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Concierge Medicine: Definition
The medical industry is a dynamic field, with primary care being an essential healthcare system. Nevertheless, challenges, such as rushed appointments, lack of price transparency, and complicated referral processes, often lead to poor health outcomes. To answer the demands of traditional primary care, concierge medicine has emerged as an innovative system, and a means to provide healthcare access to entire populations.
Concierge medicine is defined as an innovate practice where patients pay an upfront fee (on a monthly or yearly basis) through a subscription-based model in order to get better medical care. Although fees vary between medical providers and companies (approximately $50-$150/month, which might or might not be in addition to other costs), all concierge practices focus on next-level healthcare services. Concierge practices include specialized care, mobile technologies, preventative health, price transparency, same-day visits, and 24-hour access. Longer check-ups, home visits, and coordination of specialty care are also among the major benefits concierge medicine reveals (perceived by both patients and practitioners). Note that concierge practice is also known as boutique medicine, direct care, membership medicine, and retainer-fee practice.
History of Concierge Medicine
The history of concierge medicine is intriguing and foreseen all at the same time. In 1996, Dr. Howard Maron and Scott Hall established a Seattle practice in which they started charging an annual fee, avoiding the hustle around insurance reimbursements (“The History of Concierge Medicine in America: 1996-Present Day”). This approach has allowed concierge doctors to see a lower number of patients, usually under 600 people and 50 families, and provide personalized care. In comparison, figures show that standard primary care physicians manage up to 2,000 patients, which increases waiting room times and decreases personalized services. Despite the influence of primary care, standard practices face numerous challenges. To be more precise, a study revealed the main differences between the retainer and non-retainer practitioners. Compared to non-retainer doctors, retainer physicians report working with smaller patient panels (898 vs. 2,303 patients), seeing fewer people a day (12 vs. 22 patients) and having private waiting rooms (31% concierge doctors vs. 3% non-retainer physicians) (Alexander et al., 2005).
As a result, over the course of 20 years, concierge medicine has become an integrated part of healthcare practices worldwide. In the US, in particular, concierge medicine can become the major mean to transform the current primary care practices. Today, doctors provide concierge services for a variety of reasons, such as more manageable panels of patients, lower levels of stress, less administrative hassle, personalized care, house calls, and longer doctor appointments. In fact, only in 2010, there were already more than 5,000 physicians practicing concierge medicine across the US, and these numbers are increasing (Clark et al., 2010).
Concierge Medicine, Private Medicine, and Direct Primary Care
Primary care, as stated above, is facing numerous challenges. With a significant primary care physician shortfall, alternative medical systems are becoming more and more effective. Note that figures show that in the US, only 30% of all doctors practice primary care, as young physicians are going into specialty care and older doctors are retiring (“The Pros and Cons of Concierge Medicine”). In fact, data shows that between 1997 and 2005, the number of graduates who were about to enter primary care dropped by 50% – but governments have not tackled the problem yet.
Private and membership medicine, which involves non-governmental parties, and direct primary care, which provides an affordable retainer-based care model, are replacing traditional methods. Concierge medicine, in particular, is among the most appealing alternative practice models. More than 20% of physicians today are practicing or considering concierge medicine. As explained above, concierge medicine gives doctors the chance to provide personalized care, round-the-clock services, and innovative technologies. It’s not only patients who benefit; concierge medicine benefits practitioners. Boutique medicine can prevent physician burnout. Retainer medicine also eliminates burdensome paperwork and numerous bureaucratic hassles. While some patients can keep their insurance coverage, insurance papers, deductibles, claims, and write-offs are usually removed from the equation and professionals establish direct financial relationships with their patients instead. Note that figures show that the complexity of the American insurance companies takes up to $0.40 of each medical dollar spent. Smoother access and administration can only facilitate practice and prevention. What’s more, concierge medicine is becoming more accessible to the masses. Some concierge doctors accept patients with insurance policies (including Medicare), others embrace a combined approach (e.g., patients who pay an annual fee and also have catastrophic illness insurance). Either way, patients can establish an exclusive doctor-patient relationship and access comprehensive and personalized care.
