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Direct primary care software: membership billing, panel size and the stack that works

The DPC math on fees and panel size, what to ask any vendor about recurring billing, why no claims engine cuts the price, and what the full stack costs.

October 28, 2026 · 12 min read

Direct primary care software has one job the rest of the EHR market is badly shaped for: billing a person every month instead of billing a payer every visit. Everything else a DPC practice needs, a chart with room for a 45-minute visit, unlimited video, portal messaging, a panel you can sweep by hand, is cheap and well solved. The membership charge is where the products differ, and it is the first thing you should interrogate.

The economics are simple enough to run on one line. The American Academy of Family Physicians puts typical DPC membership fees at $50 to $100 a month and reports an average panel of about 413 patients in its DPC FAQ (aafp.org). At $75 a month and 400 members that is $30,000 a month, $360,000 a year, from recurring revenue you can forecast. Against that, software at $49 to $143 a month is $0.12 to $0.36 per member per month. Software is not your constraint. Panel size and churn are.

The DPC arithmetic, and the number that actually matters

Run your own version of this table before you look at a single vendor. The columns that decide whether the practice works are the fee and the panel, not the software line.

Monthly fee	Panel	Monthly revenue	Annual revenue	Software as % of revenue
$60	300	$18,000	$216,000	0.3%
$75	400	$30,000	$360,000	0.2%
$85	500	$42,500	$510,000	0.3%
$100	600	$60,000	$720,000	0.2%
$150 concierge	250	$37,500	$450,000	0.3%

Those software percentages assume a $119 a month Clinic plan with the AI scribe on. The point of the column is that chasing a $20 a month saving on software while your panel churns 3% a month is the wrong optimization. Three percent monthly churn on 400 members at $75 is $10,800 a year of revenue walking out, which is roughly 90 times the software saving.

Which is why the retention tooling matters more than the feature checklist. Bain's widely cited finding is that raising retention 5% lifts profit somewhere between 25% and 95%, and in a membership practice that arithmetic is unusually direct: a member who stays an extra year at $75 is $900 you did not have to sell. Patient CRM and event-driven campaigns exist for exactly that, and the practical version is dull: a message to anyone who has not been seen in nine months, an annual recall fired from the schedule, a birthday note, a survey after every visit.

The recurring billing question, asked properly

This is the part where I am going to be inconvenient about our own product, because getting it wrong costs you a month of your life.

There are three different things vendors call "membership billing," and they are not interchangeable:

1. Automatic card-on-file recurring charge. Card stored, charged on the 1st, retried on failure, dunning emails sent, cancellation handled. This is what most DPC doctors assume they are buying.
2. Scheduled installment plan. The amount is agreed, the dates are set, the system tracks what is due and nudges on anything unpaid, and the charge is initiated rather than fully automatic.
3. Prepaid block. The member pays for a period or a set of visits up front, and it draws down.

Our system does 2 and 3. It does not do 1. There is no card-on-file subscription engine, and we say so on the direct primary care page rather than in your second month. You bill the membership as an installment schedule or a prepaid block, the system sends automatic reminders on overdue amounts, and payments happen at the desk, online at booking, or by a link sent from the chart. If fully automatic monthly card billing is non-negotiable for you, either run a payment product alongside for the membership charge, or buy a system built around recurring billing. Both are reasonable; guessing is not.

Five questions to ask every vendor, in writing, before you pay anyone:

1. Does the system store a card and charge it on a schedule without anyone clicking, including retries on a declined card?
2. What happens when a card expires? Does the member get the email, or do I?
3. Can one household be billed as one membership with several charts underneath it?
4. Can I run tiered fees, for example adult, child, over-65, and a corporate rate?
5. If a member leaves mid-month, what does the proration do, and who writes the refund?

Question 3 catches more products than you would expect. Family billing is normal in DPC and a surprising number of systems model the payer as the patient.

[CAPTURA: el plan de pagos a plazos de una membresía mensual visto desde la ficha del paciente, con lo pendiente marcado]

Why DPC does not need an insurance engine, and what that saves

A conventional EHR is a claims machine with a chart attached. The claims machine is the expensive part: clearinghouse connections, eligibility checks, code scrubbing, denial queues, remittance posting. You took the payer out of the room, so you are paying for machinery you will never open.

