Recently, a writer for an oncology publication asked me if there was an opportunity for the concierge model in oncology. While I described the challenges that would make such a program difficult, I realized that as long as some types of extended care and consultation are not covered under most insurance and government programs, a carefully designed membership model in oncology is theoretically possible.
Designing a concierge program that works in concert with the goals and characteristics of a specialty practice is like solving a puzzle: there are many parts and they must all fit together for success. An oncology practice has very particular challenges. But for other specialty practices, some form of a hybrid concierge program, where the specialist can have a membership-based program but also continues to see new patients who are not members, can make sense and be successful.
In primary-care concierge models, the physician extends his role from a service provider, to that of patient advocate. One physician we work with refers to his role as "the producer" of his patients' medical care. The concierge physician in primary care doesn't necessarily perform all of the services but he helps patients deal with the various elements of specialty care and other medical services a patient may need. Physicians are more than a referral service—they are integral part of the "show."
Specialty care has characteristics that require a different approach. While oftentimes specialists are trained in internal medicine, they don't usually perform the services of a primary-care physician, they remain focused in their specific field. However, many patients who are managing chronic medical conditions see their specialist on an ongoing basis. As a result, that specialist may become her patients' most trusted adviser on many medical issues. Patients rely on her for advice, counseling, and emotional support.
In the past, specialists were able to offer these extra services; the cost of this time and attention was compensated by the fees that they received for procedures and encounters. However, today, in many areas of medicine, those fees are dropping rapidly. The reality is that while most specialists would love to spend more time with their patients, it can become economically impossible to perform these services. But we have found that patients of specific specialty fields still want a deeper relationship with their specialist and are willing to pay for it.
So how does a specialist put the puzzle pieces of his concierge program together? Each puzzle piece is a question that must first be answered:
1. What are the non-covered services I can offer that form the basis of the membership program?
2. What would be expected of me, the physician?
3. Does my specialty work with this model?
4. How much time would I need to spend per member?
5. What price would my patients be willing to pay for those services?
6. Are my patients actually able to pay those direct fees?
7. Would the retention rate of my patient panel make the program feasible?
8. How would I maintain a good relationship with my partners, payers, referring doctors, and my other patients?
9. How would I market the program?
10. What exactly would the program do for my practice and me?
So far, we have been able to solve these puzzles for cardiologists, endocrinologists, pulmonologists, gastroenterologists, gynecologists, and rheumatologists. These specialists have practices with the key characteristic that makes for a successful hybrid concierge program: ongoing relationships with a solid percentage of their patient panel. By introducing a hybrid program, they maintain a constant flow of new patients from referrals, consults, and episodic care, but they also can tap into the deeper, ongoing patient-doctor relationships they have cultivated.
While there are many specialty areas that can benefit from a hybrid concierge program, perhaps it is isn't quite right for all. In oncology, where there is a need for much support and help, sometimes there are concerns and unique complexities. Before a specialist, particularly one in a field like oncology, decides to move forward with a hybrid program, it's important to get clear, unbiased feedback.