Claims Management News

More Time for Patient Care with Concierge Model of Medicine

By Vera Gruessner

- There are a wide variety of different payment models being implemented across the healthcare industry. Providers and payers are deciding which will provide the best quality of care while, at the same time, lowering costs. From free-for-service and bundled payments to pay-for-performance, the healthcare payment space is transforming its practices. The concierge model of medicine is another reimbursement platform that some healthcare providers have established at their place of practice.

Concierge Medicine Platform

The concierge model of medicine is a system in which the patient and provider have a closer relationship and the patient pays an annual fee for healthcare services. The doctors then have the goal of reducing their patient loads and spending more time with their designated patients to prevent and treat their medical conditions.

To learn more about the concierge model of medicine, HealthPayerIntelligence.com spoke with Dr. Jim Williams, a primary care practitioner and user of concierge medicine payments, and Matt Jacobson, CEO of SignatureMD.

Why did you choose to adopt the concierge medicine model of payment?

Dr. Jim Williams: “This model allows me to have more time with patients and it allows me to dedicate more time and office staff time to the communication necessary to make care better. It makes me more rapidly available to my patients and their families.”

“It allows me to dedicate resources unlinked to a patient care visit to help them navigate the healthcare system. Since they’re paying a yearly enrollment fee, I am not beholden to only the doctor-patient office visit as a source of revenue.”

“Therefore, I’m able to work on their behalf and not require them to come in for every single service they need.”

When asked why did you choose to work toward expanding the concierge medicine model of payment, Matt Jacobson replied, "As a former health insurance company executive, I was frustrated with the inefficacy that I observed in the standard healthcare system. I was searching for practice model that aligned the interests of the patient and the doctor—the concierge practice model fit the bill. When we started SignatureMD in late 2006, we saw a major flaw in the concierge model—the established model required physicians to terminate non-member patients. We fixed this—most SignatureMD-affiliated doctors have incorporated a nurse practitioner or physician assistant to manage the care of non-member patients under the doctor’s supervision." 

"For patients, the current healthcare system, dominated by employer-provided, fee-based medicine, is inadequate. Medical appointments can take weeks to book, start late, and typically last only 11 minutes. This type of assembly line medicine is frustrating to patients and physicians alike. Concierge medicine offers members more time with their physicians to focus on big-picture issues like prevention; it also offers conveniences like 24/7 cellphone or email communication with a doctor, and “no wait” and same-day doctor appointments," said Jacobson.

"For doctors, especially primary care physicians, concierge medicine offers a business model that enables them to operate profitably and remain independent of large groups or hospitals. The income they earn from membership fees enables them to step off the assembly line of current healthcare delivery and treat each patient as an individual, rather than just a symptom on a chart. "

What are the biggest benefits you’ve found from concierge medicine?

Dr. Jim Williams: “The benefits for the patient are that they find their doctor is far more accessible in person because the office visits last much longer – as long as the patient needs, in fact. The shortest visit is 30 minutes. That’s how we block the time. They can be made much longer. We have 90-minute visits as well.”

“There’s no sense of being rushed. Furthermore, the practice is much smaller so the doctor and his/her staff gets to know each patient far more intimately. Far more time is available on the telephone – not just with the doctor, but with staff, the business manager and the nurse as well.”

“Because only four to eight patients per day are seeing the doctor in the office, the staff is freed up to help patients in other ways. This is an advantage to the doctor and the office staff as well. We love being able to work through things to their completion and to have the extra time to do ordinary things extraordinarily well.”

“It allows more time to manage the practice more carefully and it allows us more time to interact with our colleagues on behalf of the patient more extensively.”

Matt Jacobson: "The concierge model affords physicians the time to focus on prevention and optimization of a members health status, rather than the standard system which focuses on treating one symptom at a time and moving on.  Concierge medicine is particularly valuable to patients with one or more chronic diseases, who need to see their physicians on a regular basis."

What disadvantages did you find with traditional healthcare payment options? What led you to concierge medicine?

Dr. Jim Williams: “I found it impossible to deliver high-quality care in which both the patient and the physician are satisfied with when relegated to seeing 25 to 30 patients a day and when obligated to use an electronic medical record which slowed me down and made the interaction with the patient less personalized.”

“When the office staff was under the burden of such a large number of patients calling – in particular there are more phone calls because the doctor is less available so this led to more burden on the staff – it was not a model that worked for the patient in greatest need.”

“While a 15-minute visit might be enough if you are a younger, healthy patient with one problem such as a sore throat, it’s never enough when you’re a patient with multiple medical problems and lots of questions.”

“In concierge medicine, you find a way to do the ordinary things extraordinarily well for the more complicated patients who take more time.”

Matt Jacobson: "Under the current healthcare system, primary care physicians often must see 30 or more patients per day—unlike concierge doctors who typically have 10 appointments per day. It’s an unfortunate fact that physicians need to move volume in order to stay financially afloat. In short, medicine has become a volume business. Nobody is happy about this, physicians are burning out, and patients are getting increasingly frustrated by long waits for short visits. I knew there had to be a better way and found it with concierge medicine."

Does a greater focus on preventive medicine enable providers and payers to achieve the Triple Aim of Healthcare?

Dr. Jim Williams: “The answer is yes because we have more time with each patient to explain why preventive care is needed, to answer their questions, and to assuage their concerns.”

“For example, when I have more time, I have a better success rate of convincing patients to get a colonoscopy, or a mammogram, or even a pneumonia vaccine for the elderly. It helps that way in preventive care.”

“Also, it helps among people with highest need. There’s a potential that it greatly reduces cost of care because when the doctor is always available and can see you the same day, when the doctor can spend up to an hour – even on short notice – to handle serious problems, when the nurse and receptionist have more available time to help people with their problems, when we’re able to be that involved, this leads to fewer trips to the emergency room which cost thousands per visit.”

“It leads to fewer hospitalizations especially when the doctor makes house calls. It also leads to fewer trips to specialists – fewer referrals to specialists – because the doctor has more time to handle the little things and doesn’t need to refer people to get problems or questions answered.”

“It’s probably not reducing costs for a healthy 18-year-old, but it has a huge potential for our sickest patients with the most problems and who put the greatest demand on our healthcare system.”

Matt Jacobson: "Exactly. The majority of healthcare expenditures are spent on treating chronic diseases, most of which are preventable to some degree. Yet, as a nation we spend only 2 cents of every healthcare dollar on prevention. With its focus on personalized care and preventive medicine concierge medicine offers a viable alternative to many working and middle class Americans."