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The term “concierge medicine” seems to be making frequent appearances in our healthcare conversations as of late, and if you have questions about it, you aren’t alone. A relatively recent trend, concierge medicine (also known as retainer medicine or executive medicine) is patient-driven, personalized healthcare that appears to be, in some cases, replacing a more traditional system of medicine. But what type of patient benefits most from this service? What are the associated costs, and are any of them covered by insurance? We asked a few concierge medicine experts and even a patient to weigh in and help us understand the ins and outs of this approach that seems to be rapidly gaining in popularity.

SB Note: For this article, we interviewed people who are either in the business of concierge medicine or partaking in concierge medicine. This in no way means that doctors running a more typical practice are not invested in their patients. But, a typical primary care physician sees over 30 patients a day and has 3,000 to 4,000 patients overall. A concierge doctor typically has 400 to 600 patients and sees 6 to 10 patients a day*. This article shows the contrast of these businesses from the vantage point of why concierge medicine is so appealing. [*source]

First things first, the concept of concierge medicine revolves around the notion of getting back to individualized care. It’s a patient-centric system that allows doctors and patients to spend more time together without health insurance restrictions. It evolved as individual practices found new and improved ways to survive outside of the insurance system, and it’s catching on in a big way.

“It gets back to individualized care and staying in more frequent touch with those patients who desire to take ownership of their health outcomes,” says Dr. Traci Poole, an associate professor at the College of Pharmacy at Belmont University with an extensive background in concierge medicine. “Health insurance does not pay for providers to spend an adequate amount of time with patients, whether that’s educating them on lifestyle choices or on medications and how to use them properly. Insurance gives us a baseline payment for our services; they don’t incentivize the additional time it takes to dig into individualized care. To do that, we offer this access at an additional cost.”

Woman holding pills and glass of water

If you’re looking for a more individualized approach to your healthcare, concierge medicine may be a good fit for you.

It all comes down to the quality of care and honing in on long-term solutions with a more holistic approach. “I think concierge medicine came about because patients wanted more from their doctors than the traditional model was providing,” offers Dr. Candice Burtner, Co-Founder and Co-CEO of My Functional Pharmacist. “It’s also because doctors wanted to give more to their patients than their current model allows — they see a better way to serve their patients. Plus, we have this new generation looking for a more personalized approach to medicine. There are new mindsets coming about.”

The concierge medicine concept doesn’t only exist within smaller, private practices. It’s extending to larger healthcare systems as well. “It started as some individual private practice people saying, ‘We can’t survive on the insurance and be the type of physician or provider we want to be, so we have to get creative and start these memberships,'” says Dr. Poole. “Now, the concept has spread. I think Vanderbilt has one now. The Frist Clinic in Nashville has one at Centennial, too, so this is a concept that’s taking off.”

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So, how did concierge medicine find its way into the mainstream? It started to appear before the pandemic, but COVID undoubtedly pushed it to the forefront, as demand for easily accessible care skyrocketed. It emerged from the state of our current, traditional system, which Dr. Poole describes as “utterly broken.” It’s also prompted by our desire for convenience.

“Our society is obsessed with convenience,” she says. “We’re a commodity. We saw that years ago with drive-through pharmacies, too. We no longer want to park, walk into a pharmacy, and wait 15 to 20 minutes for the pharmacist to fill our prescription and tell us about it. We want it yesterday. We want quality, we want it fast, and we want it cheap. People aren’t getting quality care anymore, and the system is broken, so they’re seeking anything they can to get that leg up.” Dr. Burtner agrees, saying, “The traditional model is so driven by insurance and the dollar that a lot of times our doctor’s appointments get squished into this short amount of time. The doctor and patient can’t cover everything. Or sometimes, people feel they need a more holistic approach to get to the root of a problem. Doctors started recognizing that they needed a different model. In some cases, that meant stepping away from taking insurance.”

That step away from insurance is one of the significant differences between concierge medicine and traditional medicine. While providers still submit some services through insurance, concierge medicine is often synonymous with cash payment.

“I think most of the providers are trying to get away from being controlled by insurance and having their decision-making for the patient’s care controlled by that insurance, too,” says Dr. Burtner. “Some models for concierge medicine have been set up to accept both so that providers get the most out of a patient’s insurance — through lab work or some of the easy things — but the majority of the larger things, such as the extra time they’re putting in for consultations, are cash pay. Some have it set up as a monthly membership, and you have 24/7 access to the doctor.”

