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Concierge Medicine -- Just for the Rich?

Posted by Lawrence Kerr on Mon, Dec 09, 2013 @ 07:44 AM

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The phrase "concierge medicine" conjures up visions of white glove treatment, house calls to yachts, and luxury medical experiences. Some even suggest that these luxury, tailored, out-of-pocket approaches may be unethical because they divert resources from the rest of the medical system.

New models, however, are demonstrating that concierge medicine is not just for the elite. As we detailed in our last post, concierge medicine is, at its core, a direct payment model. Rather than providers caring for patients and collecting payment primarily through government or insurance programs, providers provide care and arrange payment directly. These models are sprouting up in a variety of contexts and with a wide spectrum of payment structures -- but all are beginning to prove that concierge medicine -- or at least some kind of direct care and payment model -- may be used more broadly.

One model, often termed "direct primary care", is being used for everyone from tech entrepreneurs to long-haul truckers. Sherpaa and Qliance are two companies that are providing primary care plans for as little as $50 per month, often in combination with insurance coverage for further treatment. “The concierge model carries a lot of baggage in being health care for the wealthy,” said Dr. Erika Bliss, a family physician and Qliance’s chief executive. “We want to grow this and bring the price point down to average Americans.” The outcomes have been very promising in decreased costs, increased patient satisfaction, and improved health outcomes.

In an age of physician shortages (especially for poorer patients), healthcare provider burnout, and inflated costs, researchers and government officials are seeing opportunity in direct care. An even more populist model, which is also being looked at as a possible opportunity, are clinics in major US cities that meet the needs of the uninsured, especially Spanish-speakers. These clinics offer offer round-the-clock-hours, cultural and linguistic fluency for recent immigrants, and upfront pricing that assumes a lack of insurance -- all things that make these solutions perfect for many. It is reported that "Health officials see in the clinics an opportunity to fill persistent and profound gaps in the county’s strained safety net, including a chronic shortage of primary care physicians."

Of course, there are concerns that the standard of care with low-income clinics and even direct primary care models could suffer. Some patients may not have coverage for specialists or hospital services. Some doctors may not have admitting privileges at local hospitals. And many worry that patients with more severe health needs or more limited funds may not actually end up with the care they need. That said, models like Qliance's and Sherpaa's do seem to be meeting some significant needs, and we'll likely see plenty of innovation in this direct care model in the years to come.


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Tags: telemedicine roi, communication with patients, healthcare provider burnout, affordable care act, improving patient satisfaction, concierge medicine

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