Membership Medicine Has Reached the Endocrinologist's Office

An endocrinologist sells ongoing care by the year. The price is $5,000, and she says 100 to 120 patients are enrolled.

That figure comes from a Diablo Magazine feature published Oct. 23 on physicians who sell care outside insurance. Two of the physicians it profiles are specialists. That’s the part DPC doctors might want to read closely.

Two specialists, prices on the page

Dr. Chhaya Makhija runs Unified Endocrine and Diabetes Care. Diablo reports locations in Lafayette and Fresno, plus telehealth. Her own site lists a 12-month Ongoing Care Membership at $5,000, and says insurance can still be used for labs, imaging and prescriptions. A first visit is listed at $850.

According to Diablo, the membership covers diabetes and continuous glucose monitor education, GLP-1 training, thyroid ultrasound, unlimited communication and lifestyle coaching. Makhija told the magazine why she left the insurance model:

“The duration of the visits was shortening, the volume of patients was forced to increase, and reimbursements from health insurance started decreasing over the last 10 to 15 years.”

Dr. Cheruba Prabakar, an ob-gyn, opened Lamorinda Gynecology and Surgery in Lafayette in 2022. Her memberships page lists three annual tiers. An HRT Care Membership is $1,800. Menopause Mastery is $5,200. The Concierge Circle, which adds all-inclusive gynecologic care, is $7,200. Members use insurance to cover medications, including hormones and GLP-1s, Diablo reports.

Prabakar also sells care without a membership. Her pricing page lists an annual exam at $550 and office visits from $295 to $850, before any out-of-network insurance benefit. Prices like these vary by practice and region, and these two practices set their own.

“Direct care is not just for the wealthy,” Prabakar told Diablo. Diablo reports she founded the East Bay Concierge Coalition. She told the magazine that many colleagues are tired of being “a cog in the wheel.”

The pitch is the DPC pitch

Read the quotes without the specialty names and they would fit in a DPC launch story. Shorter visits. More patients per day. Falling insurance reimbursement. Makhija describes a membership where “neither the physician nor the patient feels rushed.”

The business is different, though. Makhija also sells an $850 first visit as a one-time cost. Prabakar runs memberships and fee-for-service side by side, and her pricing page says her surgeons are out-of-network while hospital and anesthesia costs are in-network. These are hybrid practices. The membership is one product among several.

Diablo frames the trend with a Health Affairs study that counted 83.1 percent growth in concierge and DPC practice sites from 2018 to 2023. Its primary care profile, Dr. Jessica Tsuei’s JT Health in Walnut Creek, charges $250 to $350 a month, which is above the federal limit described below.

Where DPC Fits

Here’s where the two models part ways in 2026. The federal tax change that lets HSA owners keep contributing while enrolled in DPC is written for primary care only.

IRS Notice 2026-5 defines a direct primary care service arrangement as care “consisting solely of primary care services provided by primary care practitioners.” It borrows the practitioner list from Medicare law: physicians with a primary specialty of family medicine, internal medicine, geriatric medicine or pediatric medicine, plus nurse practitioners, clinical nurse specialists and physician assistants. The arrangement also can’t exceed $150 a month for one person.

An endocrinologist isn’t on that list. Neither is an ob-gyn. Prabakar’s $1,800 HRT tier works out to exactly $150 a month, but price is one test. The definition also names who provides the care.

For a DPC doctor, that’s a useful fact to hold onto. The membership fee alone no longer marks the model, since specialists are adopting it. The HSA rules mark it instead, and they mark it as primary care.