Concierge Medicine & Technology
Concierge Medicine and Self-Tracking
Reshaping the future of medicine, health and mobile technologies have become integrated tools in medicine. Concierge medicine, in particular, is the main advocate for digital solutions. Of all health technologies, self-tracking has become one of the leading approaches in practice. In fact, measuring daily activities and biometrics is essential in the so-called quantified-self movement, which incorporates data acquisition and technology in everyday tasks. Although self-tracking (or the practice of monitoring sensations, drug use, blood glucose levels, mood, reproductive functioning, and habits) has always been a focus of healthcare, today’s digital technologies take self-tracking to new levels. Health technologies provide novel opportunities, which standard pen-and-pencil and self-logging methods lack. Since concierge services are based on healthcare technologies – wearable devices, exergaming devices, smart watches, and other self-tracking tools have become essential in boutique medicine (Lupton, 2017).
Retainer practitioners support self-tracking as they use the data collected to diagnose and monitor their patients. In fact, three-quarters of doctors say that self-tracking tools are vital. As explained above, self-tracking relies on sensors, wearables, and mHealth apps, which provide automated analytics and user-friendly interfaces. Interestingly, data shows that more than 12.9 billion smart devices will be utilized by 2020, including biometric shirts, activity trackers, smart glasses, and even smart forks. Self-tracking and bio-telemetry can help experts collect meaningful data, with smartwatches and eyeglass displays being among the most popular devices on the market. Although data acquisition comes with certain data privacy and security risks, a study conducted in the US (n=2025) showed that 78% of subjects would want their practitioner to use data from their personal devices (Pare et al., 2018). Remote monitoring can actually reveal hidden patterns and triggers and improve health outcomes.
Concierge Medicine and Mobile Health Apps
Concierge practitioners have realized the potential mobile devices and apps have. In fact, mobile health app numbers are rising. Since the majority of patients, especially those living in Western societies, report owning a smartphone with a data plan, mHealth apps have become effective tools in concierge medicine. Interestingly, there are more than 320,000 health apps on the market. More and more retainer doctors prescribe apps, especially for chronic conditions and pain. Apps can support information management, health record maintenance, communications, and medical training. Note that to ensure validation practices, there are a few standard steps to be considered: the initial prescription of a certified mHealth app, the actual app download, the process of connecting to a public platform, data collection, visualization of data according to international standards, data validation by a professional, and inclusion of information in e-health records (Segui et al., 2018). We should mention that mobile-enabled patient portals go hand in hand with mHealth apps. Such portals are vital as they allow patients and doctor to communicate and exchange information, including administrative tasks and scheduling.
Mobile devices, in general, combine impressive computing and communication features, such as web searching, cameras, GPS, recorders, and memories. These features can support doctor-patient communication (e.g., video chats), interoperability (e.g., exchange of electronic health records), clinical software programs (e.g., medical calculators), and medical education (e.g., drug references) (Ventola, 2014). In fact, the digital health industry has the potential to cut costs by $7 billion only in the US (Duggal et al., 2018), which makes mHealth one of the main features in concierge medicine. When it comes to mHealth apps and concierge medicine, patients’ perceptions and app usability become crucial. It’s interesting to mention that weight loss apps are among the most popular apps on the market, as well as fitness tracking and menstrual cycle tracking.
