Words shape industries. In healthcare, they can also confuse, divide, and occasionally mislead them. Here’s what the evidence actually says.

By the Editor-in-Chief, Concierge Medicine Today

Words are my passion — and my professional obsession. I’ve spent nearly two decades watching healthcare reshape, rebrand, and occasionally mangle its own vocabulary. Few industries use language with more precision in the exam room and less precision in the marketplace.

As a student, I was fortunate to have an 8th-grade Advanced Language Arts teacher — Mrs. Nielson — who told me, “You have a gift; keep writing.” I’ve been chasing that encouragement ever since, including into the strange lexicon of membership medicine. And right now, one term in particular deserves a serious second look: bespoke.

What Does “Bespoke” Actually Mean in Healthcare?

The term “bespoke” is more familiar to European audiences than North American ones — though that’s changing quickly. In its original context, bespoke referred to custom-tailored clothing: a suit cut to the exact measurements of one individual, with no standard template applied. In healthcare, the word has been adopted to describe something similar: care designed not for the median patient, but for the specific individual in front of the physician.

According to the Advisory Board’s Solomon Banjo and Nick Hula — who explored the concept in depth on the Radio Advisory podcast — bespoke care represents a model where treatment is customized to a patient’s unique biological, behavioral, and personal characteristics, integrating medical needs with individual preference. Their key insight: healthcare has historically been designed to treat a hypothetical “median patient.” Bespoke care challenges that assumption entirely.

As Banjo noted, while the concept is promising, “we’re not prepared now, but we can absolutely develop the infrastructure in clinical education, health literacy, all across from payment to clinical decision-making to make this a reality.”¹ Hula added that bespoke care is also going to be complex — requiring clinicians who are highly skilled not just clinically, but personally: “really knowing what’s right for their patients and being able to adjust treatment decisions based off of all the factors.”

This is worth pausing on. Bespoke care, as defined by leading healthcare researchers, is less a business model and more a clinical philosophy — one that demands precision medicine, advanced diagnostics, genetic insight, and a willingness to treat each patient as a population of one. It is ambitious, expensive in the short term, and largely aspirational at scale.

So How Is It Different From Concierge Care?

The distinction matters — and the healthcare industry at-large hasn’t always been honest about it.

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Concierge medicine, also known as retainer medicine, boutique medicine, or membership medicine, emerged in the mid-1990s as a response to a broken system. Its origin story is well-documented: in 1996, Dr. Howard Maron and Dr. Scott Hall founded MD² International in Seattle, offering dramatically reduced patient panels — roughly 50 families per physician — and charging annual retainers of $13,200 to $20,000 per family.² MDVIP followed in 2000, founded by Dr. Robert Colton and Bernard Kaminetsky in Boca Raton, FL, scaling the model across hundreds of practices nationwide.³

The core proposition of concierge medicine is structural: it improves the physician-patient relationship by reducing panel size, increasing time per visit, and guaranteeing access. Where a traditional primary care physician may carry 2,500 to 3,000 patients and see 20 to 25 per day, a concierge physician typically carries 300 to 600 patients and sees 6 to 8.⁴ The math changes everything.

Bespoke care, by contrast, is a clinical and technological aspiration. It is about what happens inside the appointment — the depth of genomic profiling, the precision of diagnostics, the integration of behavioral and environmental data into a treatment plan that is truly singular. As the Georgia Tech Center for MedTech Excellence describes it, bespoke care “revolves around the idea that one size does not fit all,” leveraging genomic sequencing, biomarker analysis, wearables, and telemedicine to deliver interventions matched to the individual at a molecular level.⁵

In plain terms: concierge medicine gives you more time with your doctor. Bespoke care gives you a treatment plan built around your biology. They are related — and the best concierge practices incorporate bespoke elements — but they are not the same thing. Conflating them doesn’t serve physicians, and it certainly doesn’t serve patients trying to understand what they’re signing up for.

