By Michael Tetreault, Editor in Chief
One of my favorite quotes comes from Jeff Bezos, founder and CEO, Amazon. He said …
“Because, you know, resilience – if you think of it in terms of the Gold Rush, then you’d be pretty depressed right now because the last nugget of gold would be gone. But the good thing is, with innovation, there isn’t a last nugget. Every new thing creates two new questions and two new opportunities.”
Nothing could be more true about retainer-based, Concierge Medicine practices that gave rise to Direct Primary Care (DPC) practices. Also true is where Retail Healthcare Clinics compete with Urgent Care Centers (UC’s) and NP-led clinics are rising up to use telehealth and technology inside house calls. These innovative business models in healthcare are quickly becoming the new alternative to the traditional, managed care, insurance-based primary care offices.
“What’s attracting retailers and other companies from the outside is the financial opportunity,” said Mark Grube, managing director of Kaufman Hall, an Illinois consulting firm. “Retailers have left it alone for decades, but now they see opportunity because traditional providers have not always been responsive to the changing needs of consumers, which creates opportunities for others to step in.”* (*Source: Boston Globe, August 7, 2015)
As many of you already know, The Direct Primary Care Journal and our sister publications, Concierge Medicine Today, The American Journal of Retail Medicine and Concierge Medicine Canada have recognized the need for an alternative to traditional medical practices for a long time now, and as such, we have enjoyed advocating and championing the rise of free market healthcare delivery business models, as well as Cash-Based Surgery Centers, hospital-based executive health programs and other free market healthcare delivery sectors quickly emerging within the Free Market Healthcare marketplace.
Retail Healthcare Clinics, similar to Cash-Only Clinics and U.C.’s are something the general public hasn’t come across unless they specifically tracked them down, visited their local pharmacy or required non-emergency healthcare services.
Pharmacy, you should know, has a lot to do with these growing sectors … but that’s a story for another day. ~Catherine Sykes, Publisher, Concierge Medicine Today, The DPC Journal, American Journal of Retail Medicine
Consumers are increasingly looking for faster and more convenient options to get basic medical care, and retailers like CVS, Walmart, Target, Walgreens, Uber and others are filling the gap with walk-in clinics and other services. That’s forcing traditional health care providers, from small doctors offices to big hospitals, to react.
The Surge and Sudden Growth Of Retail Healthcare In Recent Years.
As the name suggests, Retail Healthcare Clinics are literally healthcare clinics that operate in a retail storefront setting, often inside a larger retail center which has a pharmacy inside the building.
According to Drug Store News, even Walmart has been quietly piloting its Care Clinic model, with 17 clinic openings in 2014 across several markets, including Texas, Georgia and South Carolina.
According to The Boston Globe,
“This represents a huge paradigm shift in health care,” said Normand E. Deschene, chief executive of Wellforce, the parent company of Tufts Medical Center and Lowell General Hospital. “The systems that are going to succeed are those that are going to embrace it because this is what the consumers want. Most industries follow what their consumers want. Health care should be no different.”
More options are generally good for health care consumers. But some experts are concerned that care will become more fractured and less coordinated if patients seek services at many different places. And it’s unclear whether this shift will lead to lower costs.
In Massachusetts, CVS leads the pack of retailers moving into health care. The Woonsocket, R.I., company operates 1,000 MinuteClinics in 31 states, and expects to add 500 more by the end of 2017. It dominates the retail clinic market in Massachusetts, with 58 clinics here. MinuteClinic revenue increased 21 percent in the quarter ended June 30, compared with the same period last year.
Rob Lazerow of the Health Care Advisory Board recently cited …
“Our research team is seeing two more profound applications of “retail” in health care—the emergence of a new retail insurance market and growth of retail shopping for care. For hospitals and health systems, these versions of retail prove much more disruptive than the clinic variety.”
Also, Priyanka Dayal McCluskey and Taryn Luna recently wrote …
Even supermarkets are joining the mix. The parent company of Stop & Shop has deployed nutritionists to many stores, including the one in Chelmsford. It has trained hundreds of pharmacists to help people with diabetes take their medications correctly and eat healthier diets, and is even running some classes to counsel diabetics on managing their disease.
If Stop & Shop’s pharmacy customers keep their chronic diseases under control, the company gets higher payments from insurers, said Brad Dayton, vice president of pharmacy for Ahold USA, the parent of Stop & Shop.
“We’re in a unique position,” Dayton said. “Our stores are food stores, plus we have the health and wellness capability. We’re able to combine that.”
Of the four most popular Free Market Healthcare Delivery sectors emerging today, the term “direct primary care” and/or “direct care” according to Google Trends Consumer Search ranks fourth on the list of the growing free market healthcare delivery search sectors.
Consumer search trends according to Google Trends related to “Direct Primary Care” and “direct care” are growing free market healthcare delivery terms used to describe primary care and family physicians operating across the U.S. who typically, do not accept insurance and on average, charge low monthly fees between $35-$99 per month per patient for a particular set of primary care services. While the data indicates that the search term is popular among physicians, its brand name awareness among consumers struggles. Virtually non-existent among consumers before November of 2010, according to Google Trends, it remained in the public eye for about 7 months and then almost entirely disappeared. Nearly a year and half later, the term(s) appeared again on Google where it has remained.
