Concierge health care began nearly two decades ago as an elite service, providing in-depth and specialized care for wealthy clients. Specialized doctors in big cities can charge more than $5,000 or $10,000 for annual memberships. But more middle-class models have since emerged, and the subscription-based service is even used as an alternative to traditional insurance in some primary care practices. … Albuquerque Dr. Tom Pascuzzi has been operating an independent direct primary care practice for about three years, charging a $150 monthly membership fee for his services instead of taking insurance. He also offers urgent care services for nonmembers for $175 per appointment.