Business

BUSINESS: The 2 Basic Models Used In CONCIERGE MEDICINE and DIRECT Primary CARE

By Michael Tetreault, Editor-In-Chief

JUNE 3, 2013 – There are typically two basic types of concierge medicine or direct primary care business models practiced today. Variations of these business models exist and although the average fees range from $1,200 – $1,800 per year, most models usually fall into one of the following categories.

FEE FOR CARE (FFC) MODEL (Direct Primary Care Model)
Sometime called the ‘FFC’ or ‘Retainer’

An annual retainer model, where a patient pays a monthly fee, quarterly or annual retainer fee to the physician. The retainer fee covers most services provided by the physician in his/her office. Often, vaccinations, lab work, x-rays and other services are excluded and charged for separately.

Benefits and services typically included in the contract between the physician and patient may include: same day access to your doctor; immediate cell phone and text messaging to your doctor; unlimited office visits with no co-pay; little or no waiting time in the office; focus on preventive care; unhurried atmosphere; free cell phone, text message and online consultations, prescription refills; convenient appointment scheduling and more.

Many FFC or Retainer plans may be purchased with pre-tax dollars utilizing HSA and/or FSA accounts attached to patients’ insurance plans. Please note, these programs are not an insurance company or product. Each patient should check with their physician to find out what services are included in their individual membership. These are only examples of some of the typical services provided.

Related Article … The Difference Between Concierge Medicine and Direct Primary Care >>

FEE FOR NON-COVERED SERVICES BUSINESS MODEL
(Hybrid)

A Hybrid concierge medicine practice is where physicians charge a monthly, quarterly or annual retainer or membership fee for services that Medicare and insurers won’t pay for. These services include: email access; phone consultations; newsletters; annual physical, prolonged visits and comprehensive wellness and evaluations plans. They bill Medicare and insurance companies for patient visits and services covered by the plans.

What Is Direct Primary Care?

Direct primary care (DPC) is an emerging model that has gained some attention nationally in recent years. Sometimes referred to as ”retainer practices,” DPC practices generally do not accept health insurance, instead serving patients in exchange for a recurring monthly fee — usually $50 to $80 — for a defined set of clinical services.

Related Article … The Difference Between Concierge Medicine and Direct Primary Care >>

Collectively, direct primary care (sometimes linked to the term concierge medicine) has more than a half million people on their rolls, according to the California HealthCare Foundation. They highlighted five large direct pay practices that use the retainer model in an April 2013 report. These direct primary care patient rosters are estimations:

  • Iora Health, with 2,400 patients
  • MedLion, with 3,000 patients
  • Paladina Health, with 8,000 patients
  • Qliance, with 7,200 patients
  • White Glove Health, with 40,000 patients via self-insured employers and 450,000 via health plans

Direct primary care providers help keep costs low by avoiding unnecessary referrals and by referring mainly to specialists willing to offer significant discounts. Despite this advantage, the DPC model may be hampered by low awareness among health plans and primary care physicians, resistance from some insurers, and resistance from competing hospitals and specialists.

RELATED ARTICLE …
Services Offered To Patients At A Typical Concierge Medicine PRACTICE

RELATED STORY …
BUSINESS: Getting Your Concierge Medicine Practice Past Start-Up

PHYSICIAN SELF-TEST:
Please Tell Me If I (or my practice) Would Be A Good Fit For A Direct Care, Concierge or Private-Pay Medical Practice Model.

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