This is the clearest case in all of medical software where buying less is the right move. No clearinghouse, no eligibility verification, no denial management, no ONC certification. ONC certification is worth understanding rather than fearing: it exists for Medicare and MIPS quality reporting, which a cash membership practice does not file. We are not certified and are open about it, and the longer argument is in our piece on whether a cash-pay practice needs a certified EHR.

The saving is real and it shows up in the price. Insurance-grade primary care suites are quoted per provider per month in the hundreds, usually with implementation fees on top. A chart-plus-portal-plus-telehealth system for a solo DPC doc is $49 to $107 a month.

One exception that is not an exception: some members have high-deductible plans and want to submit for their own out of network credit. That does not require a claims engine, it requires a superbill, which is an itemized receipt with your NPI, your EIN, the codes you entered, the diagnosis and the amount paid. The member files it. We generate the PDF and we do not ship a CPT database, because CPT is licensed by the American Medical Association; you enter your own codes once against each service.

Telehealth cannot be metered when access is the product

A DPC member is paying for access. If your software charges per video minute or per telehealth seat, the pricing fights your business model every single day, and you will find yourself deciding whether a question is worth a video call. That is the opposite of what the member bought.

Unlimited video is included from the Solo plan up at $107 a month, and it is a $10 a month add-on on the $49 Essential plan. It runs in the browser, so the member installs nothing, and the visit is charted in the same record with the same templates. How the video visit fits the rest of the day is worth a look if you are coming from a system where telehealth is a separate login.

The other half of access is portal messaging. Secure messages, documents, invoices, forms and appointments behind one login, answered on your schedule rather than at 11pm. Pre-visit forms completed at home mean a 45-minute visit starts on the real question instead of on medication reconciliation.

Prescribing: the one thing that will decide this for some of you

A DPC physician writes prescriptions every day. Our software has no electronic prescribing at all. Prescriptions print or export as PDF, and that is the end of the capability.

California, Florida, New York, Michigan, Minnesota and Delaware mandate electronic prescribing for essentially all medications. If you practice in one of those states, this software alone will not carry your prescribing, and you would pair it with a standalone e-Rx service. Texas and several other states still allow paper for non-controlled drugs, and there the fit is clean.

Be honest with yourself about what that means operationally. Two windows instead of one, and a prescription history that lives in the e-Rx platform rather than the chart. For some physicians that is a shrug. For others it is a dealbreaker, and if it is yours, buy a DPC-specific suite with integrated e-Rx and accept the higher price. I would rather you read that here than discover it in week three.

Labs are easier. Most DPC practices negotiate direct cash pricing with a reference lab and pass it through at or near cost, which is one of the model's best selling points. Order outside the EHR, attach the result PDF to the visit, and the number lives with the chart. There is no lab interface in our system, so the attachment is manual, and for a 400-member panel that is a few minutes a day rather than a project.

What the whole stack costs, honestly

List prices read on each vendor's public pricing page on October 28, 2026. Check them yourself, because promotions move and ours is not the only number that changes.

Line item	Monthly cost	Notes
Chart, scheduling, portal, telehealth (solo)	$49 to $107	$49 Essential adds portal and telehealth at $10 each; $107 Solo includes both
Same for a 3-clinician practice	$119 annual, $143 monthly	CRM and 1 TB included, 4th and 5th user $45 each
AI scribe	$20 per clinician	Optional; competitors listed $10 to $40 on the same date
Appointment chatbot	$20 per clinic	Optional
SMS credit	$36 per 300 messages	Reminders and follow-ups
WhatsApp channel	$40	Optional, matters if your panel is Spanish-speaking
Card processing	2.6% to 3.2% plus $0.10 to $0.30	Jane lists 2.85% + $0.25 online; SimplePractice 3.15% + $0.30
Standalone e-Rx	varies	Required in mandate states; we do not publish others' prices
Machine or CRM connector	$30 each	For example a body composition analyzer or Zoho

Against the competition for a single physician with an AI scribe on, the same date gave Noterro at $33, Carepatron at $39, us at $69 on Essential, Practice Better at $79, Jane Balance at $74, SimplePractice Starter at $84 and TherapyNotes Solo at $109. Three of those are cheaper than we are and I am not going to pretend otherwise. At three clinicians the order flips: $179 for us with the scribe on for everyone, against $285 for Practice Better Team, $299 for TherapyNotes and $352 for SimplePractice. If you want the full cost breakdown logic rather than a vendor table, our analysis of what an EHR really costs a small practice walks through the add-ons that do not appear on pricing pages.

