Exploring Innovative Health Care Models: Direct Primary Care & Concierge Medicine

Times are changing, especially in health care. As medical practices continue to grow in size, the relationship you once had with your physician might no longer feel as personal. Likewise, there is an increasing number of people who do not even have a primary care physician. In this blog post, we are highlighting two innovative health care models that people are praising: Direct Primary Care & Concierge Doctors.

Direct Primary Care

The Direct Primary Care (DPC) model is a practice & payment model where patients pay their physician or practice directly, often monthly or annually, for a defined set of primary care services. Ultimately, it is like a membership with your primary care physician. Depending on the DPC, your “membership” will include access to your physician via text, phone, & in-person visits without a per-visit charge. Many routine procedures & preventative care services are also typically included in your contract without additional cost. While insurance is not necessarily required to partake in a DPC contract, it is still highly recommended. This health care model pairs well with higher deductible plans or plans commonly referred to as catastrophic plans. Additionally, a critical illness plan is smart to pair with a DPC model.

The Summary:

  • Direct Primary Care models are designed to provide better patient to physician relationships.
  • Preventative care costs & routine care costs are often fully covered in the patient’s dues, allowing for less “unexpected expenses”.
  • DPC models are not insurance; therefore, should be paired with an insurance plan such as a higher deductible plan, catastrophic coverage, &/or critical illness coverage.
  • A DPC doctor is typically an out-of-network provider, so referrals to specialists or for special lab testing may not be accepted by the insurance carrier.
  • Some DPC doctors don’t accept Medicare, therefore, the members may tend to be younger.

Concierge Medicine

Concierge doctors provide care through a model often referred to as patient-centered care or patient-directed care. Physicians operating under this model vow to take on fewer patients in order to provide better, more thorough patient care. For example, instead of taking on the care of 3,000 patients, the physician will commit to the care of 300 hundred patients. One of the largest organizations focused on providing concierge health care is MDVIP. MDVIP describes itself as an affordable, personalized, preventive care model with reduced-patient panel practices. Chair & CEO of MDVIP, Bret Jorgensen, has clarified that MDVIP is not an insurance model & that all of their patients continue their enrollment with their preferred insurance. (Advisory Board, 2015) For example, they have many patients who have Medicare insurance which covers hospitalizations, all of the typical tests, & medications insurance would cover.

Care under concierge medicine such as with MDVIP begins with an annual visit. During this exam, the physician will perform a comprehensive assessment of the patient’s health & develop a personalized plan based on the exam. The idea is to provide preventive care, versus only seeing the patient when they are sick, or develop a problem. Furthermore, concierge doctors are not practicing “triage & refer” health care where they see the patient briefly & then refer them to a specialist.

Concierge doctors highlight their model with the availability of same-day appointments that are quality, unhurried appointments. Like Direct Primary Care models, concierge doctors provide their patients with personal access to their cell phone number & email, encouraging convenience & engagement with patients to manage their health. In addition to the patient’s preferred insurance plan, patients will also pay their concierge doctor an annual membership fee of $1,500 to $1,800 a year – depending on the market & physician.

The Summary:

  • Concierge doctors focus on preventive care & management, versus seeing the patient only when sick or a problem arises.
  • Concierge doctors charge an annual fee to join their practice, which is in addition to the patient’s choice of health insurance.
  • A concierge medicine physician generally remains affiliated with insurance networks &, therefore, can refer to specialists who are also within the patient’s network.
  • The typical concierge medicine member is an empty nester over 50 years of age.

What’s the Difference?

Although they seem similar, direct primary care & concierge medicine are different health care models. However, both models do not provide assistance for hospital care, catastrophic illness, or emergency care such as an ambulance ride, which is why health insurance coverage is still highly recommended.

Here are 5 ways in which concierge medicine & direct primary care (DPC) membership models differ:

  1. Membership Fee:
    • In DPC, members typically pay a monthly fee & may drop out of the program at any time.
    • In concierge medicine, there is an annual fee that can be paid in full or split up, but the contract is for the entire year.
  2. What the Membership Fee Covers:
    • In DPC, the membership fee generally covers unlimited patient visits.
    • In concierge medicine, the annual fee covers an in-depth comprehensive physical with screenings that go beyond what traditional insurance or a government program would support.
  3. Cost:
    • DPC membership fees are usually priced on a sliding scale, where younger patients pay less than older patients. Sometimes family rates are available.
    • Concierge medicine membership fees tend to be higher than DPC membership fees.
  4. Third-Party Payers:
    • In DPC, the doctor does not accept third party reimbursements. The membership fees paid by the patients cover basic visits, & some services are charged separately. If a patient has an insurance plan, some services offered by the DPC may be eligible for reimbursement, but the patient will initially pay out of pocket for such services.
    • Most traditional concierge medicine physicians continue to accept insurance plans & government programs, & patient visits are billed in the traditional manner. If they are in-network provider, a concierge medicine physician can also serve as a patient advocate with outside specialists, hospitals, or other health providers.
  5. Insurance Deductibles:
    • If the DPC doctor is out-of-network, the annual fees a patient pays for membership or lab fees, etc., cannot be applied to their deductibles.
    • The annual fee a patient pays to a concierge medicine physician generally cannot be deducted, but any copays or related health costs can be deducted as the concierge physician is in-network.

References:

  • AAFP. (2018, January 4). Direct Primary Care. Retrieved January 30, 2020, from https://www.aafp.org/about/policies/all/direct-primary.html
  • Advisory Board. (2015, June 10). Concierge care for all? Why MDVIP thinks the model makes sense for execs, teachers, and truck drivers. Retrieved January 30, 2020, from https://www.advisory.com/daily-briefing/2015/06/10/interview-with-mdvip-ceo
  • Lipton, W. (2018, June 14). 10 differences between concierge medicine and direct primary care. Retrieved January 30, 2020, from https://www.physicianspractice.com/article/10-differences-between-concierge-medicine-and-direct-primary-care