More than a month after HSA-eligible direct primary care became available, independent practices remain unprepared for the operational complexity employer contracts require. The DPC community celebrated regulatory victory. Private equity prepared infrastructure.

That preparation became visible throughout 2025. Frontier Direct Care announced a $20 million Series B to expand its employer-sponsored DPC platform. Marathon Health, formed from the 2024 Everside merger, operates more than 750 health centers serving over 3 million covered lives. In late January 2026, Premise and Crossover merged, creating a platform with nearly 900 wellness centers serving more than 400 employers.

A health care economist described employer health care as one of the hottest investment categories for private equity. The DPC community treats these as parallel developments. They are not. These platforms compete directly for employer relationships independent practices now hope to access.

The infrastructure gap

When HSA-eligibility launched, most independent DPC practices assumed retail membership growth would follow automatically. That assumption ignores how employers procure health care benefits. Organizations with roughly 200 or more employees issue RFPs demanding standardized PEPM pricing, geographic coverage, minimum enrollment thresholds, actuarial projections, and compliance documentation. Independent practices can serve smaller employers when expectations remain informal. The infrastructure gap opens as size and formality increase.

Independent practices built for retail membership lack this infrastructure. More than a month in, that gap remains largely unaddressed. Clinical excellence and patient experience remain necessary but are no longer sufficient once platforms demonstrate both quality outcomes and enterprise infrastructure.

Employer PEPM contracts require capabilities independent practices do not possess:

• Geographic coverage across metro areas.
• Minimum enrollment capacity to onboard 60-80 patients simultaneously.
• Actuarial modeling demonstrating 20-30 percent cost reductions.
• Standardized reporting with cost savings documentation.
• Unified contracting with legal compliance and SLAs.
• Technology integration with benefits platforms.

Each component requires capital: technology platforms ($50,000-$150,000), legal infrastructure ($25,000-$75,000 annually), actuarial consulting ($15,000-$40,000), geographic expansion ($200,000+ per location). For PE-backed platforms, these are baseline requirements already scaled.

Independent practices face three options: build collectively, get acquired, or remain retail-only.

The collective infrastructure path

The collective path is logical. Regional physicians could pool resources for shared infrastructure, competing for employer contracts individually inaccessible.

The challenge is execution. Collaborating requires coordinating pricing, sharing data, and establishing governance that distributes revenue fairly. Capital remains another barrier. Practices running on retail cash flow must finance $500,000-$1,000,000 in infrastructure before employer revenue materializes.

For years, platforms like Hint and advisor communities such as Health Rosetta have helped DPC practices operationalize memberships and connect with employers. They are important parts of the ecosystem, but they are not, by themselves, employer infrastructure. They were never designed to create the kind of shared governance, capital structure, unified multi-clinic contracting, or single strategic owner for employer performance that large organizations increasingly expect. Until those foundations exist, even the best tools and referral channels remain tactics searching for a strategy.

For most independent practices, the rational near-term strategy is to remain selective: limit employer groups to those under 100 employees where expectations remain informal, avoid committing to enterprise SLAs or quarterly reporting, and treat employer revenue as supplemental. Practices serving larger employers must invest in collective infrastructure now, accept platform acquisition, or prepare for contracts to migrate to better-capitalized competitors.

The window for building infrastructure exists but is narrowing. Employers are evaluating vendors now. Platforms are signing contracts.

What the market reorganization looks like

Private equity recognizes that employer-sponsored DPC operates under superior economics: more predictable revenue, lower churn, B2B contract renewal instead of continuous patient acquisition.

A parallel dynamic affects concierge medicine, as employer-funded executive health programs replace out-of-pocket memberships. The competitive landscape will likely include national platforms with comprehensive infrastructure, regional aggregators serving specific markets, and independent practices both DPC and concierge serving patients whose employers do not offer direct care benefits.

Independent practices waiting for HSA-driven retail growth may discover they prepared for the wrong market expansion. The growth is occurring in employer procurement, where infrastructure requirements determine market access.

The strategic choice

HSA-eligibility created regulatory permission for employer-funded DPC. It did not eliminate the operational barriers that make employer contracts inaccessible to independent practices.

The DPC community celebrated policy victory while private equity built infrastructure. More than a month into implementation, platforms continue announcing expansion capital. Employer contracts shift to vendors with geographic coverage, actuarial capabilities, and enterprise technology.

Independent practices can participate in this market reorganization. For physicians who value clinical autonomy and ownership, well-structured coalitions represent the only realistic path to employer contracting without becoming a platform employee. Success requires recognizing that employer procurement operates under different economics than retail membership, building or joining the infrastructure those economics demand, and executing faster than well-capitalized platforms capture employer relationships first.

The infrastructure gap is real. The timeline pressure is real. But the opportunity for strategically positioned independent practices remains.

Dana Y. Lujan is a health care strategist and operator with more than twenty years of experience across payers, providers, and health systems. She is the founder of Wellthlinks, a consulting firm that helps employers and providers redesign care models through concierge and direct primary care, and author of The CEO Physician: Strategic Blueprint for Independent Medicine. Dana has led multi-state network development, payer contracting, financial modeling, and compliance initiatives that strengthen provider sustainability and employer value. She previously served as president of the Nevada chapter of HFMA and is pursuing a JD to expand her expertise in health care law and compliance. She has been featured in Authority Magazine and publishes on KevinMD, MedCity News, and  Medium, where she writes on health care innovation, direct primary care, concierge medicine, employer contracting, and compliance. She has forthcoming BenefitsPRO. Additional professional updates can be found on LinkedIn and Instagram.