The first quarter of 2026 has already given us enough data points to say with real confidence that the Direct Primary Care movement is doing something it has not done in any prior year, which is that it is growing in ways that are both broader geographically and more sophisticated operationally than anything we saw in 2024 or 2025. We spent the last few weeks pulling together public listings from the DPC Frontier mapper, scanning state-level business registrations in the handful of states that make that data easily searchable, and comparing notes with operators in five different regions to try to get an honest read on what is actually happening on the ground rather than relying on the slightly rosier numbers that the trade associations tend to publish.
NEW PRACTICE OPENINGS KEEP OUTPACING LAST YEAR
By our best count the first quarter brought somewhere between 90 and 110 net new DPC practices online across the country, which is meaningfully ahead of the pace we saw in Q1 2025 and puts the movement on track to add roughly 400 to 450 new practices this year if the current trajectory holds. The geographic distribution is also different than it used to be, because while Texas, Florida, and North Carolina are still the largest contributors in absolute numbers, the per-capita growth leaders this quarter were Tennessee, Indiana, and interestingly Pennsylvania, where several operators have told us that the post-HSA-eligibility wave of inquiries from small employers has pushed a handful of previously hesitant family physicians to finally pull the trigger on starting their own practices.
THE HSA CHANGE IS REAL, BUT IT IS NOT A TIDAL WAVE
Speaking of the HSA change that took effect January 1st, the early signal from operators we have talked to is that it is meaningfully helpful but not quite the transformational catalyst that some of us hoped for heading into the year. The practices that were already set up to accept HSA payments and had even a modestly informed membership base saw a clear bump in both retention and upgrade conversations in the first sixty days, and several operators told us they are hearing from a new category of prospect, namely young healthy professionals who previously did the math and decided a DPC membership was not worth sacrificing HSA contribution room for but who now have no reason not to sign up. That said, the effect is concentrated among members who were already HSA-savvy, and the broader public awareness of the change is much lower than you would expect given how much coverage it got in the DPC press late last year, which means there is still meaningful marketing work to do before the full economic impact plays out.
EMPLOYER CONTRACTS ARE QUIETLY ACCELERATING
The quieter but arguably more important trend this quarter has been the acceleration in employer DPC contract signings, particularly among self-insured employers in the 50 to 500 employee range. Several brokers we talk with regularly told us that first-quarter inquiries are running roughly 40 percent ahead of the same period last year, and the conversation has shifted in tone from "tell me what this DPC thing is" to "show me three references in my industry and let's talk about rollout." That shift matters because it suggests the category has crossed the chasm from curiosity to legitimate consideration among the kind of mid-sized employers who were always the right target for this model but who historically moved slowly because nobody wanted to be first.
EHR CONSOLIDATION IS FINALLY HAPPENING
On the technology side, the first quarter saw a noticeable acceleration in DPC practices consolidating onto fewer, more capable EHR platforms. A year ago it was still very common to see operators running their clinical charting on one system, their messaging on Spruce, their billing through Hint or Stripe, and their telehealth through a third-party tool. What we heard from operators this quarter is that the appetite for stitching five or six tools together is genuinely declining, and the practices that switched platforms in Q1 overwhelmingly moved toward more unified systems that handle clinical, billing, messaging, and patient-facing mobile all in one place. Whether that trend holds for the rest of the year depends a lot on how the pricing and feature competition plays out between the incumbents and the newer AI-forward entrants, but the direction of travel is clear.
WHAT TO WATCH NEXT
Looking ahead to the second quarter, the three things we will be keeping an eye on are whether the HSA conversion effect strengthens as more HSA administrators actively promote DPC as an eligible expense, whether the employer contract acceleration translates into actual patient volumes by mid-year or remains a pipeline story, and whether we start to see consolidation or partnerships among the smaller regional DPC networks that have been quietly scaling in Texas, the Carolinas, and the Mountain West. All three feel like they are moving in the right direction, and the first quarter data suggests that by the time we write the mid-year report the DPC map is going to look meaningfully bigger than it does today.