Concierge Medicine, Connected Health, and Social Media
Social media channels and e-platforms can enhance doctor-patient communication. Concierge doctors provide round-the-clock care and encourage more connectivity with their patients. Many retainer practitioners use emails and text messages to empower patients and connected health. By supporting connected health and portability of health data, practitioners can decrease waiting times, medical costs, and stress levels. In fact, new patient-relationship management systems can empower patients and their active role in connected health. Doctors and nurses can set reminders for upcoming vaccinations or tests. In addition, people can send pictures of their irritated skin, for instance, or schedule a video call with their doctors, which is an essential feature of telemedicine. Why wait in a crowded room only to get a prescription, when a concierge doctor can diagnose your symptoms online and send you a prescription over the Internet?
Note that a growing number of doctors use social media and blogs to optimize social media health communication (Campbell et al., 2016). Social media plays a crucial role across numerous industries. Therefore, despite the strict HIPAA rules, doctors engage in social media, including Facebook and Twitter, to help patients outside of the office. Social media channels can benefit marketing as well. Note that figures show that 40% of patients use the Internet to find reviews of practitioners. Social media, on the other hand, can help doctors create a better image and use business analytics techniques to attract new patients. It can also help practitioners establish a close relationship with their patients and support health practice. Data shows that 60% of doctors benefit from social media. They can see what their patients eat, for example, and improve their medical services. Most of all, since more than 20% of patients search platforms to get medical advice, physicians can use social media to post credible and educational content. Links to news and research become essential (Wither, 2017). Last but not least, for medical graduates entering concierge medicine, social media advertising tools can be beneficial to promote their services.
Telemedicine and Concierge Practice
Telemedicine is another crucial aspect which makes concierge practice appealing. In fact, since concierge practices provide next-level healthcare, telehealth becomes an essential concept. With cloud-based health information technology, telemedicine can benefit people, especially those living in remote areas and hard-to-access regions. As experts say, telemedicine is the modern version of the house call. Retainer doctors utilize health technologies to provide online and video consultations 24/7. What’s more, virtual appointments can save time and resources – one of the main benefits of concierge care. As stated earlier, patients can simply show lab results or a picture of a tick bite without all the hassle around commuting, time off from work, and travel expenses.
Telemedicine supports an innovative connected health model, which is highly valued in concierge medicine. Video chats and mobile apps, as explained above, facilitate telemedicine. Patients and doctors are connected all the time, with the main goal to keep patients healthy and content. It’s not surprising that, according to data, 64% of patients would attend a video appointment, and many more would join a concierge practice.
Digital Data and Medical Records
Data can shape the future of medicine. It’s not a secret that data-driven care benefits concierge medicine. As data acquisition (with data being collected from sensors, apps or online platforms) needs to be digitalized and integrated, concierge practitioners use technology to incorporate data. From electronic medical data to genomic data and wellness data (collected from different formats and caregivers), concierge practitioners can create a comprehensive medical record. Information can be easily visualized and shared after consent. Interestingly, patients are able to store their physician-created electronic medical record in HL7 format, which is the universal health format. By implementing standards and HL7-formatted files, patients and medical facilities can exchange data digitally. To be more precise, providers and patients can access and modify mobile-enabled records. Note that data exchange is an essential aspect of Connected Care and concierge medicine.
It’s interesting to mention that location is another metric that can help doctors create a comprehensive record (Geraghty, 2017). Location-based data can provide valuable information about where one works, lives or has traveled in order to assess risks, pathogens, and pollutants. The growing influence of this medical approach, called geo-medicine, can improve diagnoses and patient outcomes. It can be highly valuable not only in concierge medicine but in disease surveillance in order to analyze vectors (e.g., mosquitos) and pathogens (e.g., Zika), for instance.
