A Survey of 131 DPC Practices Named the Tool Physicians Cannot Give Up. It's Not the Billing Platform.

One hundred thirty-one DPC practices just voted on the single non-EHR tool they’d keep if they could only choose one. Hint Health, a leading DPC billing platform, came in second.

The winner was Spruce Health, a patient messaging and communication platform. Spruce also won the dedicated patient communication category, by more than two-to-one over the next competitor, and took the telemedicine category as well.

Those results come from the Battle of the Support Stack · Summer 2026, a reader-voted survey run by The Toolkit, the community publication from My DPC Story. 131 DPC practices across 40 states cast ballots across nine non-EHR tool categories. No paid rankings. No vendor influence. Anonymous ballots segmented by practice size and years in DPC.

What the nine-category survey actually covers

The ballot tracked the support layer that DPC practices build below the EHR: patient communication, telemedicine, membership billing and payments, AI and automation, and five other categories. Each category produced a ranked winner. At the end, physicians answered one more question: if you could keep only one tool on this entire list, which would it be?

Hint Health placed first in membership billing and payments. Hint manages recurring subscription billing, member onboarding, and clinical and communication workflows for practices that want a unified system. That it placed second overall despite owning the category where DPC’s core revenue operation runs says something about what physicians weight when stripped down to one answer.

The Toolkit described the patient communication results as “the most decisive win of the entire Battle.” Physicians who voted for Spruce cited three specific features: a texting experience patients actually use, an after-hours auto-reply that sets boundaries without going silent, and EHR integrations that keep the communication thread connected to the clinical record.

What billing and messaging are doing in a DPC practice

Billing tools and EHRs are foundational. Nearly every practice has them, and they typically become infrastructure to build workflows around rather than tools physicians seek out. The communication layer is where the DPC experience lives for patients day to day, and the survey result confirms that’s also where physicians anchor their practice identity.

DPC’s pitch to patients is access. Same-day visits, a physician reachable by text, a response after hours. When the membership contract says “unlimited access,” it’s the communication platform making that real in practice. Switching a billing platform means workflow disruption and a migration weekend. Switching the messaging tool patients use to reach their doctor means explaining to every patient why the contact has changed, a trust disruption of a different order.

Hint’s strong showing in billing also makes sense structurally. DPC practices run on subscription revenue, and a billing failure is an existential threat to a practice that has no fee-for-service fallback. Physicians know this. The fact that communication still outpolled billing in the runoff suggests that physicians feel more confident in the replaceability of billing tools than in the replaceability of the messaging relationship. You can recover from a billing platform swap. You can’t unring the bell on a botched patient migration.

A caveat the data carries: 131 practices drawn from a community publication’s readership is not a random sample of the roughly 3,163 DPC practices nationwide. My DPC Story’s audience skews toward physicians already engaged with DPC culture and community. The directional finding, that communication matters more than billing to the physicians most invested in DPC’s identity, is credible. The exact margins are not the point.

What To Watch

Elation Health acquired Aster in June 2026, adding a front-office voice agent to its platform. Atlas.md has patient communication features built into its platform. The broad direction is toward tools that can do more within a single interface, which puts standalone messaging apps like Spruce in an interesting position: the results show physicians value what Spruce does specifically, but the market is moving toward unification.

The question the Summer 2026 survey raises for the next cycle is whether AI-native communication tools (ones that can draft after-hours responses, flag urgent messages, or summarize conversation history for the physician’s morning review) displace standalone messaging apps, or whether the physicians who voted for Spruce’s boundary-setting auto-reply would rather have one tool that does that specific thing right.

The Summer 2026 results are a baseline for tracking that. The Summer 2027 survey will be the first sign of whether anything moved.