February 3, 2014 • By Mary Rowland
It’s probably time to look more closely at what is called “concierge medical service” or “direct primary care,” among other labels. Not all such practices label themselves in the same way, nor do they offer comparable services, making it difficult to compare them. Shopping for this type of plan by price is a worthless endeavor. That’s like shopping for a car by price and learning that a Smart Car costs a lot less than a Bentley.
Like many things we buy, such as whole life insurance, buying the cheapest product usually means you are getting the lowest benefits. And there’s probably no other place where the range and quality of benefits are broader than in the concierge health-care marketplace. I found no two practices that were exactly alike, although I certainly didn’t talk to all the concierge firms. Not by a long shot.
Analyzing products and services to find the best option for your clients’ needs is one of the most valuable services a financial advisor can provide. Prices differ widely and so does coverage. The label “concierge” gives the impression that these services are only available for the rich. But if that’s ever been true, it is rapidly changing. Most practices now offer a range of services from near-total coverage to scaled-down services for those who can’t afford a concierge.
An article in The Wall Street Journal on November 10 said that there are an estimated 5,500 concierge practices nationwide and that about two-thirds charge less than $135 a month on average, up from just 49% three years ago, according to Editor, Michael Tetreault of Concierge Medicine Today. Another incentive to look to the “concierge” alternative is the clause in the Affordable Care Act that allows direct primary-care to count as insurance compliant with the ACA, provided it is bundled with a wraparound catastrophic medical policy.
One of the best reasons to help your clients find the right policy is that it much improves the clients’ risk profile and creates a solid bond between advisor and client. Many—if I had done an actual poll, I think I could say “most”—of these practices do not accept insurance. Eliminating insurance billing cuts 40% of the practices’ overhead expenses, enabling them to keep fees low, doctors say. But one of the largest, MDVIP, founded 12 years ago in southern Florida, takes both insurance and Medicare. MDVIP now has 700 doctors and 200,000 patient members. The practice serves members “from Maine to Hawaii,” according to Dan Hecht, CEO. Ninety-four percent of these members renew every year. Like the other practices, MDVIP screens doctors and “nine out of 10 we don’t accept,” Hecht says.
To me, the screening of doctors, which most concierge practices do, is a big benefit. At MDVIP, “the doctor receives the bulk of the concierge fee,” which runs from $1,500 to $1,800 a year, Hecht says. Each new patient selects a primary care doctor in his or her location from the list of 700 physicians and meets with that doctor for one and a half hours to get a complete executive physical, which is covered by the plan and might cost $1,000 otherwise. The results are sent to the Cleveland Heart Lab at the Cleveland Clinic, which prepares a detailed report along with recommendations, ranging from seeing a heart or cancer specialist to starting a gluten-free diet and everything in between. If the recommendation is for a gluten-free diet, the patient would be given a gluten-free menu and even a week’s shopping list to get the necessary supplies.
The annual fee does not include visits to specialists. So each member must have a wraparound catastrophic insurance policy. After this first visit, this primary care doctor will see your client once a year for 30 minutes; the visit will start precisely on time. When Hecht became CEO of MDVIP four years ago, his financial planner “was so excited because she was already a member of MDVIP,” Hecht says. As with many other services, members can be seen by an approved local doctor wherever they travel.
MDVIPhas 14 “medical centers of excellence” such as the Mayo Clinic, Johns Hopkins, the University of Texas, Memorial Sloan-Kettering and the Cleveland Clinic. I am providing all these details about MDVIP not because I have judged it to be the best available plan for everyone but because it accepts insurance and Medicare, which is a rarity in this health-care sector and I know that would be a valuable benefit for some of your clients. Concierge doctors also negotiate with specialists and labs to secure discounts for patients who would otherwise pay out of pocket.
When I started reporting this article, I was a skeptic. But talking with these doctors and CEOs helped me realize how much pain and anxiety I might have avoided had I been a member of one of these practices. That’s particularly true of the access to specialists. For example, when our 6-year-old daughter developed a blinding eye disease, we went to the nearest emergency room in the middle of the night where the on-call doctor called her situation “modified bliss,” quoting The Mikado, because she was not dead. He had no idea what was wrong. Neither did the next six pediatric ophthalmologists we saw in Manhattan.
