What Is the Concierge Medicine Model of Healthcare?
The concierge medicine model arose in the 1990s as an alternative to traditional primary care, as long wait times for appointments coupled with short visits were beginning to frustrate physicians and patients alike.
Interest has since increased due to the rise in healthcare operating costs, the increased administrative burden of supporting public and private insurance while meeting regulatory reporting requirements, and cuts to insurance reimbursements, concierge medicine consultant Terry Bauer told Scientific American.
How Concierge Medicine and Primary Care Differ
The biggest difference between concierge medicine and primary care is the payment model. Concierge practices charge a flat retainer fee, typically collected monthly or yearly. While fees can vary from $1,200 to more than $20,000 per year, the average annual concierge medicine fee tends to be between $1,500 and $2,500 per year, or roughly $125 to $210 per month, according to the concierge practice PartnerMD.
For the cost of the retainer fee, patients benefit from longer in-person visits; hour-long annual wellness exams are not uncommon. In addition, concierge medicine practices typically offer same-day or next-day appointments along with after-hours access to care via phone, text or email. The fee may also cover wellness programs, health coaching and other types of services. Some practices offer discounted services for additional family members. MDVIP, for example, offers care to members’ children until they turn 26.
Concierge medicine practices can provide this level of patient care because they see fewer patients. MDVIP caps membership at 600 patients per office, says CEO Bret Jorgensen. That is a common membership cap, compared with 1,000 to as many as 4,000 patients per primary care practice, according to a paper in the Annals of Internal Medicine.
“People are willing to pay for a comprehensive wellness exam and year-round support,” Jorgensen says.
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How Concierge Medicine and Direct Primary Care Differ
Direct primary care (DPC) is like concierge medicine in the sense that practices charge a flat fee to patients and offer members greater access to in-person and virtual care. However, there are two key differences.
One is that, as the name implies, DPC is solely for primary care, while concierge medicine may also cover specialty care. This tends to make DPC less expensive than concierge medicine but also less comprehensive in the services it can offer.
The other is that DPC practices don’t accept insurance, while the American Academy of Private Physicians estimates that 75 percent of concierge medicine practices do. (Generally, concierge practices that don’t accept insurance tend to charge higher membership fees, according to AARP.)
For patients, insurance covers care that’s not included in the membership fee. For practices, insurance reimbursement provides an additional revenue stream; Jorgensen says MDVIP gets about 20 percent of revenue from insurance, which is roughly an even mix of Medicare and commercial plans.
The Technology That Supports Concierge Medicine
Most of the technology that concierge medicine practices use would be largely familiar to primary care physicians. There are electronic health records, both homegrown and commercial (MDVIP uses Athenahealth), along with patient portals, customer relationship management systems, various analytics tools, digital marketing software and telehealth platforms. (Providers such as Forward have garnered attention for incorporating comprehensive biometric scanning into annual wellness visits, with the goal of having more personalized health and wellness plans due to an abundance of personal health data.)
The difference between primary care and concierge care, according to Jorgensen, is how that technology is used.
With concierge care, email and text messaging, for example, are less about pushing alerts and more about maintaining ongoing communication. The same is true for virtual visits: Patients use the services a practice provides instead of opting for a third-party app.
“We’re trying to engage on a deeper level, to make sure that the follow-ups do occur,” he says. “That’s because there’s a doctor who knows them on the other end.”
Concierge medicine also tends to look at analytics differently, Jorgensen says. Because practices aren’t subject to the same stringent quality reporting requirements as primary care practices, they have more latitude in assessing physician performance or patient satisfaction. “We can talk to physicians about the changes that will be most impactful. That leads to insights that improve behavior,” he said.