Dana Y. Lujan, MBA
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.
Finance
The independent medicine community celebrated when the numbers dropped. Eighty-three percent growth in practice sites. Seventy-eight percent more clinicians. Conference decks updated overnight. Nobody asked who owns them now. The Health Affairs data is real. The growth is real. What…
The independent medicine community celebrated when the numbers dropped. Eighty-three percent growth in practice sites. Seventy-eight percent more clinicians. Conference decks updated overnight. Nobody asked who owns them now.
The Health Affairs data is real. The growth is real. What the numbers do not show is ownership. And ownership is where the story changes.
Goldman Sachs Asset Management, Charlesbank Capital Partners, Blue Sea Capital, Shore Capital Partners, and Revelstoke Capital Partners …
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Private equity in direct primary care is winning
Policy
In a few weeks, the direct care community will celebrate the one-year anniversary of getting what it had been asking for. By the end of the first quarter, before the rule had been in effect for a single full billing…
In a few weeks, the direct care community will celebrate the one-year anniversary of getting what it had been asking for. By the end of the first quarter, before the rule had been in effect for a single full billing cycle, it was already clear that the more consequential effect was not affordability. It was market design. As I wrote in January, when tax-advantaged dollars enter a care model, they …
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The direct primary care HSA rule did not fix access
Policy
You were told physician-owned hospitals were finished. That the 2010 legislation closing them out of Medicare was permanent. That if you wanted to own something, your options were a direct primary care practice, a concierge model, or a slow negotiation…
You were told physician-owned hospitals were finished. That the 2010 legislation closing them out of Medicare was permanent. That if you wanted to own something, your options were a direct primary care practice, a concierge model, or a slow negotiation with the health system already employing half your colleagues. The hospital. The thing you actually trained to practice in. That was off the table.
It may not be anymore. But the …
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Physician-owned hospitals get a narrow CMS opening
Physicians
I play Go. Not chess. Not checkers. Go: the ancient strategy game where the objective is not to capture pieces but to claim territory. In chess, you attack. In checkers, you jump. In Go, you place. Each stone lands quietly.…
I play Go. Not chess. Not checkers. Go: the ancient strategy game where the objective is not to capture pieces but to claim territory. In chess, you attack. In checkers, you jump. In Go, you place. Each stone lands quietly. Each position builds on the last. The opponent is still arguing about three moves ago while the board is already decided. The board has been built one placement at a …
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Securing physician autonomy with employer-sponsored direct primary care
Policy
According to the Primary Care Collaborative, primary care accounts for roughly 5 percent of health care spending, yet it influences nearly 90 percent of downstream costs. That statistic is not a compliment. It is a diagnosis. And for a profession…
According to the Primary Care Collaborative, primary care accounts for roughly 5 percent of health care spending, yet it influences nearly 90 percent of downstream costs. That statistic is not a compliment. It is a diagnosis. And for a profession that has spent decades accepting influence as a substitute for economic ownership, it is long past time to read it that way. For decades, physicians …
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The economic shift from fee-for-service to direct primary care
Policy
A piece circulating in the direct primary care community made a confident claim: that the best DPC physicians will not need employer-aligned models or adjacent entities because individual consumer demand will sustain them. Fully booked by individuals, insulated from institutional…
A piece circulating in the direct primary care community made a confident claim: that the best DPC physicians will not need employer-aligned models or adjacent entities because individual consumer demand will sustain them. Fully booked by individuals, insulated from institutional complexity, answerable to no one but their patients.
It is a satisfying idea. It is also an empirically untested one.
The history of DPC is built on physicians willing to challenge entrenched …
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The future of employer-aligned DPC and physician autonomy
Policy
Elevance Health recently reported that it expects to lose more than 180,000 fully insured group plan enrollees in 2026, with its CFO describing the strategy as "prioritizing disciplined pricing and margin integrity over volume." UnitedHealth has made similar statements. Both…
Elevance Health recently reported that it expects to lose more than 180,000 fully insured group plan enrollees in 2026, with its CFO describing the strategy as “prioritizing disciplined pricing and margin integrity over volume.” UnitedHealth has made similar statements. Both are effectively walking away from the fully insured employer market, where administrative complexity no longer justifies the economics.
At the same time, private equity is pouring capital into …
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Why private equity is betting on employer DPC over retail
Policy
Recent federal policy discussions have introduced a framework that would place health care affordability dollars into individual-controlled accounts rather than routing them through insurers or employer benefit plans. Still at the framework stage and requiring legislative action, the architecture being…
Recent federal policy discussions have introduced a framework that would place health care affordability dollars into individual-controlled accounts rather than routing them through insurers or employer benefit plans. Still at the framework stage and requiring legislative action, the architecture being explored signals a potential shift in how health care purchasing power flows through the system.
