Health Care of the Future: Concierge Medicine’s Next Big Challenge Is Fitting In

This article from back in February of this year came to mind in reading about the direct primary care headlines of the last few days. It forecast the movement of private physicians toward direct care and concierge medicine could cure the ailing health system. Recent movements in the industry suggest that the time is coming quicker than anyone anticipated.

Brad Broberg for the Puget Sound Business Journal Feb. 1, 2013

The first generation of most innovations is beyond the reach of the masses. But if someone truly builds a better mousetrap, the product and price will evolve until the benefits outweigh the costs and the masses embrace it.

Cell phones, laptops and flat screens are recent examples. Concierge medicine could become another. Pioneered in Seattle, the concept is catching on as one possible cure for an ailing health care system.

Concierge medicine — also known as direct primary care — is an alternative approach to traditional primary care. Patients or their employers pay a monthly or annual retainer. Doctors see limited numbers of patients but offer unlimited appointments and extended hours, with no co-payments. And insurance companies? They’re the odd man out unless a patient needs specialized care the primary doctor can’t provide.

By collecting a retainer rather than billing an insurance company, concierge medicine saves time and money spent on paperwork and gives doctors more freedom to treat their patients as they see fit rather than as insurance companies dictate.

The short-term goal? Provide more responsive, convenient and efficient primary care. The long-term goal? Prevent serious — and expensive — medical problems from developing downstream because of improved primary care upstream.

Different targets

Seattle providers MD2 International and Qliance Medical Management Inc. are longtime leaders in this emerging field. Dr. Howard Maron started MD2 in 1996. Dr. Garrison Bliss founded Qliance in 2007 after practicing concierge medicine since 1997. Although the two providers target different segments of the market, both are thriving — a testament to the appeal of the concierge medicine model.

“I don’t think there’s any two ways about it. We need to innovate in health care,” said Peter Hoedemaker, CEO of MD2 (pronounced “MD-squared”).
When most people think of concierge medicine — if they’ve heard of it — they envision patients with deep pockets who receive ultra personalized care from superstar doctors who are at their beck and call.

That’s the five-star formula Maron followed when he started MD2. Over the years, MD2 has opened offices in seven other cities — the latest coming this month on New York’s posh Park Avenue. Each office consists of just two doctors, and each doctor cares for no more than 50 patients and their families. The cost: $25,000 a year.

“This isn’t for everybody,” Hoedemaker said. “Our (business model) is targeted to a specific demographic.”

While MD2 may expand to a handful of additional cities, it will not compromise its business model to serve a less exclusive swath of the population.
“We’re tiny and we’ll always be tiny,” Hoedemaker said. “This is the way (Maron) wants to practice medicine.”

Sticker shock

Qliance is concierge medicine for folks who would faint from sticker shock at MD2’s retainer. Qliance retainers range from $54 to $89 a month, depending on age. The big difference: Qliance doctors work with hundreds of patients, compared to 50 families for MD2 doctors. Nevertheless, that’s a marked improvement over the 2,000 or more patients seen by many traditional primary care doctors.

“Our goal is to take the concept and turn it into a model that can be widely disseminated and widely affordable to everybody,” said Dr. Erika Bliss, president and CEO of Qliance, and a cousin of the company’s founder.

The company operates clinics in Seattle, Tacoma, Kent, Mercer Island and Bellevue. The Bellevue clinic is located in the headquarters building of Expedia, where it serves both employees and the general public.

Concierge medicine is all about restoring the close relationship between doctors and patients that is lost when insurance acts as a middle man, Erika Bliss says. Faced with tight controls on reimbursement, most primary care doctors must schedule as many appointments as they can if they want to make a good living, and must conform to strict treatment guidelines.

Qliance operates outside the insurance system’s orbit. Physicians earn a fixed salary plus bonuses based on patient satisfaction and quality of care benchmarks. The result? Doctors can meet with patients for half an hour or more instead of 10 minutes or less and they have more freedom to use their judgment when making treatment decisions.
Fleeing paperwork

Dr. Randi Leggett, who joined Qliance a year ago, was happy to escape the mountain of paperwork and the pressure to see as many patients as possible that came with billing insurance companies.

“It was frustrating to me,” she said, “because I felt it was a bad way to take care of people.”

Example: When appointments are brief, primary care doctors may be unable to fully diagnose a patient’s problem.

“If you have 10 minutes to see a patient who says they’re having chest pains, you don’t have time to ask a lot of questions, so you’re going to send them to a specialist,” Leggett said.

While it’s natural to err on the side of caution, it’s possible the referral could have been avoided — and the cost saved — if the primary doc could have spent more time with the patient.

When Leggett joined Qliance, many of her patients followed, including Don and Betty Jo MacPhee, retirees who live in Bellevue. They appreciate the longer appointments and extra level of attention.

“She actually makes house calls and hospital calls,” Don MacPhee said.

Another upside is that Leggett can now make better use of the phone and email to communicate with patients because Qliance considers that part of the job. Insurance companies usually don’t.

“It fits our needs,” Don MacPhee said.

The challenge for Qliance is to integrate the concierge medicine model into the overall health care system rather than expect it to stand alone. Qliance recently teamed with the Cigna health insurance company to offer employers a bundle that provides primary care for employees through Qliance and insurance for specialty care through Cigna — all at a combined price that’s competitive with traditional insurance coverage.

The partnership is a litmus test of “concierge medicine for the masses,” Erika Bliss said. “We fully expect the model to work.

Hopefully the ability of those in the greater Seattle area to find a concierge doctor will spread across the nation.

Full article on Puget Sound Business Journal

About Concierge Medicine Journal

Concierge Medicine Journal (CMJ) curates breaking concierge medicine news, and editorial opinion on a wide variety of topics relevant to the practice of Concierge Medicine.

No comments yet... Be the first to leave a reply!

Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Google+ photo

You are commenting using your Google+ account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

%d bloggers like this: