CARLIN, MD: Telemedicine may be the key to concierge medicine’s success.

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To date, concierge medicine has been largely the domain of physicians, but as cost pressures continue to squeeze hospitals and health systems, it’s only a matter of time before these entities get in the game. Physicians need to get ready.

Hospitals and health systems have refrained from entering the concierge medicine market because of a societal perception that the healthcare delivery model provides better care for those who can afford it and leaves those who can’t to settle for lesser quality care. But soon that hyper-sensitivity will go away. Here’s why: intense, relentless cost pressure. You think it’s bad now? It’s going to get brutal as hospitals and health systems fight to survive.


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We are already seeing signs of the survival battle. Many hospitals have been acquired and have become part of large health system networks. And hospitals and health systems are starting to cut out the middlemen – insurers – by expanding into insurance themselves.

At some point, there won’t be anything left to consolidate and they’ll have taken all the large measures they can, but the cost pressures will still be there.

When hospitals and health systems hit that tipping point, they will look around for marginal dollars and they will set their sights on concierge medical practices, which will have grown as patients – particularly those of the baby boom generation – tired of waiting to see their doctor and became willing to plunk down their $1,200 a year to join a concierge medical practice where they will at least be sure to have their calls returned.


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While some hospitals and health systems will have recognized the concierge medical practice potential early – for instance, Duke Medicine, which is already in the market – most will have waited too long and will find the market dominated by private practices.

This will leave hospitals and health systems with essentially two options: They will buy private concierge practices much as they have purchased private specialist and primary care physician practices and/or they will put pressure on the insurance companies to shut out those private practices that refuse to be bought.


Stanford Concierge Medicine Program

Maybe this scenario is five years away, maybe 20, but it is coming. How can physicians best position themselves now to take advantage of this further consolidation of the markets? They can give themselves an edge by advocating for and preparing themselves for a whole new disease management model – continuous, incremental chronic care treatment through telemedicine.

cmt selft test 2015Under the scenario of a consolidated healthcare market where the hospital network is both the insurer and has a geographic monopoly, the health system’s net revenue will depend on its total premiums collected minus cost of care delivery. The lower the cost to deliver care, the better the bottom line.

Keeping the costs of care delivery down means emphasizing prevention, and for that they’ll need physicians. But with the physician shortage there will not be enough physicians to handle the load. Hospitals and health systems will need an affordable alternative to achieve their economic and care goals. The solution is a continuous care telemedicine model.

Because of the structure of concierge practices, physicians in concierge medicine today are uniquely positioned to champion such a telemedicine model now.

In the short term, a continuous care telemedicine model will help them earn more as physicians begin to be paid based on their outcomes rather than by episodic core event. Based on the frequent capture of key biometrics (blood pressure, glucose, activity, weight), such a telemedicine model allows physicians to actively monitor their patients and make incremental adjustments to treatment plans that will result in better patient outcomes and keep patients from needing care that is more expensive to deliver. It goes without saying that such a level of care is better for patients, too.

Improved outcomes through telemedicine will re-empower physicians because they will be able to achieve the sense of healing and effectiveness that got them into medicine in the first place. And they will be leading the way in the healthcare market’s changing dynamics, which will put them, in the long term, in a position of strength when hospitals and health systems come knocking.

Daniel Carlin, MD, is the chief executive officer and founder of WorldClinic, a concierge telemedicine company based in New Hampshire with offices also in New York. A former chief medical officer in the U.S. Navy and refugee camp physician with training in surgery and emergency medicine, he currently holds a consultant-staff appointment at Lahey Hospital and Medical Center in suburban Boston and is a frequent speaker to medical and international development audiences.


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