Asked why payers should be interested in getting involved in concierge medicine, in which patients receive more personalized care for an annual or monthly fee, Kevin Grabenstatter, managing director and partner at L.E.K. Consulting, says: Think like a consumer.
The typical concierge medicine patient, says Grabenstatter, often has a high net worth, is 35 years of age or older, and is not yet on Medicare. These patients tend to live in major metropolitan areas such as Boston, Dallas, Seattle, and Beverly Hills.
“For the affluent, the most compelling element of the concierge [medicine] option is fast-track appointments,” says Grabenstatter. “It’s a little more downscale for the mass market, where it’s about access to top physicians, whether that’s real or perceived.”
Concierge medicine patients, who receive perks such as same-day appointments and 24/7 access to physicians, are more than two times as likely to recommend their physician as patients who don’t go to this type of practice, according to consulting firm Bain & Company’s research. Still, patients’ interest in concierge medicine is strongest when they’re thinking about a relationship with their own doctor, not a “conceptual doctor,” says Jeremy Martin, a principal at Bain & Company. That’s why patients are more likely to follow their physician if the physician transitions to a concierge medicine practice, he adds.
It’s easy to see why the value proposition for physicians is strong, too. In order to stay in business, a physician at a traditional medical practice—one that accepts Medicare and commercial insurance—must care for approximately 2,400 patients. When compared with the 600 patients a physician at a concierge medicine practice needs to manage—which also allows them to spend more time with their patients—it stands to reason that 40% of physicians say they would consider concierge medicine, says Martin, referring to his firm’s research. Caring for patients at a concierge medicine practice also allows physicians to maintain a better sense of work-life balance and a better lifestyle in general, he adds.
So where do payers fit in the concierge medicine ecosystem? Experts say that the national leader to watch is UnitedHealthcare, which launched Harken Health in 2015. Harken Health has health centers located in Illinois and Georgia, where membership-paying patients (the plan offers various plans at different cost levels) receive unlimited primary care and around-the-clock access to their doctors.
Members also have access to health coaches and behavioral health specialists and the ability to have health-related questions answered by phone, e-mail, or video chat, according to the company.
Most other major national health plans aren’t currently offering options like Harken Health.
A Cigna spokesperson says that the payer doesn’t preclude its contracted physicians from offering such plans on their own, provided that those physicians don’t exclude patients who don’t opt for that type of plan.