Setting Up Concierge Medicine Services to Contribute to Healthcare Improvements

By Dustin Miranda, CSSBB, CPHQ | Consultant | August 7, 2019

Concierge medicine gets a bad reputation for being an elitist service that only the affluent can afford. However, when implemented correctly, concierge medicine bridges the gap between high-quality, value-based healthcare and affordable access.

While concierge medicine is not a new concept, it is being implemented in new ways thanks to advances in healthcare and technology.

Concierge medicine grew out of a need for patients to have more time with their doctors – and for physicians to have more time to truly get to know their patients. The model allows providers the time necessary to capture a patient’s complete story, get to know the patient’s unique history, and treat the whole person rather than just the acute symptoms.

As a delivery method for health care, concierge medicine has been around for more than 20 years. Historically, healthcare services via concierge have been provided outside of a patient’s health insurance plan, meaning the patient would have to cover the full cost of the healthcare services.

However, with the availability of HIPAA-compliant remote visitation services, plus an increasing demand for value-based reimbursement models, greater numbers of organizations are choosing to establish concierge medicine operations in order to better serve patients.

At John Lynch & Associates, we provide services related to setting up concierge medicine practices in ambulatory settings. In several cases, our clients have been able to put into practice the ideal theoretical concepts that remind providers of “the good old days” when physicians were able to spend more time with patients, understand their illnesses fully, get to the root of the problem, and – ultimately – treat them better.

Now, as concierge medicine is garnering more attention, there are several options for healthcare providers to consider when implementing their own concierge medicine practice.

Options That Give Providers Freedom

At their inception, the entire cost of a visit with a physician via concierge medicine was on the patient, meaning a single visit with a physician could cost anywhere from $100 to $300 and up.

Since the vast majority of concierge medicine providers do not have advanced equipment, that fee does not include additional costs such as lab tests or diagnostic imaging. Luckily, these costs can often be covered by an insurance plan if the patient is covered.

However, the current landscape of concierge medicine is shifting drastically.

In time, we have seen an emergence of hybrid healthcare plans that allow for some coverage of concierge services while other services still need to be covered by the patient directly. The goal of these programs is to get patients access to the benefits of concierge medicine without the high-cost barriers to entry.

Some of these programs even broke new ground by offering both physical and mental health services in one concierge program – some going so far as to offer chiropractic services, acupuncture, and yoga classes. If a patient was in need of any specialized care or testing that fell outside of the concierge services, such costs were billed to the patient’s insurance.

Unfortunately, many of these models – though desirable and beneficial to patients – were not sustainable in the long-term and caused organizations to hemorrhage money to the point of forced closure.

The Future of Concierge Medicine
When we are talking about the potential for better patient satisfaction, improved provider satisfaction, more holistic care, and even integrated care services, there is vast potential to make a positive difference in countless patients’ lives.

The challenge, however, is to create a concierge model that is measurably beneficial to patients and fiscally sustainable for healthcare organizations.

In my work at John Lynch & Associates, I help healthcare organizations understand how to:

  • Build their unique model for financial success.
  • Design workflows for maximum efficiency without detracting from the patient experience.
  • Check in, check out, and follow-up with patients who are seen remotely.
  • Properly bill insurance companies using specific codes that apply to concierge medicine to ensure proper reimbursement.
  • Price out the model to include every element required to run a successful concierge practice.

In doing so, we have been able to see successful concierge models in action. Three specific trends are beginning to emerge from this groundbreaking work.

1. Flexible Healthcare Plans

Many healthcare organizations struggle to discuss contract negotiations for concierge medicine and services with their healthcare plans.

For example, should concierge medicine be offered as a bundled service or as an ad hoc service? Should a healthcare organization focus on offering concierge medicine to a single population sub-set or for a specific service vertical such as general mental health?

Over time, as increasing numbers of organizations are seeing the long-term health and cost-saving benefits of value-based reimbursement models, concierge medicine is a logical next step, which means more health plans are taking notice and opening dialogues with providers to create flexible healthcare plans.

2. Integration of Mental Health

Concierge medicine has also found a cozy home in the mental health sector where many patients have limitations to accessing care or special circumstances around required treatments.

