Spotlight on Healthcare and Concierge Care

Between the recent U.S. Supreme Court ruling upholding the constitutionality of the Patient Protection and Affordable Care Act of 2010, the Presidential debates, and planning for the new 3.8% Medicare Contribution Tax on unearned income coming next year for individuals earning more than $200,000 and couples earning more than $250,000, healthcare has been in the news a lot lately.

So, moving from the political stage to the personal realm, this is a good time to assess how satisfied you are with your health insurance. Maybe you have already addressed this question during the annual benefit enrollment period at work, but your answer should depend on more than an evaluation of your company’s offerings.

Let’s first consider the big picture. In their “2012 Health Confidence Survey,” the Employee Benefit Research Institute (EBRI) received diverse responses when they asked Americans to rate the country’s health insurance. Twenty-eight percent consider the country’s health insurance to be “good,” 28 percent say “fair,” and 26 percent rate it “poor,” while 12 percent rate it “very good” and 5 percent say it is “excellent.” Translate those results into classroom grades, and just 17 percent would rate our health care system in the A/B+ range. That’s disappointing.

Interestingly, however, in contrast with their ratings for the national health care system, respondents to the EBRI survey were generally more positive when asked to rate their own health plan. In fact, more than half of those with health insurance say they are “extremely satisfied” or “very satisfied” with their current plans. Of course, you have to wonder if this response is colored by the same behavioral overconfidence that has resulted in over 80 percent of drivers rating their driving skills as above average, or 87 percent of Stanford University’s MBA students rating their academic performance above the median!

In my view, the most interesting finding of the EBRI study came from the other end of the satisfaction spectrum where one third of respondents claimed they are only “somewhat satisfied” with their own health insurance. Simply, when it comes to your health and the health of your family, being “somewhat satisfied” with your healthcare is problematic.

If you find yourself among the dissatisfied, and your complaints center around waiting weeks to see your doctor, delays in the waiting room, feeling rushed during the appointment or poor access to medical referrals, you may want to explore a relatively new offering on the healthcare scene — concierge health care. As a supplement to your regular insurance, concierge care is a membership program focused on preventive care with 24/7 access to doctors and specialists. In short, concierge health care strives to make personalized medical care more convenient for patients.

Concierge medicine isn’t available everywhere. These retainer-based practices first emerged in Seattle in the mid 1990s and, today, concierge care is largely centered on both coasts. However, some estimates indicate that at least half of the states have at least one concierge provider.

One of the largest franchises, MD2, was founded in Bellevue, Seattle and has clinics in Chicago, Dallas, New York City, Palo Alto, Portland, San Francisco, and Seattle and plans to expand soon to Washington D.C., Houston, and Los Angeles. The pitch to healthcare consumers is clear from the company’s website: “Imagine having a doctor who really knows you, understands your health issues, and cares about meeting your every healthcare need. MD2 is like having a doctor in the family, available 24/7 to provide you and your family with the highest level of care. We’re available and in touch. We don’t just protect your health: We protect your privacy, your time, your lifestyle.”

Another well known concierge health care company is MDVIP, a wholly owned subsidiary of Procter & Gamble, with more than 450 concierge physicians across the nation. Unlike a traditional practice where doctors see an average of 2,500 to 4,000 patients a year, MDVIP says its doctors’ practices have only 600 patients who enjoy same-day or next-day appointments and 24/7 availability to doctors via email and cell phone. Describing their unique approach to healthcare as “proactive, instead of reactive,” MDVIP touts comprehensive wellness programs that include advanced screenings and physician counseling for a wide range of issues such as heart health, emotional well-being and weight management. They pledge to focus on wellness, not just illness and to “get to know you as a whole person, rather than as a faceless name on a chart.”

Concierge care is often referred to as “Cadillac healthcare” because the cost can be substantial, depending on the level of coverage and services you select. To provide some ballpark figures, program membership fees typically run from $1,500 to $25,000 a year. Keep in mind, too, that membership fees are in addition to what you already pay for health insurance. While concierge care might provide access to a specialist or a service not covered by your traditional policy, a standard doctor visit to get a flu shot, for example, could still be covered by your current health insurance carrier.

Although often billed as a win/win because patients get more attention and doctors appreciate dealing with fewer patients and less paperwork, insurance companies are not fans of concierge care. In fact, large insurers such as Cigna and Blue Cross Blue Shield exclude doctors with limited-caseload practices from their provider lists. Additionally, there’s the ethical issue of whether the wide adoption of concierge care would create a two-tiered national health care system because the additional expense of the concierge plans would be prohibitive to many consumers.

Unfortunately, concierge care is new enough that there are not too many studies that analyze whether this new approach to healthcare delivery results in healthier patients. The statistics I found on the impact of this new approach on patient health came from MDVIP. In 2007, MDVIP reported that hospital stays were down 60 percent and emergency-room visits were down 80 percent among its 55,000 patients, compared with those covered by traditional managed-care plans. Those statistics are impressive, but they do not come from an independent source, nor are they particularly current.

So, who might be best-suited to invest in a more personalized relationship with a physician through concierge care? According to Wayne Lipton, founder and managing partner of Concierge Choice Physicians, the best candidates are “patients who want an emphasis on prevention and wellness as well as those who are managing chronic illnesses, either for themselves or a loved one.”

As the national healthcare debate continues, concierge medicine is likely to be a part of the discussion. However, concierge care is not something to jump into without doing your research. Perhaps more so than with traditional care, a good doctor-patient relationship is essential with to concierge care. After all, that’s what you’re paying extra for. Accordingly, before joining a concierge care practice, you should thoroughly interview the doctors. You’ll also want a clear understanding of just what you are paying for. For example, how many times a year will your personal doctor be available for in-person appointments? How will referrals be made? Are there costs in addition to your annual retainer? How frequently will your annual fee increase? And, of course, it’s wise to get any contract reviewed by your attorney.

In conclusion, particularly because our healthcare landscape is changing, future insurance costs and benefits will be difficult to predict and health care decisions will become more complicated. To that end, you may want to discuss healthcare planning in greater detail with your physician, health insurance representative and financial advisor.

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