Concierge medicine: What health execs need to know

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.

Grabenstatter

“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.

Harken Health

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. 

Next: A threat to the traditional model?

A threat to the traditional model?

Martin describes concierge medicine as a “rapidly growing market,” and points to Bain & Company’s research, which reveals that 20% of patients are interested in a concierge medicine option.

He also points out that this interest cuts across all income levels and age levels. “It’s not just the 1 percenters in Manhattan,” he says, which casts the net wider than Grabenstatter’s definition of this market.

Patients are looking for a better overall experience in healthcare, a strong personal relationship with their doctor, and longer appointments-and they don’t want to have to wait for access. Another driver is patients’ growing interest in preventing disease and maintaining a healthy lifestyle, adds Martin.

“Everyone, payers, providers, vendors … they’re chasing the affluent segment out of necessity. The general need to cross-subsidize less profitable lines of business-especially with affluent patients with a proven propensity for self-pay, which is directly connected to concierge medicine,” can help, he says.

Still, Grabenstatter notes that most payers aren’t yet jumping in full speed.

“[Payers] are being cautious, and I think they can probably remain so unless or until their big employer group customers demand more from them or until concierge medicine starts taking a bigger bite out of the market share,” he says. This calculus will be different depending on geographic area, he adds, pointing to the metropolitan areas where concierge medicine has taken hold. Still, he refers to concierge medicine is a “tiny market,” so payers can largely “bide their time right now.”

Grabenstatter says that in the long-term, some factors at play could “force” payers to get involved in concierge medicine. One is the general rise in high-deductible health plans, which makes for more of a “consumerist model,” he says.

Another potential driver is the uncertainty about TrumpCare and its potential pullback of coverage, which could push many patients to look for options similar to concierge medicine, he adds.

When it’s time to jump

Deane

John Deane, chairman of Advisory Board Consulting, says payers interested in testing the waters first need to determine how concierge medicine works with their strategy for delivering a better healthcare plan. Then there are the types of strategies payers could deploy to deliver concierge medicine, such as Harken Health’s partnership with Boston-based Iora Health, (which manages its clinics), and has a great deal of expertise managing care, he says.

Next, payers need to conduct studies to determine if enough of the market is interested in concierge medicine.

Most payers don’t have the national presence or scale that UnitedHealthcare has, so going into concierge medicine directly on their own might not be the best approach, advises Grabenstatter. At the same time, one thing payers don’t want to do is “boot” concierge medicine physicians out of their network, meaning dropping providers who pursue concierge medicine for their practice.

“Don’t be that payer,” he advises. “You want to be the channel partner of choice to help the providers at these concierge [practices] drive volume,” says Grabenstatter. “Currently, they’re reliant on direct-to-consumer outreach advertising and marketing or partnerships with wealth management companies. …If you can help [concierge medicine] practices, and payers are well positioned to do that, [concierge medicine practices] could expand their footprint reach,” he says.

One way that payers can help concierge medicine practices is to list them as options for beneficiaries when they visit payers’ websites looking for providers, says Grabenstatter.

Aine Cryts is a writer based in Boston.