A recent Medical Economics profile of Josh Umbehr, M.D., the family physician behind AtlasMD, lays out a case for direct primary care (DPC) that's less about ideology and more about arithmetic. Umbehr has run an insurance-free practice since 2010, and his pitch to skeptical physicians is disarmingly simple: a panel of a few hundred patients paying a modest monthly fee, low overhead, and no billing department adds up to a sustainable, even lucrative, practice — without a single insurance claim ever being filed.
But the part of his story that matters most for clinics building or scaling a cash-pay model isn't the pricing formula. It's what happens after the visit.
Referrals Are the Real Bottleneck
Umbehr's practice leans heavily on doctor-to-doctor telemedicine consults to handle specialty questions — getting input from a dermatologist in a day or two rather than waiting months for a traditional referral. Imaging works the same way: a scan that might sit in an insurance pre-authorization queue for one to two weeks can happen same-day when the patient is paying cash and the clinic already has the right relationships in place.
That's the part most DPC and cash-pay practices get wrong when they start out. The membership model is easy to explain to patients. Building a reliable bench of labs, imaging centers, specialists, and ancillary providers who will work on transparent cash terms — and actually turn results around fast — is a different problem entirely, and it's usually the one that determines whether a practice can deliver on its promise of speed and simplicity.
Why This Matters Beyond One Clinic
The article frames this as an individual physician's operating advantage, but the underlying shift is bigger. As DPC and cash-pay medicine keep growing, and as more patients arrive already expecting insurance-free care to be fast and transparent, clinics need infrastructure they can't build alone: a vetted network of labs, imaging, pharmacy, infusion, coaching, and diagnostic partners who already operate on cash-pay terms and won't drag a same-day promise into a two-week wait.
That's the gap Nodera Health exists to close. Instead of every DPC, functional medicine, or longevity practice having to independently source and negotiate with imaging centers or labs willing to work outside insurance rails, Nodera curates that network once and makes it available to clinics that need it — so the "same-day CT" or "dermatology consult in 48 hours" experience isn't dependent on one physician's personal Rolodex.
The Takeaway for Clinics
The economics of cash-pay primary care are, as Umbehr argues, simpler than most physicians assume. But simple economics still depend on operational reliability behind the scenes. A clinic can nail the membership pricing and still lose patients if a routine referral takes three weeks to resolve. The practices that will define the next phase of this movement won't just be the ones with the right price point — they'll be the ones with the right vendor relationships already in place.
Nodera Health builds and manages that vendor network for cash-pay and DPC clinics, so physicians can focus on medicine instead of chasing down imaging centers and labs willing to work outside insurance.
Source: Austin Littrell, "Charge less, earn more: A family doctor's case for direct primary care," Medical Economics, June 22, 2026.