Whether or not this specific framework advances, the direction of travel is clear. Health care …
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Retail health care vs. employer DPC: Preparing for 2026 policy shifts
Conditions
A recent Johns Hopkins study has reignited that debate. The research documents rapid growth in concierge and direct primary care practices and warns that these models may worsen access to care. That framing feels intuitive. It is also incomplete. It…
A recent Johns Hopkins study has reignited that debate. The research documents rapid growth in concierge and direct primary care practices and warns that these models may worsen access to care.
That framing feels intuitive. It is also incomplete.
It assumes that traditional primary care access was functioning before physicians began moving into fee-based models. It was not.
Long before concierge and direct primary care gained traction, primary care access had already …
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Concierge medicine access: Is it really the problem?
Conditions
Primary care innovation has always been framed around access, autonomy, burnout, and patient experience. Direct primary care (DPC) in particular is often positioned as a solution for physicians exhausted by fee-for-service complexity and for patients who want a more personal…
Primary care innovation has always been framed around access, autonomy, burnout, and patient experience. Direct primary care (DPC) in particular is often positioned as a solution for physicians exhausted by fee-for-service complexity and for patients who want a more personal relationship with their doctor.
This article focuses on how the broader economic landscape has shifted in ways that directly affect DPC, especially in light of the rapidly evolving national discussion around …
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Is direct primary care sustainable in a downturn?
Policy
Even the most "affordable" DPC models struggle in lower-income markets because the behavioral economics of these populations create high churn and unstable revenue. Practices that succeed in underserved areas nearly always diversify into employer partnerships, institutional contracts, or expansion into…
Even the most “affordable” DPC models struggle in lower-income markets because the behavioral economics of these populations create high churn and unstable revenue. Practices that succeed in underserved areas nearly always diversify into employer partnerships, institutional contracts, or expansion into higher-income neighborhoods. Without understanding these behavioral and economic realities, physicians risk building a model the community cannot sustain long-term.
I previously argued that physicians must answer five market questions before …
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Direct primary care in low-income markets
Physicians
In my previous article, I examined why direct primary care (DPC) practices fail, focusing on financial modeling, compliance risks, and the gap between what's legal and what's sustainable. But there's a more fundamental issue that precedes all of those concerns:…
In my previous article, I examined why direct primary care (DPC) practices fail, focusing on financial modeling, compliance risks, and the gap between what’s legal and what’s sustainable. But there’s a more fundamental issue that precedes all of those concerns: market-model fit.
The direct primary care community loves to debate panel size, membership pricing, and model purity. We dissect what went wrong when practices fail. We blame insufficient commitment, poor …
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Why DPC market-model fit matters most
Conditions
I didn't understand why, especially since I had just spoken with him before his travels. The day my son's father, Joseph, died, I was sitting in a nail salon. A friend from the military called, offering condolences. I didn't understand…
I didn’t understand why, especially since I had just spoken with him before his travels. The day my son’s father, Joseph, died, I was sitting in a nail salon. A friend from the military called, offering condolences. I didn’t understand why; until I checked social media and saw the news of an airplane crash. My heart knew before my mind could process it.
Six years later, same month, just five days …
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Grief and leadership in health care
Policy
I'm going to say something controversial: the DPC community's obsession with "purity" is missing the point. After two decades designing health care financial models, negotiating payer & vendor contracts, and building compliance frameworks, I've learned that most alternative payment models…
I’m going to say something controversial: the DPC community’s obsession with “purity” is missing the point. After two decades designing health care financial models, negotiating payer & vendor contracts, and building compliance frameworks, I’ve learned that most alternative payment models don’t fail because they’re impure. They fail because someone forgot to do the math.
When $1 million can’t save a bad idea
The University of Houston medical school launched a direct primary …
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Why direct primary care (DPC) models fail
Policy
Physicians tell me they want out of the insurance grind, but they're terrified to actually do it. That fear is costing them years of autonomy they could already have. As someone who supports both DPC and concierge physicians, I believe…
Physicians tell me they want out of the insurance grind, but they’re terrified to actually do it. That fear is costing them years of autonomy they could already have.
As someone who supports both DPC and concierge physicians, I believe in the purity of the DPC model, but I also believe in practical pathways to get there. Hybrid models aren’t the compromise position; they’re the strategic bridge that makes the transition …
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The smart way to transition to direct care
Policy
For years, concierge medicine and direct primary care (DPC) were viewed as fringe alternatives, reserved for affluent patients or entrepreneurial physicians willing to step outside the insurance system. But in my opinion, these models are no longer "nice-to-have" side projects.…
For years, concierge medicine and direct primary care (DPC) were viewed as fringe alternatives, reserved for affluent patients or entrepreneurial physicians willing to step outside the insurance system. But in my opinion, these models are no longer “nice-to-have” side projects. They’re becoming essential pathways for physicians to reclaim careers, reduce burnout, and meet patient expectations in an evolving health care landscape.
Burnout is pushing physicians to the edge.
The pandemic only magnified …
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Why doctors are leaving insurance-based care
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