California, Illinois and New York Are Among the Top Five States for DPC Clinician Growth. Employer Adoption Is Probably Why.

Analysis by DPC Insider — Market Desk
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Sources: Hint Health Releases 2026 Direct Primary Care Trends Report: Data Shows DPC Has Moved From Niche Alternative to National Healthcare Infrastructure · STATE OF DIRECT PRIMARY CARE — DPCA Member Insights Committee, 2026

When direct primary care started growing rapidly in the 2010s, its geography made sense. The model has concentrated in suburban markets, particularly in the South and Midwest. Places where physicians could open practices without competing against dense health system infrastructure, and where the economics were straightforward enough to validate an unproven model.

The Hint Health 2026 Direct Primary Care Trends Report, released in April and drawing on data from more than 2,700 clinicians and 1.4 million members, includes a finding that complicates that picture: some of the fastest DPC clinician growth in the country is now happening in California, Illinois and New York. All three are now among the top five states for DPC clinician growth.

That is the opposite of where the model was supposed to be hardest to build.

The Number That Explains the Shift

Hint describes the report as the most thorough DPC analysis to date. That also means it reflects Hint Health’s view of the market, and Hint has an interest in showing growth. The geographic finding is worth taking seriously while holding the source in mind.

The headline number in the 2026 report: employers now fund 60 percent of active DPC memberships, the first time employers have funded a majority. Employer-sponsored DPC rates have held within a narrow $55 to $65 range for five consecutive years while conventional insurance premiums have kept rising.

In California, Illinois and New York, self-funded employers have strong incentives to find a predictable alternative to conventional insurance arrangements. Per-employee healthcare costs have risen across the country, and large metropolitan markets concentrate the employers with the most spending at stake. Employer-sponsored DPC offers a predictable monthly rate for a defined primary care scope.

The geographic shift probably follows the employer adoption curve, though Hint’s press release and public blog present both findings separately, without drawing that connection.

What the Practice Economics Look Like

A physician entering the Chicago market through an employer contract has a structurally different startup than one opening a solo practice in suburban Missouri.

An employer contract gives the practice a defined workforce pool from day one, though actual enrollment depends on how the benefit is structured and how many employees opt in. The practice starts with a captive audience rather than building from zero. The individual-member model requires patient acquisition one person at a time over many months, with revenue that stays thin until the panel reaches a viable size.

Employer-sponsored rates, at $55 to $65 per month, sit well below the national DPC average. The DPC Alliance’s physician survey, published in 2026 on data collected in October 2024, found the national average at $98.64 per month. A practice with 600 employer-sponsored members at $60 per month clears roughly the same revenue as one with 370 members at $98. The panel count required for viability is higher, but volume arrives in bulk rather than one at a time.

Urban markets, with their larger pools of employed workers and dense employer presence, make the employer-sponsored channel easier to source. That is probably the structural reason California, Illinois and New York are seeing the growth they are.

What To Watch

Two risks follow the model into those markets, and neither will resolve quickly.

The first is contract concentration. A practice built around two or three employer contracts faces a cliff if any of those employers changes benefit vendors, changes ownership, or cuts the offering. A practice with 500 scattered individual members, by contrast, loses one or two at a time. Urban-market practices in employer-heavy arrangements can manage that exposure by spreading risk across multiple employers, holding a floor of individual members, or accepting the volatility in exchange for predictable volume. Which approach takes hold will say something about how durable this growth actually is.

The second is clinical independence. The feature that draws many physicians to DPC is the absence of a third party directing the care. No insurance company. No prior authorization. The physician and patient work out what the visit covers. An employer is a different kind of payer than an insurance company, but it is still a payer with its own interests: productivity metrics, wellness programs, cost targets. Those are not the same constraints as insurance billing, but they are constraints.

The most useful next signal from this market shift will be what DPC physicians in employer-heavy practices say about clinical autonomy in future DPC Alliance physician surveys. If those scores hold steady against the rest of the field, the model is intact in urban markets. If they diverge, it is a sign that the employer relationship is shaping the care in ways that matter.

DPC membership grew 837 percent per capita from 2017 to 2025, according to the Hint Health report. The question that growth is now forcing is whether the model arriving in its newest markets is the same model that built its base in the South and Midwest.