For members, the doctor is in
Patients get what they pay for with Member Plus Family Health Care. What they pay for — in the form of an annual membership fee — is the assurance of access to their doctor whenever they need it, longer appointments when they come to the clinic, and overall a closer personal relationship with the doctors and clinic staff who actively communicate with patients to make sure they’re following a preventive health care plan.
Crandell said the biggest appeal of the Member Plus model — sometimes referred to as “concierge medicine” — is the opportunity for more interaction with patients. The membership fees make it possible for the doctors to see fewer patients and devote more time to them.
“Honestly, it’s about the time … the fact I don’t feel so pressured to shuffle patients through the door,” he said.
Where a traditional family practice has 1,400 to 1,600 patients per doctor, Crandell said Keyes tries to keep that between 600 and 800 at Member Plus. The practice model that he’s developed “is about getting to know his patients better, and take better care of them.”
A recent example was Crandell coming in to the clinic over the Labor Day holiday weekend to treat a patient who had a skin infection. Often the only option for someone in that situation would be an expensive emergency room visit.
But for a Member Plus patient, “As far as insurance is concerned, it’s billed as a routine office visit,” Crandell said.
The clinic’s membership plan, which also includes a secure portal patients can use for online access to their medical records and other health care information, is not a replacement for health insurance. However, Keyes said the enhanced access that members pay for helps ensure better outcomes for patients and may even result in lower overall health care costs over the long term if patients need fewer specialist visits and hospital stays.
“The concept is we would be able to see everybody on the day they need to be seen,” explained Keyes, who also reserves one afternoon a week to make house calls. “It’s a little higher level of service.”
They can even help patients who aren’t able to come in to the clinic, such as students away at college who are covered under a family membership. “We’re in the process of restructuring our fee schedule so it will be more affordable for younger people,” he said.
The clinic offers a College Guardian program for $15 a month, and members can call any time to consult about a medical concern. It may be an urgent matter that requires a trip to the emergency room, or it might be treated simply with a doctor’s advice dispensed in a phone call.
For example, Keyes said one of his patients has a daughter in Ohio who could have avoided an unnecessary ER visit.
“She wasn’t part of our practice, and she incurred a huge bill for what we probably could have solved over the phone,” he said.
The two Member Plus doctors had known each other for several years before Crandell left Bainbridge Island in 2012 to spend a year at a family practice in rural New Zealand.
“I was interested in experiencing medical care outside the U.S., and I wanted to give my family an experience with life and culture outside the U.S.,” he said.
Crandell had filled in at the Bainbridge clinic when Keyes was on vacation, so when Keyes decided his growing practice needed a second physician, he knew Crandell would be a good fit and called him in New Zealand.
“He does a remarkably good job, and the patients loved him,” Keyes said.
The model of concierge medicine — Keyes prefers the less-elite sounding term “direct primary care” — originated in Seattle in the 1990s. Before opening his Bainbridge clinic, Keyes spent a year working in such a program at Virginia Mason Medical Center.
“They were doing it at a higher cost, and I thought there was a niche for doing it in a more affordable way for more people,” he said.
At Member Plus Family Health Care, annual memberships range from $120 to $780 and can be paid for in monthly installments of $10 to $65. Membership provides enhanced access, but the clinic bills patients’ insurance for the cost of their care — office visits, procedures, etc.
Virginia Mason, which has a clinic on Bainbridge Island, pioneered a concierge medicine program called the Lewis and John Dare Center. Membership is much more expensive: $750 quarterly for an individual or $1,250 for a couple, and members may add children ages 18-25 for $500 per child. The Dare Center touts the benefit of access to a large staff of experienced doctors and top-flight specialists at a renowned medical center; its website notes the ability to “integrate you into Virginia Mason Hospital and Clinic Specialists.”
Unlike a private practice, a center such as Virginia Mason is restricted from bundling payment for medical services into its membership plan.
That’s a different model offered by private practices such as Seattle Premier Health, which markets itself as a concierge medicine clinic that charges a $2,500 annual membership fee. That fee, though, covers the cost of primary-care physician services such as an annual physical exam and other preventive care, urgent care for colds and common illnesses, and minor in-office procedures such as Pap smears and skin biopsies. Patients still need an insurance plan that covers major medical costs not included in the membership.
Keyes said his clinic’s direct primary care plan is a model that could be viable in places other than an affluent community such as Bainbridge Island.
“It can work well anywhere,” he said. “A lot of (patients) just perceive the need to have better access to a physician.”
The membership model in various forms is increasingly popular among physicians and patients. The American Academy of Private Physicians and other health care industry groups estimate there are 2,500 to as many as 5,000 doctors nationwide who have direct primary care practices, charging membership fees of $600 to several thousand dollars.
With Crandell coming on as a partner, Keyes changed the name of his practice to Member Plus and expanded the clinic into a separate space from the main office in the complex of buildings at 123 Bjune Drive near Eagle Harbor. Crandell is currently there two days a week, and works part time at the Virginia Mason clinic in Federal Way.
“We’re hoping to be busy enough to have Blain come on full-time,” Keyes said, adding that he’d like to add a nurse practitioner or a physician’s assistant to the clinic staff within the next year. “We’d like to bring on someone specifically for women’s health care.”
Being accessible to patients 24/7 may seem daunting, but Crandell said patients “respect our time as doctors,” and aren’t likely to call at odd hours unless it’s warranted.
“It hasn’t been that much of a drain to take calls,” Keyes said. “It becomes as if you’re never on call. It’s part of the service, what we consider to be our responsibility to our patients.”