HOW THE AFFORDABLE CARE ACT SPARKED THE RISE OF CONCIERGE MEDICINE
For millions of Americans, the Affordable Care Act — known widely as Obamacare — was a good thing: it meant expanded coverage, protection for those with pre-existing conditions and free preventative care. But for more affluent households, it told a different story. The healthcare guidance many relied on started to erode — along with personalization, continuity of care and the ability to navigate a new complexity of medical networks. The rise of concierge medicine for high-net-worth families became the unintended consequence. I don’t mean the kind of practice that embraces well-designed phone apps and Scandinavian interiors but a new model built on that which the ACA couldn’t deliver: more time with patients, a new emphasis on strategy and expert coordination.
The Access Problem Was Solved. The Experience Problem Was Exposed.
Universal access granted healthcare to all, but what everyone — not just HNW households — really needed was a sense that someone was managing their care. After the ACA gained traction, many people received letters from their primary care physicians stating that they were transitioning to concierge practices and to pay or they won’t be able to see them anymore. But what made this especially concerning to affluent households was that they simply function differently — with multiple specialists across different systems, frequent international travel, longevity planning and a strong desire for privacy and continuity of care. They’re accustomed to healthcare that’s managed with the personal oversight and coordination.
Even as coverage improved for the country as a whole, affluent families faced a different challenge: the healthcare landscape became more crowded, yet less coherent. Compounding this even further was the ongoing provider shortage: too many patients and not enough physicians.
Physicians Left Because Their Patients Needed More — Not Less
Luxury branding didn’t spark the rise of concierge medicine; necessity did. The concierge model was built by physicians who wanted to deliver the kind of personalized, relationship-based care that their highest-need patients wanted, and what they set out to do upon graduating from medical school. In other words, the way doctors were traditionally trained to deliver care.
However, in the ACA landscape, maintaining a traditional practice meant forcing doctors into seven-minute visits and treadmilling through endless paperwork. In addition, affluent families often present with complex cases and multi-layered health histories. This kind of care could not be managed in the ACA system.
Concierge medicine enables physicians to practice in a manner that aligns with the way families actually utilize care. This meant longer, more thoughtful appointments, proactive outreach, a deeper familiarity with family medical histories and direct access without the red tape. It wasn’t about leaning into a boutique luxury vibe — it was a response and correction to the physician shortage, restoring time and continuity of care to a profession that had lost both.
A trend? A fad for the affluent? Or the shape of things moving forward? The numbers reveal that the U.S. concierge medicine market was valued at $7.35 billion in 2024 and is expected to grow at a 10.3% compound annual growth rate through 2030, according to Grand View Research. In the U.S. there are about 5,000 to 7,000 physicians and practices that are currently operating under this model, most focused on primary care. Far from luxury branding, this shift reflects a demand for deeper relationships, more predictable revenue and better outcomes for patients who expect personalized oversight.
A 2024 systematic review found concierge models deliver higher patient satisfaction and proactive preventive care, but also noted the lack of strong data linking them to longer survival.
Families Needed Advisors, Not Just Access
As the healthcare system grew more complex, wealthy families realized that insurance coverage alone couldn’t protect health the way a wealth manager protects capital.
They began seeking:
Medical strategy
Care management across multiple systems
Faster access to subspecialists
Oversight that prevents misdiagnoses and delays
Global coordination when medical issues arise abroad
In wealth terms, they wanted a financial strategist for their health — someone who could curate, quarterback and safeguard the most important asset they have: longevity and wellbeing.
This is why concierge practices, VIP hospital programs and independent healthcare advisory firms began to surge in the post-ACA era. The market wasn’t expanding because people wanted nicer waiting rooms. It expanded because people with complex lives needed a strategic healthcare partner.
The Affordable Care Act succeeded in expanding access and protections, but it also revealed what access alone can’t buy: judgment, continuity and the confidence that every decision is being optimized. For affluent families, those intangibles matter as much as any investment strategy. They expect from healthcare the same level of strategic guidance they receive from their wealth advisors, tax planners, and estate attorneys. That expectation is now shaping the next era of care — led by concierge medicine for high-net-worth families, a model built not on luxury but on time, insight, and expert coordination across every stage of life.