In summary, not all Direct Primary Care practices are concierge practices, and not all concierge practices are Direct Primary Care practices. The terms are not synonymous. The key to differentiation is whether or not a third party payer is involved. If not, then the model is a direct pay, or Direct Primary Care model, no matter what the fees.
Although there are currently less than 300 (SOURCE: DPC Frontier, 2015) identified or ‘branded’ DPC Clinics in the United States alone, they continue to be an almost underground success. With all the changes in medicine today and the increasing move toward value, DPC is a definite and increasingly valuable part of the answer to decreasing cost and improving quality, particularly in primary care and family medicine. Although predicting the future is difficult, it looks bright for the new sector of DPC Medicine.
It’s important to note that since federal registration is not required nor is DPC or Concierge Medicine considered a categorical specialty on their own, these figures are an approximate count of the “true” and more accurately described “full-service” Membership Medicine clinics/practitioners (MMCs) operating across the U.S. from 2007-2015.
It is also important to note that industry physician surveys, investment analysts and industry experts tell The DPC Journal, that they believe that there are an additional 6,000 physicians who practice some form of Membership Medicine (i.e. Concierge Medical Care or DPC) across the U.S. at this time equating to a total of approximately 12,000 MMCs in the U.S. — representing a total of less than 6% of all licensed primary care physicians in the U.S. (2014).
Another way to to look at in perspective, is these 12,000 MMCs represent just over 1% of all licensed physicians in the U.S. across multiple specialties. According to the most accurate observers and news reports in recent past, we caution that exact numbers are hard to come by. But the shift has been gradual, as has the positive data coming out of the MMC marketplace and use and acceptance by consumers.
“We believe — and this is after years of verifying doctors, talking with actual doctors, talking with business leaders, and talking with physicians who are influencers — that there are those physicians who are verifiably, actively practicing some form of Membership Medicine in the U.S., with probably another few thousand practicing under the radar,” Concierge Medicine Today tells CNN Money and CNBC in an in-depth interview earlier this year. “Many physicians don’t want to draw attention to themselves and prefer keep a low profile. Right now, far more traditional doctors are telling surveyors that they plan to switch than actually appear to be doing it.”
Concierge practices composed exclusively of concierge patients (most practices include a mix of concierge and traditional patients) generally limit their panels to 600 or fewer patients per physician. Direct Primary Care practices, because they charge a lower fee, need more patients on their rosters and can typically have about 700-1000 patients, according an analysis by Medscape in May of 2014. As the writer of the Medscape articles adds, ‘The distinctions between concierge medicine, private medicine, and direct primary care may be ultimately meaningless, since some doctors call themselves whatever they feel sounds better, and there are so many practice variations, many overlapping, that it often isn’t clear which is which.’
BUSINESS MODELS: A Simple Look at the Best Corporate Structure for Your DPC Practice.
Dr. Cory Annis, an Internal Medicine and Pediatrics physician who recently transitioned her practice from fee-for-service to Direct Primary Care who spoke recently (Summer 2015) at a Direct-Pay Medicine panel at the Pri-Med Southwest Conference in Houston, TX, said the name “Direct Primary Care” doesn’t do justice to the concept or explain it very well to patients. She makes an analogy between DPC and Community Supported Agriculture (CSA), where consumers purchase “memberships” in farms and receive a share of fruits and vegetables in return. She also uses the term “Blue Collar Concierge” to describe DPC to her patients. Read this full interview here.
Another related search on Google Trends reveals that the term “Concierge Medicine” was also nearly non-existent before October of 2006. The trend climbed significantly until November of 2013, when it skyrocketed due to 6-month, in-depth analysis by The Wall Street Journal with significant content and research contributions contributed by Concierge Medicine Today, Qliance, MedLion and several other Concierge Medicine and DPC physician practices. In addition to this popular story and national press coverage, Fox News, The New York Times along with hundreds of other media outlets, Concierge Medicine is maintaining and increasing its popularity and rising among consumers.
Until a certification program becomes more widespread, these numbers will continue to be approximations. Given these variables, modern-day variations in the business models and the ill-defined nature of these healthcare categories defined within MMC, it is impossible to calculate an exact number. However, these figures were assimiliated from 2007-2015 and come from the largest database of Membership Medicine physicians and clinics which has been assembled by The Concierge Medicine Research Collective, a geo-coded Masterfile database which began in 2007. This Masterfile database is an accumulation of industry interviews from expert sources; prominent medical school university surveys (2009-2015); as well as a manual “count” of the DPC Clinics operating currently in 2013-2015.
A quick search on Google Trends reveals that the term “retail healthcare” was practically non-existent before 2007. The trend has continued to climb and remain significantly “searched” until recently, when it skyrocketed. While it’s not the most scientific analysis, this search tool indicates how the free market healthcare delivery concept’s popularity has grown in just the last few years.
Last, but not least, the most popular Free Market Healthcare Delivery Sector term according to Google Trends Consumer Search … “Urgent Care Centers.” Urgent Care Centers are the most popular and consistent free market healthcare delivery consumer search term.
Google Trends is a public web facility of Google Inc., based on Google Search, that shows how often a particular search-term is entered relative to the total search-volume across various regions of the world, and in various languages.