Blockchain, Concierge Medicine, and Safety
When it comes to digital data, interoperability and safety become crucial aspects. Interestingly, the accounting platform blockchain that makes cryptocurrency (e.g., bitcoin) available, can be implemented in medicine. Blockchain is a tool that can transfer secure data in an encrypted ledger, which is visible to everyone with access. Concierge doctors can adopt this approach to transfer data securely. Medical records, for instance, can come from different providers but stored in one, secure ledger. The same approach applies to information from clinical trials and sensors, which can be added in the form of blocks to the same chain (Molteni, 2017). It can also apply to prescriptions, patient-centered electronic health systems, clinical trials, payments, and legal medicine. In fact, blockchain can support contract negotiation, especially when practitioners enter concierge practice and transfer patients (Roman-Belmonte et al., 2018)
Although the blockchain technology is still new in the field of medicine, it’s a powerful tool. In fact, a study showed that more than 16% of health executives are willing to implement it in practice. Since concierge doctors utilize technology to the fullest, they can become pioneers and support data exchange and safety via blockchain technology.
Smart Hospitals and Digital Health
As concierge doctors are willing to implement technologies in practice, they can transform medical facilities into smart hospitals. Smart hospitals provide not only comfort and aromatic coffee, but optimized services. In fact, a recent report showed that smart hospitals have better management systems, infrastructure, and digitalized networking. Digital data can be used to improve cloud computing, data analytics, remote monitoring, pharmacy automation, and security. What’s more, big data can lower medical costs, including genomics, radiology, and oncology.
Smart patient rooms, in particular, are becoming more and more popular. Digital solutions connect monitoring devices and smartphones to provide nurses and staff with a patient’s medical history. Large displays can inform patients about the healthcare team or their scheduled procedures. Interestingly, research shows that by educating patients, technology can improve not only user experience but healing. Patients can use tablets and other devices to track their medical records, results, treatment plans, or even watch relevant and educational content on TV.
Concierge Medicine: Digital Pills and Perspectives
Another technological advancement which concierge doctors might focus on is the smart pill. It’s not a secret that medication adherence is a huge challenge in healthcare. In fact, data shows that more than 50% of patients do not take their pills as prescribed. While medication logs and text messages can help doctors and patients tackle the problem, technological solutions take a step further: doctors today can benefit from new digital pills which can send medical information and track drug adherence. Interestingly, the first smart pill was approved by the US FDA in 2017 (Rukcer, 2018). The pill is an antipsychotic medication which sends signals when it mixes with the stomach fluids to a sensor. Consequently, the sensor, which is attached to the patient’s body, sends information via a mobile device application. Note that the ingestible sensor itself was approved in 2012 to track other common illnesses (e.g., type 2 diabetes).
As long as there’s informed consent, digital pills can improve not only concierge medicine and direct care, but clinical trials and medication compliance. This novel approach can reduce costs and ER visits. Smart pills can be used to monitor patients in their own homes and help doctors track recovery, which can lead to a decrease in medical costs and rehospitalization rates.
E-prescribing and Artificial Intelligence
With the newest advancements in healthcare technology, e-prescribing has become one of the main advantages of concierge medicine. Sophisticated e-prescribing systems are able to create and refill prescriptions and transfer vital information, such as drug interactions, allergens, and dosage. As mentioned above, patients do not have to make an appointment only to get a prescription. In addition, e-prescriptions eliminate the risks of inaccurate treatments due to unclear handwriting. According to data, the e-prescribing market is expected to reach $888 million by 2019. To set an example, only in the US, e-prescribing is a promising niche, with more than 70% of physicians using e-prescription software programs, and 96% of pharmacies accepting e-prescriptions (Is e-Prescribing the New Frontier in Healthcare Technology?)
Note that all the technologies implemented in concierge practice and e-prescribing rely on Artificial Intelligence to make diagnoses and treatment recommendations. A curious study based on a simulation of 500 random cases revealed that automated decisions and predictive models could lead to a 50% reduction in costs and 40% improvement of health outcomes (Harris, 2013).
