What is the Concierge Medical Model of Health Care?
The concierge medicine model emerged in the 1990s as an alternative to traditional primary care, as long waits for appointments coupled with short visits began to frustrate both doctors and patients.
Interest has since grown due to rising health care operating costs, increased administrative burdens to support public and private insurance while meeting regulatory reporting requirements and declining insurance reimbursement, said Concierge Medicine consultant Terry Bauer. 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 fee, usually collected monthly or annually. While fees can range from $1,200 to more than $20,000 per year, the average annual concierge drug fee is typically between $1,500 and $2,500 per year, or roughly $125 to $210 per month, according to PartnerMD’s Concierge Practice.
For the cost of the retention fee, patients benefit from longer in-person visits; one-hour annual health check-ups are not uncommon. In addition, concierge practices typically offer same-day or next-day appointments, along with access to after-hours care via phone, text or email. The fee may also cover wellness programs, health training and other types of services. Some practices offer discounted services for additional family members. MDVIP, for example, offers care for members’ children until they turn 26.
Concierge medical practices can provide this level of patient care because they see fewer patients. MDVIP limits membership to 600 patients per office, says CEO Brett Jorgensen. That’s a common membership limit, compared with 1,000 to as many as 4,000 patients per primary care practice, according to a paper in Annals of Internal Medicine.
“People are willing to pay for a comprehensive wellness checkup and support throughout the year,” Jorgensen says.
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How concierge medicine and direct primary care differ
Direct primary care (DPC) is like concierge medicine in 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 exclusively for primary care, while concierge medicine can also cover specialty care. This tends to make DPC less expensive than concierge medicine, but also less comprehensive in the services it can offer.
Another is that DPC practices do not accept insurance, while the American Academy of Private Physicians estimates that 75 percent of physician practices do. (In general, concierge practices that don’t accept insurance tend to charge higher membership fees, according to AARP.)
For patients, the insurance covers care that is not included in the membership fee. For the practice, insurance reimbursement provides an additional income stream; Jorgensen says MDVIP gets about 20 percent of insurance revenue, which is a roughly even mix of Medicare and commercial plans.
Technology that supports concierge medicine
Most of the technology used by medical practice concierges would be largely familiar to primary care physicians. There are electronic health records, domestic and commercial (MDVIP is used by Athenahealth), along with patient portals, customer relationship management systems, various analytics tools, digital marketing software, and telehealth platforms. (Providers like Forward have drawn attention to including comprehensive biometric scanning in annual wellness visits, with the goal of having more personalized health and wellness plans because of the wealth of personal health data.)
The difference between primary care and concierge care, according to Jorgensen, is how the technology is used.
With concierge care, email and text messages, for example, are less about pushing alerts and more about maintaining constant communication. The same goes for virtual visits: patients use services provided by the practice instead of opting for a third-party app.
“We’re trying to engage at a deeper level, to make sure there’s follow-through,” 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 are not subject to the same stringent quality reporting requirements as primary care practices, they have more freedom in evaluating physician performance or patient satisfaction. “We can talk to doctors about the changes that will have the biggest impact.” It leads to insights that improve behavior,” he said.
