This article is about a new model of healthcare that is rapidly becoming a major player in the American health industry.
Despite being a remake on older style model of medicine, I believe it represents the future of health reform.
It is called concierge medicine.
Let me explain how it works.
What is concierge medicine?
Patients having concierge medicine currently pay about $100 USA a month directly to their physician.
For this money, they receive a type of primary care ‘case management’.
They can usually get same day appointments with their Doctor. These appointments go for half an hour, compared to five or ten minutes.
Their Doctor follows up on test results and treatments.
Their doctor can visit them in their own home, or when they have been admitted to hospital.
Because Doctors earn more per patient, they are able to maintain much smaller caseloads.
And as Doctors income is based on their patients subscriptions rather than third party systems like Medicare or private health insurance, they can escape the overwhelming burden of bureaucratic paperwork.
“Concierge medicine means you have a direct relationship with your doctor”
says James Maskell, a functional medicine expert and founder of KNEW Health , a community-based health plan.
It’s really a return to old fashion family medicine, pre world war II.
What makes me think that concierge medicine is the next unicorn?
Let’s compare this phenomenon with a list of guidelines on what is a Unicorn startup, by Aashish Pahwa, founder and chief editor at Feedough.com.
Concierge medicine allows the Doctor and patients to connect directly and gives them both more control and a better experience.
The pain points of excessive regulation, box ticking paperwork and loss of control for doctors and fragmented poor quality medical care for patients disappears.
Patients can start to develop a relationship with doctors and as a result, are more compliant with their treatments, reducing hospital admissions.
This transforms healthcare from its modern dependence on crowded and error prone Emergency Departments, expensive medical specialists and risk over servicing. Instead they receive better primary care and stay away from hospitals. Overall this is a cheaper and more effective way to manage population health.
Concierge medicine abolished the need for third party health payment systems like Medicare and health insurance.
Big insurer and big government are made redundant as patients and doctors work together directly.
It’s lose lose for big insurer and big government. No financial or political control of medicine. But for Doctors and Patients it’s a win win.
First movers advantage
In 25 years concierge clinics have steadily grown to be a well established, financially successful and clinically sound movement.
They have their own organisation, funding, research, startups legal and financial support.
From their beginning in 1996 Concierge practices are now a powerful legal and professional force, challenging the cosy relationships between middlemen and bureaucrates in current government and private insurance run medicine.
Concierge medicine is the only health model in America that completely cuts out the middlemen.
There is no competition in this space. ‘Tech savvy ‘solutions like telemedicine all depend on third party payment systems.
Technology paradigm shift capitalism
Clunky, bloatware EHR’s do not represent good technology
Almost all unicorns capitalise on a technology paradigm shift going on in their industry.
However, technology is more than restaurant rating apps and online banking.
Technology is about fixing real problems. Engineers don’t just write abstract code. They build bridges, design water pipes and test buildings for stress.
Modern EHR’s don’t solve problems, they make current ones even worse. EHR’s are not ‘new’ technology. They are just an electronic version of an old problem.
In fact modern EHR’s are being identified as the leading culprit in physical burnout.
The digital disruption of concierge medicine is from NOT forcing doctors to use clunky, bloated clinic software.
It comes from putting Doctors in a position where they choose their OWN software, or even, go back to pen and paper if they wish.
Remember, technology is not just about computer code. It’s about solving the root cause of problems.
Social media has given people a forum outside mainstream media
Love or hate Twitter and uTube, they have change the world forever.
There are no secrets anymore. For example, the entire world knows that traditional EHR’s are currently hated by Doctors across the globe.
Don’t believe me?
Watch the hilarious ‘Hitler finds out he needs to use Epic EHR skit below.
What new technology will concierge medicine bring?
Whatever it’s name it will be.
- Customer focused
- Connect doctors and their patients in a 24/7 manner
- Have a great user experience.
Concierge medicine is successful that renewal rates for subscriptions are over 90% each year. These are astonishing rates for a ‘non essential’ product that offers no tax breaks.
Surveys show that of those doctors aged 45 or younger, 17 percent said they plan to transition in whole or in part to concierge medicine in the future.
It fixes the major pain points of both Doctors and patients.
Less stress, better quality of care, more coordination, less avoidable hospital visits and good old fashioned relationship building.
Concierge medicine is fundamentally a return to private medicine.
There some alternatives, some clinics partner with health insurers and take part payment from them. Other clinics partner with government Medicare.
But essentially concierge practice is private practice, outside the control of governments or private insurers.
How does concierge medicine work, and what are some examples?
Concierge medicine clinics can charge patients between $50 a month to $25,000 a year. At present, $135 to $150 per month is the national American average
Patients get same day appointments, more face time, house calls, ED visits, supervision of tests and results. Their doctors also often run alternative therapies like Tai Chi to reduce their patients stress.
Practice sizes range from 100 to 1,000 patients per physician compared with 3,000 or more at a traditional practice
One Doctor dropped his traditional practice of 3,000 patients down to 400 when he moved to concierge medicine.
There are between 1,000 and 5,000 concierge practices in the USA today. Up to 12,000 doctors are practicing concierge medicine. A survey of 20,000 doctors showed that more than 20% of doctors are currently practicing concierge medicine now or plan to switch to concierge medicine in the future.
Some are straight cash, others take some private insurance patients, a few have started partnering up with Medicare and Medicaid.
Hospitalisation rates for concierge patients are much lower. For example MDVIP clinic patients with private insurance are 72% less likely to go to hospital than normal patients. MDVIP clinic patients with Medicare are 79% less likely to go to hospitals.
Here are some American concierge clinics. Several feature in ‘health startup’ publications.
What are the negatives and why should we consider moving to concierge medicine?
Concierge medicine is accused as being ‘elitist’, for the rich and inherently socially unjust.
It is suspected as being ‘not under government control’.
It is touted as being open to exploitation by ‘unscrupulous people’.
Other negative arguments include, cherry picking healthy patients, lack of regulation and risk of social injustice.
While there is not enough large scale data to match up third party and concierge practices to prove or disprove these claims, the fact is that concierge works for most doctors and patients, it is growing rapidly and it does keep people out of Emergency departments.
Why reform healthcare?
Concierge medicine comes at the end of 70 years of government and insurance funded healthcare. This has ended up with loss of control by doctors, huge paperwork, physician burnout and decreasing patients satisfaction.
Health budgets across the western world have skyrocketed and are now completely unsustainable.
For all this money, over servicing and price gouging is rampant, while satisfaction levels for both patients and doctors has crashed.
Life expectancy for Americans is on the decline. Meanwhile doctors now have the highest suicide rates of any profession.
Nothing in the current system works. Change is inevitable. And soon.
Across the West, ageing populations, rising health costs, extended time people are spending on welfare, decreasing availability of jobs and rising public expectations are putting enormous pressure on government budgets.
Sooner that people realize, the money is going to run out.
We either have to reform bloated and ineffective health systems, or they will simply collapse.
© Wikihospitals December 2019
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