A Brief Taxonomy of Terms — Because It Matters

Over the past 20 years, a proliferation of terms has emerged to describe the evolving relationship between primary care and subscription-based models. Understanding the differences is not academic — it shapes patient expectations, physician positioning, and regulatory treatment.

Concierge medicine / retainer medicine: Enhanced access and relationship-driven primary care funded by a membership fee. Typically involves reduced panel sizes, same-day appointments, and 24/7 physician access. Many practices also accept insurance for services covered under the patient’s plan.

Direct Primary Care (DPC): A lower-cost membership model that eliminates insurance billing entirely, relying on flat monthly fees. Developed in the mid-2000s as a more accessible alternative to traditional concierge medicine. DPC fees typically range from $50 to $100 per month, compared to concierge averages of $125 to $200 per month.⁶

Boutique medicine: Often used interchangeably with concierge medicine, though the term has largely fallen out of favor given its elitist connotation — one the industry has spent years trying to correct.

Bespoke care / bespoke medicine: Highly personalized, technology-enabled care designed around the individual patient’s biology, preferences, and circumstances. Encompasses precision medicine, genomics, and advanced diagnostics. Can exist within concierge and DPC frameworks, but is defined by clinical depth rather than access model.

A colleague — a trusted attorney in this space — captured the challenge well at the American Academy of Private Physicians conference in Phoenix in April 2015 when he said: “Let’s focus on substance, not labels.” He was right then. He’s even more right now, as the terminology continues to multiply and confuse.

The “Insideritis” Problem

Here’s where the industry needs to look itself in the mirror.

Author and leadership speaker Carey Nieuwhoff uses the term “insideritis” to describe a condition that healthcare has contracted in epidemic proportions: the tendency of organizations to view themselves exclusively through an internal lens, assuming that patients — the customers — understand the jargon, the acronyms, and the distinctions that insiders take for granted.

As Nieuwhoff observes: “Perhaps the insiders know what you’re talking about, but I don’t. Nor does anyone new or not yet embedded in your culture.”

This is not a small problem. Research published in ScienceDirect found that medical jargon is used on average more than once every four minutes in patient encounters — and only half of those terms are ever explained.⁷ The consequences are real: studies have associated poor health communication with medication non-adherence, missed diagnoses, reduced patient engagement, and lower satisfaction scores.

When a patient hears “concierge,” “DPC,” “bespoke,” “retainer,” and “membership” used interchangeably — sometimes within the same marketing brochure — they don’t parse the nuances. They get confused. And confused patients don’t enroll. Or worse, they enroll in the wrong model and feel misled.

This is not only a marketing problem. It is a trust problem. And in healthcare, trust is the product.

What the Evidence Shows

There is a growing body of evidence — imperfect but directionally clear — that membership-based medicine improves outcomes when implemented well.

A 2012 study by Klemes et al. published in the American Journal of Managed Care found that MDVIP-affiliated concierge patients were 42% to 62% less likely to be hospitalized than matched non-members. A follow-up study in Population Health Management (2016) showed MDVIP members had 20% to 24% fewer emergency room visits than matched controls over a three-year period.⁸

More recently, a 2025 systematic review in the American Journal of Medicine (Privitera et al.) analyzed 49 studies from the prior decade and confirmed that concierge models are associated with increased patient and physician satisfaction, along with reduced hospital admissions.⁹

The American Journal of Medicine has also noted the structural reality clearly: concierge physicians carry panels of 400 to 600 patients and see 6 to 8 patients per day, compared to the 2,000 to 3,000 patient panels and 20+ daily visits typical of traditional primary care.¹⁰ When physicians have time to practice medicine, outcomes improve. That shouldn’t be surprising — but somehow, in American healthcare, it still requires a footnote to be believed.

How Language Shapes — and Limits — Healthcare Innovation

It’s worth remembering that even the most foundational concepts in medicine were once unfamiliar, contested, and poorly named.