For example, court ordered treatment for substance abuse is an ideal service for implementing, measuring, and analyzing concierge medicine services. Patients who have been court ordered to attend treatment services, counseling services, or group programs, or who need to receive home visits, medical checks, and psychiatric med checks are able to discretely complete their treatment without worry about the stigma of going to a mental health or behavioral health facility.

Through the advent of telehealth and telepsychiatry – also known as videoconference-based mental health – this is entirely possible when concierge medicine models are set up correctly.

3. Integrated Care Focused on Sociocultural Factors

Over the past ten years, many healthcare providers have gradually merged physical health and behavioral health into one program to provide integrated care services. The logical next step for integrated care is to progress toward a concierge medicine approach.

In doing so, not only will the model allow for a greater emphasis on both physical and behavioral health simultaneously, but also the model will support providers having the time to fully explore the relationship between physical and behavior health while giving patients improved access to the services to support holistic well-being.

Concierge medicine also facilitates the careful consideration of social determinants that affect physical and mental wellness such as living environment, income level, nutrition, the availability of fresh and non-processed foods, the availability of active lifestyle options, access to education, and so forth.

Many modern concierge practices have nutritionist, mindfulness-based stress reduction, and health coach services available, which are greatly needed but generally not covered under health insurance. As integrative health takes on a bigger role within our healthcare system, we are starting to see more qualitative and quantitative metrics supporting the idea that holistic care perspectives have greater positive impacts long-term.

As such, I anticipate seeing more of the concierge approach folded into integrative health so that patients can receive care from physicians as well as other specialists whose services feed into the overall health and wellness of a person.

How to Get to the Idyllic Future

Our healthcare industry is driven by numbers, which is why the tracking of metrics, consistent reporting, and careful analysis are the absolute most important elements of advancing our healthcare toward this more effective model.

Healthcare plans and healthcare delivery organizations need to see quantitatively that these programs are making a difference in patients’ lives. Already, we are seeing a trend toward improvement in patients’ overall health, lowered rates of depression, increased happiness, reduced number of medications prescribed, and a reduction of fiscal health deficiencies within the value-based care model.

As we make the extension into concierge medicine, the healthcare industry will be required to show widespread improvements for both patients and healthcare plans before the discussion can ever be widely had at the state and federal levels.

We can reimagine what is possible for medicine rather than falling into the trap of assuming it will always be as it has been. All we need is data for healthcare organizations to get on board and positive personal experiences for patients.

Once patients see that they feel happier, are healthier, and have spent less money to accomplish these achievements via the concierge medicine model, providers and healthcare plans will have no choice but to engage such services on a broader scope.

Practical Next Steps to Advancing Healthcare

Certainly, healthcare organizations will need help balancing the costs of delivering health care with the reimbursement model; luckily, that help is available. Key factors to consider before launching a concierge program include:

  • Understanding what patients want and need.
  • Detailing and tracking the demographics for the patient population that the program is going to serve.
  • How best to set baseline measurements.
  • How to structure a concierge medicine program to ensure the organization does not lose money so providers can focus on healing patients.

Recently, several programs have been designed and implemented, proving that concierge medicine programs do have potential to succeed in practice while helping patients thrive.

Currently, concierge medicine is unrealistic for a large subset of the population due to income limitation. However, the concepts and the tenants of concierge medicine ought to be available to everyone because such a model is making a bigger impact in patients’ lives. This is what health care should look like in this country. With buy-in from patients, providers, and plans, the wheels of change will start turning.

With this glimpse into the behind-the-scenes architecture of what concierge medicine is and how it can dramatically improve patient and provider experiences, now is the time to reconsider what is possible. Though the majority of patients have never experienced concierge medicine and the majority of healthcare organizations do not know where to begin to set up a successful concierge practice, such a strategy is the future of medicine in our country.

Do you have questions about setting up a concierge medicine program within your healthcare organization? Get in touch with us and we will help you build a successful program with the ability to affect massive health improvements in your community.

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(623) 980-8018

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PO Box 11651 Glendale, AZ 85318-1651