Concierge Medicine: Pros and Cons
Personalized Care: Benefits for Patients and Doctors
Retainer medicine has numerous advantages over non-retainer medicine, with personalized care being one of the main benefits. As explained above, patients pay an annual fee and get exclusive services. Instead of dealing with paperwork, reimbursements, and reports, concierge practitioners focus solely on their patients. Other benefits of concierge medicine include house calls, personalized care 24/7, wellness evaluations, smart facilities, and comfortable environment. Nurses lines can also benefit concierge practice and support transparency. The numbers of chatbots for healthcare are also increasing (answering up to 80 % of routine questions), which can decrease customer service costs.
Concierge medicine, on the other hand, benefits doctors. We should mention that due to pay discrepancies among specialists and the excessive workload primary care physicians face, primary care is slowly collapsing. What’s more, a recent study revealed that three-quarters of physicians perceived standard medicine as unsatisfying. Therefore, it’s not surprising that out of approximately 16,000 students who graduate from medical schools across the US, only 600 students a year plan on entering primary care practice. Figures show that non-retainer practitioners take on more people to compensate the transaction costs of all the insurance companies involved. Physicians who practice concierge medicine, on the other hand, do not deal with insurance policies and paperwork, which allows them to focus on their patients and practice medicine in a personal manner (Clark et al., 2010).
Preventative Medicine and Reduced Costs
Concierge medicine incorporates an innovative, functional approach and focuses on preventative medicine. Since concierge doctors limit the number of patients they see, they can spend more time with their patients. By spending more time with their patients, doctors have the unique chance to scrutinize causes and find solutions. Instead of ordering tests, concierge doctors engage in communication and prevention. In fact, by gaining a deeper understanding of their patients, concierge doctors can improve a patient’s emotional well-being. Having fewer patients also allows doctors to set reminders for routine check-ups and schedule specialized care appointments. Note that for this purpose, secure text messaging can be implemented to exchange information in compliance with HIPAA and HITECH Act requirements. Concierge practitioners can even become coaches of wellness in order to support a patient’s healthy lifestyle, including sleep, nutrition, and fitness. Optimizing health and exploring triggers of a disease can reduce costs and improve health outcomes.
It’s not a secret that prevention of disease can lead to reduced costs. Since patients with chronic diseases and disabilities make up the majority of medical costs, concierge doctors can focus on preventative medicine and eliminate the cause of disease before it develops. Concierge doctors do not have to waste time on documenting data but can rely on technological solutions and personalized care instead. In comparison, non-retainer practitioners face numerous administrative hassles and documentation burdens. A study showed that clinic staff spends more than 15 hours a week documenting quality measures instead of providing actual care (Casalino et al., 2016). What’s more, the money non-retainer practitioners pay for interactions between the practice and the insurance company can be invested in medical care and smart facilities (Clark et al., 2010).
Accessible Practice via Technologies
Technology plays a significant role in concierge medicine which makes services accessible. From online scheduling to video chats, patients and practitioners have the unique opportunity to utilize technology to collect, report, and store data. In fact, electronic health record platforms are essential in modern medical practices. Patient portals empower patients and reduce unnecessary visits. What’s more, mHealth apps have the potential to engage patients in a non-invasive way. Apps provide immediate access to medical services at no cost. Customer relationship management software programs are also essential to help doctors and patients build a complementary relationship. Doctors can even connect with patients on social media. In addition, patient experience matters – lengthier visits, wireless sensors, and digital images facilitate check-ups.
Technologies improve patient outcomes as well as concierge practices. Apart from data acquisition, remote monitoring, and social media, doctors can utilize technology to educate a wide range of populations. In fact, concierge doctors have more time not only for their patients but for volunteering, which makes retainer medicine accessible to everyone (Clark et al., 2010).