Evidence-based medicine (EBM) — today a cornerstone of clinical practice — was first formally defined in the early 1990s by Dr. David Sackett and colleagues at McMaster University. Their landmark 1996 paper in the BMJ articulated what EBM was and, crucially, what it was not: not a cookbook, not a replacement for clinical judgment, but a systematic integration of the best available research with individual clinical expertise and patient values.¹¹

EBM didn’t arrive fully formed or universally accepted. It was debated, mischaracterized, and resisted. Sound familiar?

Today’s membership medicine landscape is experiencing a similar moment. “Concierge” is being stretched to cover everything from $50/month DPC subscriptions to $30,000/year executive health programs. “Bespoke” is being adopted by practices that offer nothing more bespoke than a longer annual physical. “Direct care” means three different things depending on who is saying it and in what state.

The industry’s own insideritis is part of the problem. When physicians and administrators group these models together for convenience — and separate them only when they come under criticism — patients pay the price in confusion, misplaced expectations, and eroded trust.

The Prescription: Substance Over Labels

I am not arguing that one model is superior to another. Concierge medicine, DPC, bespoke care — they are each solving real problems for real patients, just in different ways and at different price points. The subscription-based economy is coming for healthcare whether the industry is ready or not, and every one of these models represents a meaningful step toward something better than the status quo.

What I am arguing is that words matter. That clarity is not a luxury — it is a clinical and ethical obligation. That when a patient walks into a “concierge” practice expecting bespoke genomic profiling and walks out with a slightly longer annual physical, something has gone wrong — not in the medicine, but in the language.

Price transparency has become a legal requirement in healthcare for a reason. Terminology transparency should be treated with the same seriousness. The retail clinic in your neighborhood now lists its prices. The DPC practice publishes its monthly fee. The concierge practice explains its panel size. That is progress.

Bespoke and concierge are not the same. Neither is inherently better. But knowing the difference — and communicating it clearly — is how this industry earns the trust it keeps insisting it deserves.

Sources & Citations

1. Banjo, S. & Hula, N. (2024). “Bespoke Care: Healthcare’s Tailored Future.” Radio Advisory, Advisory Board. https://www.advisory.com/radio-advisory/204
2. Wikipedia. “Concierge Medicine.” Citing MD² International founding, 1996. https://en.wikipedia.org/wiki/Concierge_medicine
3. FindMyDirectDoctor.com. “Exploring Concierge Medicine History in America.” Citing MDVIP founding, 2000. https://www.findmydirectdoctor.com/blogs/exploring-concierge-medicine-history-in-america
4. Dalen, J.E. & Alpert, J.S. (2017). “Concierge Medicine Is Here and Growing.” American Journal of Medicine. https://www.amjmed.com/article/S0002-9343(17)30358-3/fulltext
5. Georgia Tech Center for MedTech Excellence. “Entering the Era of Bespoke Care: A Comprehensive Overview.” https://medtech.gatech.edu/entering-the-era-of-bespoke-care-a-comprehensive-overview/
6. EBSCO Research Starters. “Concierge Medicine (Retainer Medicine).” Consumer Health. https://www.ebsco.com/research-starters/consumer-health/concierge-medicine-retainer-medicine
7. Pitt, M.B. et al. (2021). “Identifying and Classifying Medical Jargon Through Analysis of Recorded Standardized Patient Encounters.” ScienceDirect / Patient Education and Counseling. https://www.sciencedirect.com/science/article/abs/pii/S0738399121000537
8. Rebel Health Alliance (2026). Citing Klemes et al. (2012), American Journal of Managed Care, and Population Health Management (2016). https://rebelhealthalliance.io/blogs/news/what-is-concierge-medicine-a-complete-guide
9. Privitera et al. (2025). Systematic review of concierge medicine outcomes. American Journal of Medicine. Cited in Rebel Health Alliance (2026), op. cit.
10. Dalen, J.E. & Alpert, J.S. (2017), op. cit.
11. Sackett, D.L., Rosenberg, W.M.C., Gray, J.A.M., Haynes, R.B., & Richardson, W.S. (1996). “Evidence-based medicine: what it is and what it isn’t.” BMJ, 312(7023), 71–72. DOI: 10.1136/bmj.312.7023.71

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