It was not until we found Dr. Michael Weiss, a uveitis specialist at Columbia Presbyterian Hospital in New York, that we could even put a name to the disease. Weiss treated her for 20 years until her health plan in Boston would no longer cover his care and then it was like starting over again. And when I was attacked on Fifth Avenue in Manhattan and crushed my hip, I had it wired together in the nearest emergency room. I wonder if I had been a member of one of these groups, I would still have needed two more hip replacements and endured continuing pain for nearly 20 years.
So one of the many benefits that attracted me to PinnacleCare, one of the earliest and most distinguished in this broad field, is their research department. Certainly, PinnacleCare is not unique in gathering detailed patient data. But it may be unique in the extent of that service. As a PinnacleCare member, your client has access to a doctor 24/7 anywhere in the world.
If your client is traveling and has an emergency medical condition, PinnacleCare will tell your client which doctor to go to and furnish that doctor with necessary background information.
Dr. Miles Varn, chief medical officer, gave this extreme example to The New York Times in October 2007: “A member began to experience heart palpitations while on a business trip in China. I called the hospital; arranged for a translator, who was there on arrival; and followed that with faxed medical records within minutes. The patient was seen immediately. His EKGs indicated an acute heart attack. I reviewed faxes of the EKGs with a Chinese-speaking cardiologist at Johns Hopkins University and confirmed the diagnosis. The particular hospital was not equipped to handle an acute heart attack, so our team arranged emergency air evacuation.”
Bruce Spector, founder and CEO of PinnacleCare, set up the company when he realized his family office had advisors for many risks in life, such as financial risks, but none for health care. Spector, a serial entrepreneur, sold his earlier three ventures “very successfully,” he says.
Spector gives this example of how the service spreads quickly once a company recognizes its value: Ten years ago, Northern Trust contacted PinnacleCare to work with a group of a dozen family office executives with over $1 billion in assets each. Most of these family offices joined PinnacleCare. Northern “took note of that,” Spector says, and soon offered the service to its financial advisors as a service for other clients. Effective January 2014, every employee of Northern Trust—there are more than 8,000 of them—is covered by PinnacleCare.
Although the company is 13 years old, it began to work with employers only two years ago, according to Varn. Employer plans are less broad and more affordable. In the wake of the Affordable Care Act, many practices have designed different levels of coverage as well as offering employer-based plans, which the employer pays for or offers to employees at a lower cost. In fact, it is the concierge plans that are less costly that are fueling much of the growth in concierge medicine. Some employers pay for the service for employees; some offer it to employees at a cost of perhaps $30 a month.
Qliance, in Seattle, offers primary care through seven clinics, chiefly in Washington state, for a flat fee of $59 to $99 a month, which includes all the services that the clinic offers. The clinics offer seven-day access for services like basic checkups, treatment of minor ailments and electrocardiograms or EKGs.
Qliance serves large companies such as Expedia (READ FULL STORY …). The company was founded in 2007 “with the goal of making a practice that would work for the wealthy and the nonwealthy,” according to Dr. Erika Bliss, CEO. Qliance doubled its membership to 20,000 on January 1, 2014. “We are trying to do the bread and butter of primary care,” says Bliss.
One other area financial advisors should look at carefully is the use of flexible spending accounts, where individuals are allowed to set aside up to $2,500 in pretax dollars to pay for eligible medical expenses. Originally, these dollars were subject to a “use it or lose it” rule, whereby any money left in the account at year-end would be forfeited. In October 2013, the U.S. Treasury Department changed that rule to allow employees to roll over up to $500 into the next plan year. Some doctors told me that concierge service fees are not eligible for FSA dollars. Others said they were. It may depend on the type of service you are contracting for. Hecht at MDVIP says, “Tens of thousands of our members use FSAs.”
What I have described is only the tip of the iceberg in this field. Yet I’ve decided to look further into these services myself. The vetting of doctors and specialists is one of the chief reasons that the idea appeals to me. As well as the service’s ability to include doctors across the spectrum of medicine, whereas with a typical practice, doctors are likely to refer to a specialist who works at the same hospital, partly because these are the doctors he knows best. “If your primary-care doctor (in a traditional practice) is at Mount Sinai, the specialists he or she gives referrals to are other doctors at Mount Sinai,” says Hecht.
Regardless, researching these plans for your clients could become an important part of due diligence. A new year is a good time to start. So get going!