Price Transparency Empowers Patients
One of the main benefits concierge practice has is the fact it relies on price transparency. Studies show that price transparency can lead to better adherence. With complicated insurance processes and reimbursements, however, standard health services become a burden for patients, especially those with low income. Sadly, surveys show that price information is often unavailable (Saloner et al., 2017). Data reveals that 63% of providers are unable to offer transparency to patients as they lack patient-facing cost estimation tools and staff. Therefore, to support price transparency, concierge doctors advocate for clear pricing signals – a common practice in many countries around the globe. Health consumerism and effective utilization of resources become two of the main goals in retainer medicine. What’s more, as explained above, concierge doctors are trying to reduce costs by focusing on preventative medicine and wellness. Instead of treating reoccurring symptoms, doctors aim to find the cause of the problem (for instance, instead of prescribing painkillers, doctors can conduct online surveys to assess triggers of headaches).
Price transparency empowers patients, which is the focus of digital health. Consumer-driven healthcare is a must in today’s healthcare practices. Concierge doctors give patients a choice – to join concierge medicine or not – based on clear fees and price lists. After all, the boutique practice can be defined as a working business model for family medicine (Clark et al., 2010).
Fees and Insurance Policies: Benefits and Challenges
Although concierge medicine has numerous advantages, critics claim that not many people can afford concierge care. In fact, statistics show that in the US, there are fewer African-American and Hispanic clients, fewer diabetics and patients with coronary artery diseases, and fewer Medicaid insured in concierge medicine. Some experts also claim that concierge medicine is unethical as it may lead to double-billing, disparities, and abandonment (Lo, 2011). To avoid abandonment, though, concierge doctors should help their non-participating patients to transfer to other practitioners or provide enough notice. Concierge doctors must establish clear price sets and agreements to support transparency and empower patients. After all, doctors have the right to switch to concierge practice. Interestingly, figures show that doctors who convert to boutique practice can retain more than 25% of their current patients (“Is Concierge Practice the Right Decision for You and Your Patients?”).
Other critics claim that concierge practice is costly. Concierge systems are not a substitute for health insurance, and often, the fees do not cover ER visits or visits to specialists. While it’s true that insurance companies or Medicare do not reimburse the annual fee for concierge medicine, experimenting with payment methods can only remove administrative burdens, improve patient outcomes, and help doctors provide a steady source of income. Since insurance companies, particularly in the US, have gained way too much control over medical decisions, healthcare has become a two-tiered system. Note that a report revealed that people who use their insurance had to wait longer for their mammography checks. In addition, insurances are usually used for accidents that rarely happen. Interestingly, the American Academy of Family Physicians revealed that primary care addresses 90% a patient’s health problems and concierge doctors claim that insurance companies have made primary care expensive (Clark et al., 2010). For uninsured people (around 49 million people in the US), on the other hand, traditional healthcare and hospitalization are almost inaccessible. By paying out of their pocket, though, patients can have an active role in healthcare practices and decisions – which means concierge medicine can become accessible to everyone. By paying an annual fee, which can be only $5 a day, many patients can access concierge services and receive better primary care. Note that these costs may be covered by the patients’ health savings and clients may keep their high-deductible insurance.
Concierge Medicine: Conclusion
Concierge medicine is an innovative system in which patients pay a retainer fee and get exclusive services. While there are many debates around concierge medicine and standard insurance policies, it’s a fact that people – regardless of age, race, and gender – must have access to personalized primary care. Concierge care has numerous benefits, such as short waiting times, longer appointments, digital healthcare, access 24/7, in-person visits, house calls, wellness services, and preventative medicine. From mHealth apps to easy renewal of prescriptions, digital solutions improve retainer medicine and reflect the future of digital health. Concierge medicine can benefit not only patients but practitioners. By reducing paperwork, primary care doctors’ workloads and levels of stress can decrease. What’s more, preventative medicine can lead to reduced medical costs, ER visits, and rehospitalization rates both nationally and internationally.
Although concierge practices across the globe vary in structure and payment conditions, it’s a fact that concierge medicine has numerous advantages over traditional primary care, with digital health being a major benefit. Concierge care is not only a novel concept but an established practice which provides quality care and exclusive services. In the end, concierge medicine can improve doctor-patient communication and change the future of medicine.
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