal, compliance, and operating review. Confirm current rules with counsel before launch.

• American Academy of Family Physicians (AAFP): Direct Primary Care practice model, typical membership fees, and DPC data brief.
• Internal Revenue Service: Notice 2026-5 and related guidance on DPC service arrangements and HSA compatibility beginning 1 January 2026.
• Centers for Medicare & Medicaid Services: Medicare opt-out and private contracting guidance.
• U.S. Department of Health and Human Services: HIPAA Privacy and Security Rule guidance.
• CMS CLIA program: certificate requirements for testing on human specimens, including waived testing.
• OSHA: Bloodborne Pathogens Standard, 29 CFR 1910.1030, and exposure control plan requirements.