Imagine a doctor that will come to you any time, any place or just a reliable, easy-to-reach person who will coordinate the logistics and timing of your health care. Sounds like a dream, right? It’s becoming more and more possible with rising start-ups, physicians increasingly leaving the traditional healthcare market, and an ever-changing policy environment.
A little known clause of the ACA allows direct primary-care, i.e. concierge medicine, to count as ACA-compliant minimum essential coverage as long as it’s bundled with a “wraparound” catastrophic medical policy to cover emergencies. Once only accessible by the elite, new policies and trends bring concierge medicine to the middle class. Independent practices or corporate firms charge around $50-$100 per month as a retainer fee or subscription. They will then see or speak with a patient as many times as necessary as well as provide boutique services for an additional cost.
So why pay concierge retainer fees in addition to mandated insurance? It’s worth it. Insurance coverage has shown sharp increases in cost sharing, companies keep plan premiums as low as possible by raising deductibles to exorbitant levels, some as high as thousands of dollars in out of pocket expenses before insurance coverage kicks in. Individuals who choose plans with high-deductibles and minimal premiums for emergencies can put the money that they save up front towards the concierge retainer fee.
A study of a concierge practice in North Carolina found that patients spent 12% less out-of-pocket than had they gone to a regular doctor. With fewer patients, doctors can spend more time with individuals and because they are paid by retainer can be available through alternative mediums including video, email and phone. High retention rates of 93% indicate patient satisfaction with this model.
This form of practice could exacerbate the already critical shortage of primary care physicians by limiting provider patient loads, or it could provide an incentive for young doctors to enter primary care, with the ability to practice medicine on their own terms without the often-added government burden. Many doctors are turning to this alternative practice as a way to get back to simply treating and truly helping people instead of worrying about the politics and regulations.
Concierge medicine comes in many forms, each with unique attributes. Concierge medical practices, clinics, and firms provide people with the navigation to take advantage of price transparency and personalize healthcare. Concierge doctors often negotiate with specialists and labs to secure discounts and show fees upfront. For example, a mammogram that would traditionally cost $350, could cost only $80 with the concierge discount price. If costs seem to high, patients always have their insurance plan to fall back on. Similarly, companies like Grand Rounds or Better work to untangle the complexities of the health care system. They will help patients find the best-fit doctors, set up online consultations, and determine insurance coverage for procedures and providers. Insurance companies are also capitalizing on the ACA clause and opening concierge clinics that offer many of the same style services.
Concierge medicine is a much-needed solution for personalized consumer-centered healthcare. Concierge medicine is the future of health care in America.