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The idea of a healthcare membership is another break from traditional medicine. Most concierge medicine providers charge a monthly or yearly fee, including enrollment and access to additional services and longer care appointments. They also bill insurance where possible, so you aren’t coming out-of-pocket for every service.

However, many potential concierge patients get hung up on the financial aspect. “The only downside is the cost,” says concierge patient David about his own membership. “It was initially $1,500 annually. Now, it’s $1,800 annually for each of us. However, that can be paid with a Health Savings Account, so in reality, it’s two-thirds of the cost since income tax is not applied. Initially, it’s hard to justify the cost, but my wife and I feel that there are actually healthcare cost savings in the long run. It’s evident this will pay dividends from both a health and financial perspective.”

Dr. Poole admits that concierge medicine is tailored for people with disposable income, though she would love to see it have a broader impact. She also says the trick is doing due diligence in advance by thoroughly researching concierge medicine providers and asking the right questions. “Make sure that you’re getting the services you need, and the offerings are equal to the value you’re paying,” she advises. “I’ve seen up to $10,000 per year for concierge pharmacy services, and that’s insane. No pharmacist is doing so much work that you should pay them $10,000 upfront for the entire year. There’s a spectrum of costs, and it can be a little more expensive [than traditional medicine]. But generally speaking, I think it’s decently affordable.” Dr.Burtner agrees, adding, “I think that cost is one of the common misconceptions. People see it as a lot more expensive than it really is. When you get down to it and start comparing, most people will find that it’s not as expensive as they thought.”

Is Concierge Medicine Right for You

While concierge medicine may rely on patient insurance for certain things — lab testing, for example — many of the services afforded by a concierge doctor come at an additional cost.

So, who benefits most from concierge medicine? The general answer is anyone who wants extra attention from their health provider. On a deeper level, you should consider concierge medicine if you frequently travel and need medication refills or access to your doctor regardless of time zone and location, or if you have a large family for which you’d like to keep everything as efficient and streamlined as possible. Dr. Poole also says, “One of the untapped resources are individuals with complex disease states that they need to stay on top of. If you’ve got something that’s treated with several medications or requires lots of testing and monitoring throughout the year, you should think about a concierge physician.”

While the term “concierge” may carry associations to service professionals who can schedule everything from hard-to-snag restaurant reservations to theatre tickets, concierge medicine is slightly different. In fact, patients shouldn’t expect carte blanche access to their providers. “When you use the term concierge, a lot of people think that means they can get what they want when they want it, and that isn’t the case,” says Dr. Poole. “That’s not the intent of concierge medicine. The intent is to have a more personalized, patient-centered care, and to spend that quality time with each patient, so things don’t get missed and the system doesn’t neglect patients, which is a growing problem.”

While a concierge physician certainly affords you additional access, it doesn’t necessarily equate to the all-hours response that so many patients anticipate. “Concierge medicine has some misnomers to it,” admits Dr. Poole, “namely, that it’s full 24/7 access. Yes, that’s true, but it’s really about engagement. It’s about being accessible when the patient’s ready to engage … I think one of the misconceptions is that it’s an urgent emergent care model, and that’s not what it’s intended to replace. If you’re having a heart attack, you should still go to the emergency room; don’t contact your concierge physician. The biggest misnomer is that it replaces the visit and the required assessment. In my case, people often reach out asking if I can call them in prescriptions. I can’t do that over the phone or email. We still have to provide quality care.”

Nevertheless, there are some significant benefits. If you’re a concierge patient and you fall and break your arm, you can likely expect priority treatment and a same-day appointment. In fact, despite any misconceptions, David says he has been pleasantly surprised by the level of access to his concierge physician.

Although it was a selling point on the front end, we were surprised at how accessible our doctor became after the switch to concierge,” he says. “What had previously been the typical weekend call with symptoms of illness turned into immediate access to our doctor all the time. An 8 a.m. fever on a Sunday with a request for medical response and medication suddenly became a text straight to our doctor rather than an answering service and immediate response. Because of the close relationship that we now have with our doctor, including annual, in-depth physicals and other check-ins, he understands our health status and typically responds within an hour.”

Though you may not be able to rely on a concierge physician for more severe needs such as surgeries or hospitalizations, it’s clear that this new system is a strong contender for those looking for a more customized approach to medicine. For more information about whether or not concierge medicine is a good fit for you, you can contact Dr. Burtner at myfunctionalpharmacist.com for virtual assistance or check out mdvip.com and partnermd.com for more information about a concierge physician near you.

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