Concierge Medicine and Value-Based Healthcare

March 12, 2015

The new focus on value-based reimbursement models has some wondering just where and how concierge medicine fits into the new paradigm.

In the past, providers of healthcare services would usually win battles over payments; they provided the skill and service; they received the revenue. Today the pendulum has shifted; the system favors those who pay for the services indirectly - the government and insurers.

The motivation for payers is understandable, considering what we pay for healthcare. The socially acceptable goal is simple: to reduce healthcare costs while increasing quality in a system that is comprised of many fiefdoms, all fighting for their piece of the pie.

The current approach to paying providers is about much more than cutting individual reimbursements. It starts with gathering information and defining "quality," and from that, moves on to rewarding "performance."

While this approach has many challenges and some regard it as a game of smoke and mirrors, it is clear that the pie is basically fixed. Everyone who enjoys a piece of it has to earn it by cost reduction and meeting the new value-based reimbursement methodology. Such systems rely heavily on data analysis, transparency, and the development of large healthcare systems that will ultimately have to be controlled by government or quasi-government standards.

So where does concierge care fit into this large-scale change in the provider environment?

In a "free society," an obvious result of this change in approach is that the private healthcare sector will grow to meet the demands of those who are not satisfied with the ongoing transformation of healthcare. A small, but important segment of the delivery system will address the sector of business that is dedicated to this demand. However, concierge care is not just about non-participating physicians; it is about creating an environment that is different from the third-party-based environment. Some of the forms of concierge care even bridge the two disparate markets.

For years, providers promoted their practices as "better" than their competitors. They said that their physicians were better, their facilities were better, their staff was better, or anything else to distinguish themselves from their competition. Today, standardization is the new direction of healthcare. Practices now have a greater reliance on midlevel providers, less mapping to one physician, more vertical integration, and more direct and indirect limitations on the care that is offered and provided to patients.

Concierge care is about changing the environment in which physicians deliver care. It is about changing the nature of the relationship between physicians and patients. The economic relationship does not constrict face time with patients, but rather increases that time. In addition, it changes the role of the physician from caregiver to partner in the process.

This can only be accomplished by consumer driven payments - an alternative to the standard or value-based system. While the standard system may deliver good care, there are a significant number of people who want a style of care that is more personalized. By this, I do not mean treatment that is personalized to each individual patient, as in cancer treatments based on one's biomarkers, but rather care that stresses a one-to-one relationship between a patient and his doctor.

While some concierge management companies make claims of improvement of care, the company that I work for does not make such a claim. Our patient satisfaction is measured by rate of renewals and in surveys that speak to program satisfaction. Rather than claim an improvement in care, our programs can boast a proven improvement in patient satisfaction. Concierge medicine is a consumer-driven product; our customers demonstrate their satisfaction through their participation.

The changes in healthcare today are driving a polarization toward private care as well as larger systems to deliver standard care. The variety ensures that patient needs can be met in different ways, and hopefully, expand the quality of and satisfaction with the care that they receive.