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Does One Size Fit All in Concierge Programs?


The recent changes in healthcare are starting to create more uniformity in healthcare models; but do we still need options for MDs and patients?

In business, companies often try to create a single-service model, a "solution" made for all, and they fit clients into that box as though they were selling a franchise. Consultants often follow the same path - finding an avenue that has worked and sticking with it. The uniformity of this approach creates opportunities for cost savings and predictability.

The healthcare landscape is no different. With all the new regulations and challenges in medicine today, it is not surprising that medical practices are being forced into more homogenous models. However, when it comes to implementing a successful concierge program, which often fits under the broad category of a "membership" model, it is important to remember that your practice and your patients are unique. There are many needs and approaches that should be considered.

However, for vast swaths of the healthcare marketplace, this emphasis on choice is not the norm. Patients today are often forced to pick a physician - not based on what aligns with their health concerns - but from a list of names. While it was not necessarily the intent of HMOs to depersonalize physicians, in this manner, they actually did.

It's because of the ongoing march of "big box" and impersonal healthcare that concierge medicine is starting to win over more patients and even some skeptics. It simply better meets patients' needs and preferences. It's important to note that concierge patients don't want the perks - what they want is the personalized experience and relationship with their chosen physician - the doctor drives participation.

In concierge programs, each physician has a different style and area of experience. Some physicians focus on the benefits of nutrition, exercise, or sleep. Others deal heavily in gastric issues or sports medicine, for example.

We think that patients should have some control over what they pay for and that physicians should be able to deliver the care they deem appropriate. This is the consumer model of services.

Concierge medical care is a market-driven product, meaning it is driven by demand for the product, and also the economics of where it is located; just like a hot dog is far more expensive at a ball park than at a fast food outlet. A competitive environment shapes true consumer-driven healthcare, particularly when there is a shortage of providers, leading to price variations from place to place.

The patients' wants and needs are different as well. Geriatricians have significantly different demands placed upon them than family practitioners have. Patients in rural areas who travel a long distance to see their chosen physician may have different needs than urban patients. For example, some may value the 24-hour availability of their physician due to chronic health concerns, others to avoid a long, perhaps needless drive to the office.

Also very different are the motivations, concerns, and goals of physicians who start concierge programs. Some physicians do not want to give up patients, while for others, scaling back their patient panel is most important. Some doctors work at a frantic pace while others are slower and more contemplative. Some do not mind being connected to their patients at all hours, while others hate the idea of 24-hr coverage. Some are nearing the end of their career and are looking to extend it, others have family obligations that limit their time.

The value proposition can also vary in the membership model itself. As a patient, are you just paying an access fee? Is it an administrative fee? Do you get to be a part of a smaller practice? Do you see the doctor or do you see the mid-level assistant? Do you have to have an annual visit or is it just a retainer? Do all the services get covered under one fee or do you pay for the follow-up services? Does an annual fee for all of the services give you more than just a bundled fee? What exactly does my membership fee cover?

The only characteristic that is common to all membership-model approaches is that practices look directly to patients for compensation. But within your practice, how a membership model actually works should be structured with your practice and your goals in mind - not necessarily a one-size-fits-all model.

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