Skip to main content

Adults Direct Care

The first vertical expansion after v1 pediatric DPC is operational. Same product, simpler workflow.

The thesis​

If we solve pediatric DPC — the hardest UX problem in primary care because it has two stakeholders per patient (parent and child) and complex family dynamics — then adult primary DPC is downhill. Single stakeholder, no guardian model, no developmental milestones, no parent-app/child-record indirection. The Starlight Practice surface area shrinks, not grows, when we move from pediatrics to adults.

Why adults DPC is a real market​

The DPC movement isn't pediatrics-only. It's a category-wide reaction against fee-for-service primary care, and the math (1,000 DPC members generating more revenue than 6,000 fee-for-service patients with way less overhead) applies to adult primary care as well as it does to pediatrics. See the full DPC market sizing in the core business plan.

SegmentUS practitioner count
Primary care physicians (adults + family medicine)~118,000
Pediatricians~30,000 (subset of above structure)

Adults primary care is the larger addressable market on a practitioner basis, and the pain points are identical: tool sprawl, EHR fatigue, billing complexity, parent-app-equivalent (patient app) maturity gap.

What carries over from pediatric Starlight​

  • Family / Household + Guardian + Patient model — degenerates cleanly to adult patients without changes (Family of one; Guardian and Patient are the same person; Household billing still useful for spouses or family DPC plans).
  • Subscription billing — same Stripe model, same per-patient + install-fee pricing. Likely a slightly different rate card for adults vs pediatrics (TBD).
  • AI scribe — same Whisper + Claude pipeline. Adult visits are typically shorter than pediatric well-child checks, which means scribe ROI is comparable per visit but compounds faster on visit volume.
  • Patient app — instead of a parent app, a patient-self app. Same push, same per-issue threads, same refill button.
  • Single-pane-of-glass thesis — invoicing, scheduling, accounting, marketing, all integrated. Same wedge against incumbent EHRs.
  • Compliance posture — HIPAA + SOC 2 work done for v1 carries over wholesale.

What's different​

  • No parent app moat. Adult patients are their own decision-makers. Less stickiness from "the parent doesn't want to give up the app." Have to win on the practitioner side and on direct utility to the adult patient.
  • No newborn home-visit differentiator. Different premium-pricing wedges apply (e.g., concierge after-hours visits, mobile-RN house calls for chronic-care patients).
  • Different chronic-disease emphasis. Pediatric chronic care = asthma, T1D, ADHD, eczema. Adult chronic care = T2D, hypertension, hyperlipidemia, mental health. The chart's right-rail "active conditions" surface needs different default panels.
  • Workflow surface adds: lab integrations matter more (Quest/LabCorp via Health Gorilla — already on the v1 stack roadmap), specialist referral coordination, prior-auth letter drafting, Medicare-Advantage integration (only relevant for non-pure-DPC hybrid practices).
  • HEEADSSS and well-child schedule drop out; preventive-care guideline content shifts to USPSTF and ACPM recommendations.

Competitive landscape (sketch)​

Atlas.MD itself serves adult DPC practices, not just peds — they are explicitly the incumbent in both. Other adult-DPC EHRs include Hint, Elation Health (broader scope, not pure DPC), AMD Global Telemedicine, and a long tail of generic EHRs adapted for DPC. None of them are AI-substrate, parent-app-native, family-billing-native the way Starlight is. The wedge that wins us pediatrics also wins us adults — we just have to actually deliver pediatrics first.

What it would take​

Roughly:

  • One real adult DPC practice as customer-zero-equivalent (Austin connection or warm referral).
  • A small product surface diff: chronic-condition right-rail panels, USPSTF preventive-care reminders, an adult-flavored patient app branding pass.
  • Pricing review (likely simpler — no family rollup default).
  • Marketing positioning that doesn't lean on the parent-app moat as the primary hook.

The engineering lift to extend Starlight from pediatric DPC to adult DPC is substantially smaller than building Starlight in the first place. This is the leverage.

Open questions​

  • Does Dr. P know an adult DPC practitioner in Austin we'd want as our adults customer-zero?
  • Is there a hybrid pediatric-and-adult family-medicine DPC profile that's an even better wedge than "pure adults" — i.e., a doc serving entire families? That might collapse adult and pediatric onboarding into one flow earlier than expected.
  • Pricing: same per-patient model, or move to per-family for hybrid practices?

This bet is not in v1 scope and shouldn't be — but flagging it here so the engineering decisions in v1 don't accidentally foreclose the path. Specifically: keep the data model patient-centric, not pediatric-specific, and treat "child + guardian" as one specialization of a more general Patient + responsible-party model.