Some Wilmington medical practices have been taking a membership-based approach to primary care, offering patients more time with providers for an annual fee and aiming to improve health outcomes through a holistic, preventive approach to care.

Jeremy Pepper, a board-certified physician assistant, owns Access Internal Medicine (AIM), a membership-based functional medicine practice in Wilmington. This practice model, also known as concierge care, represents a deliberate shift away from the traditional fee-for-service payment model.

Membership-based primary care typically charges an annual fee instead of billing for each service and typically limits patient capacity. According to Pepper, the model lets physicians spend more time with each patient rather than maximizing provider capacity. 

“I did (traditional internal medicine) at another local practice for about 10 years, and then got involved with seeing too many patients, burning out, realizing that seeing 30 patients a day is not something that's sustainable,” said Pepper. 

He added, “To have that ability to have time and not be rushed on both ends is unbelievably valuable.”

The membership care model is growing in popularity: A 2025 study published in Health Affairs found that concierge and direct primary care practices surged 83% between 2018 and 2023.

AIM isn't the only such practice in Wilmington. Another example is Port City Direct Primary Care, opened by doctors Brian Collins and Michael Cullura in 2025.

Pepper said his practice has seen steady patient growth since it was founded in 2016.

For Kristina Saunders-Gardner, a family nurse practitioner who also specializes in menopause and midlife care for women and has worked at AIM for three years, the model has proven effective in treating patients holistically. 

“The biggest thing is the ability to treat the whole person and have time to do so,” she said.

AIM uses a functional medicine approach to care, focusing on identifying root causes and providing prevention-focused care guided by patients’ goals. That approach requires more intentional interaction between patients and providers, Saunders-Gardner said. 

“In a conventional clinic, you see about 25 to 30 patients a day, so that ends up being less than 15 minutes per patient,” she added. “Here we see eight patients, so I get an hour with every patient.”

Saunders-Gardner explains that she works with patients to understand how health issues may be interconnected and what their lab results may mean, rather than focusing on a single health issue at one time. 

AIM’s membership fee covers a personalized wellness plan and services not covered by insurance, according to the practice’s website. Most health insurance plans are compatible with membership, and the practice also accepts Medicare but not Medicaid, Saunders-Gardner said.

Membership benefits include same-day or next-day appointments, an annual comprehensive physical, expedited specialist appointments and around-the-clock access to a provider by phone. Patients may still face additional costs for services outside the membership or their insurance coverage.

AIM also offers a self-pay option, with discounts on labs, Pepper said. 

“If you don't have insurance, we also have a plan for that too, where you can just use the membership model,” Pepper said, “and then you just pay extra for some lab work and some other things that you may need.”

Annual fees are $1,000 for a single person under fifty and $1,500 for a single person over fifty, with options to pay quarterly, semi-annually, or annually. Patients paying without insurance will pay a $100 surcharge for a listed membership plan, with an exception for small-business group membership packages, according to the website. 

As the 2025 study on membership-based care models noted, direct primary care is often associated with high annual fees and high barriers to entry for care. 

While cost may be the model’s main drawback, Pepper said AIM has worked to keep its pricing competitive. Since its founding, the practice has raised prices by only about 10% over its 10 years of operation, he said.