According to a new report from NPR and the Harvard T.H. Chan School of Public Health, more than one in five adults in the top 1 percent of the population pay an additional fee for direct access to their primary care physician. This type of care delivery model—called concierge care, or concierge medicine—boasts round-the-clock physician access, same-day appointments, and highly-personalized, comprehensive care. It comes with a cost, of course.
But in the past decade or so, this tailored take on healthcare has gained widespread traction outside of high-income patient populations, too. Why? No matter what you call it—concierge care, membership medicine, platinum practice—they all share the same common goal: radical hospitality in healthcare.
How does it work?
When the concierge medicine model first appeared in the mid-1990s with Seattle-based MD2 International, it introduced the idea of “luxury medical care” and came with a price tag to match—with patients paying up to $25,000 per year for the boutique healthcare experience. What’s more, this cost was paid in addition to regular health insurance premiums and didn’t cover the costs of hospitalization or specialist consultations.
Though some patients still pay a five-figure fee for their care, the average fee for membership in a concierge practice nowadays is between $1,500 and $2,400 a year—or between $125 to $200 a month.
In the past five years or so, the emergence of direct primary care (DPC) practices have introduced other lower-priced models of subscription-based, on-demand care. DPC is a similar care delivery model that charges patients a flat-rate retainer for readily accessible, highly personalized primary care. Unlike concierge medicine models, DPC physicians do not accept insurance payments or participate in government programs like Medicare; they rely solely on patient membership fees.
Direct primary care practices offer greater pricing transparency because of this—with patient membership fees averaging less than $100 per month for unlimited doctor visits.
Advantages of the concierge care model
It’s true that the notion of retainer-based medicine is an enticing prospect for many physicians considering an alternative to the traditional care delivery model. The flat-rate, subscription-based payment structure guarantees a predictable revenue based on member volumes and eliminates the potential stresses of a fee-for-service practice.
As the healthcare industry moves away from fee-for-service payment models and towards value-based care, many doctors are compelled to re-conceive their approach to care delivery. With this in mind, most physicians cite improved doctor-patient relationships as their leading motivation for transitioning to concierge medicine.
With 20 or fewer patients to see in a day and appointment times lasting anywhere from thirty minutes to an hour—depending on patient needs—concierge care physicians are able to devote more time and energy to each patient.
More than that, many practitioners feel that they’re able to deliver a higher quality of care than they might otherwise be able to at a fee-for-service practice—where they might be scheduled to see as many as 30 patients in a day. Without the performance pressures, scheduling conflicts, and administrative burdens of a traditional primary care practice, concierge physicians report feeling more satisfied with their work and, thus, more able to provide the best possible care to their patients.
Physicians aren’t the only ones to benefit from this model, though. Flexible scheduling and unfettered access to a physician with an intimate knowledge of their patients’ personal health histories make concierge medicine particularly well-suited to the needs of those living with chronic medical conditions. While the flat-rate membership fee doesn’t cover specialty care services that some patients with chronic illnesses may require, the unrestricted physician access—both on the phone, or in the doctor’s office—provides these patients with the support that they need.
Disadvantages of the concierge care model
According to Concierge Medicine Today, an estimated 12,000 physicians currently practice concierge medicine—a small fraction of the roughly one million licensed physicians and allied care professionals in the U.S. For most of these physicians, leaving their patients behind was a primary concern in considering the switch to concierge medicine.
A concierge care or direct primary care practice might average between 450 to 600 patients, while a typical primary care practice might average closer to 2,500 patients. With fewer patients being seen, a greater number of primary care physicians is needed in order to provide care for the increasing numbers of displaced patients—a reality that seems hard-won in light of physician shortages and declining interest in primary care specialties.
Membership-based care services also pose the potential to limit care access for low-income patients, or for patients in rural areas not served by small-practice, concierge care providers. More than that, the nature of small, membership-based medicine means that physicians can be more selective in choosing which patients to take on—creating the potential for implicit bias to find its way into the care delivery model.
Though the industry-wide transition to a value-based care system means that providers are, on the whole, focused on patient satisfaction and high-quality care delivery, the simultaneous growth of alternative models like concierge medicine is quickly changing the face of U.S. healthcare. These shifting ideas surrounding care delivery methods will be interesting to observe in the next decade to come.
Learn more: 2020 healthcare trends
Are you interested in understanding how concierge medicine and alternative care delivery models will impact healthcare delivery in 2020 and beyond? Join Definitive Healthcare CEO Jason Krantz on January 29th at 2pm for our first webinar of the year: 8 Top-Of-Mind Trends for Physician and Hospital Buyers In 2020.
Webinar attendees will address key topics such as:
Continued growth of concierge health & wellness initiatives
Evolving role of the consumer in healthcare
What’s next for value-based care delivery
Make sure you’re prepared for a shifting market and a new decade – register today!