Two things that are not line items and should be. First, there is no free trial here: signup is paid, online, about three minutes, and the smallest commitment is one month. Second, migration is free and you run it yourself. You export from your old system, upload the Excel or XML, check the result, and if an import came out wrong you delete it whole and upload it again corrected. There is no paid migration service to buy.

Reporting you will actually open

Three numbers run a DPC practice, and you want them without exporting anything: membership revenue by month, visits per member per year, and who has not been seen in a while.

The first tells you whether the business is growing. The second tells you whether your panel size is sustainable, because a panel using 5 visits a year each needs a different cap than one using 2.5. The third is your churn early-warning system, since the member who stops coming cancels three months later. Practice reports cover production per provider, occupancy and revenue over any date range, and the panel-wide search lets you pull a list by any field when something needs a sweep.

Set a review date once a quarter and look at those three. Most DPC practices that stall do so because nobody noticed the visit rate climbing until the schedule was full at 350 members.

When a DPC-specific product is the better buy

Four cases, stated plainly.

If you need fully automatic card-on-file recurring billing inside the EHR, buy a product built around it.

If integrated e-prescribing in one window is essential, especially in a mandate state, buy a suite that has it.

If you want employer contracts with eligibility files, census loading and invoicing to the employer rather than the member, that is a specific DPC feature set and we do not have it.

If you plan to bill Medicare for anything, you need a certified system and claims capability, which we deliberately do not have.

What is left is the common case: a solo or two-doctor panel of a few hundred people, flat fee, no payer, long visits, unlimited video, and a software bill under $150. That is what the DPC and concierge configuration is built for, and it is the shape the rest of the product assumes too.

Frequently asked questions

What does direct primary care software cost per month?

For one physician, list prices on October 28, 2026 ran from $33 (Noterro Core) to $107 (our Solo plan), with most options between $35 and $79 before an AI scribe. Our Essential plan is $49 a month billed annually or $59 month to month, Solo is $107 with the portal and unlimited telehealth included, and a one-to-three-clinician Clinic plan is $119. At a 400-member panel, $119 a month is about $0.30 per member per month.

Does DPC software need to bill insurance at all?

No, and that is the point of the model. A DPC practice collects a membership fee from the patient, so there is no claim to submit, no eligibility to verify and no denial to work. Our system has none of that machinery, which is why it costs a fraction of an insurance-first EHR. Members who want out of network credit get a superbill PDF and file it themselves.

Can the software charge my members' cards automatically every month?

Not ours. We bill the membership as a scheduled installment plan or a prepaid block of visits and send automatic reminders on anything unpaid, but there is no card-on-file subscription engine that charges and retries on its own. Ask any vendor that question directly, in writing, and ask what happens when a card expires.

How many patients can one DPC physician carry?

AAFP's DPC FAQ reports an average panel of about 413 patients, and its DPC statistics section cites a higher 2025 average, so treat any single figure as a range rather than a target. The practical limit is set by your visit rate: a panel averaging 5 visits a year needs a smaller cap than one averaging 2.5. Track visits per member per year and let that number set your panel, not a benchmark from someone else's practice.

Can I prescribe from the chart?

Not electronically. Prescriptions print or export as PDF, with no e-prescribing module and no drug database. California, Florida, New York, Michigan, Minnesota and Delaware mandate electronic prescribing for essentially all medications, so in those states you need a separate e-Rx platform alongside. Texas still allows paper for non-controlled drugs.

Is a DPC membership agreement considered insurance?

Many states have passed laws clarifying that a direct primary care agreement is not an insurance product, but the wording and the conditions differ by state and some states have no such statute. Read your own state's rule with an attorney before you draft the agreement. No software vendor can answer that question for you, and we will not pretend to.

We make practice management software for cash-pay clinics with no claims engine at all, from $49 a month, unlimited patients, BAA included. See the DPC and concierge setup, or open an account and bill your first membership on it this week.

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