Concierge Medicine: back to basics

Concierge ("boutique", "VIP") medicine has received much criticism, mainly on the grounds of its questionable (for some) ethics. In my view, it also deserves some praise. Even if its business model is not all that sophisticated, it is nonetheless an attempt to break with the homogeneity in private practice models.

Its emergence signals dissatisfaction, from both physicians and patients, with an insurance-imposed system that leaves them with few degrees of freedom. For physicians, CM changes the economics of their practice but also the very nature of the service they provide. Through a retainer model (as it used to be the norm in the past, by the way), the physician becomes again an agent for the patient, and not for the insurance company. For patients, CM is an answer for a service level that the insurance-mediated system doesn´t provide, one in which the physician is not subject to any restriction by a third party in terms of accessibility or utilization of resources. A doctor that also doubles as a counselor that helps them navigate an increasingly complex healthcare system (a service for which there is an unmet demand that Revolution Health intends to address in a different manner).

CM changes the incentives inherent to the prevailing practice model. The current reimbursement methods are skewed towards the attention of the acutely sick, resulting in episodic, disconnected care. Two major segments are neglected in this scenario:

- The "healthy", who face difficulties in accessing relevant preventive and wellness services, screening programs and counseling.

- Those with chronic diseases, who would benefit from more frequent encounters with their doctors and a higher accesibility through non-presential communication (telephone, web ... channels that are not adequately exploited because they are not reimbursed). The life of diabetics, asthmatics, etc., would be far easier if they were able to consult with their physician the many doubts that arise on a day-to-day basis (should I adjust my medication?, should I worry about this funny new symptom I am having?). Not to mention the fact that this model is likely to be more effective and efficient (even small improvements in the control of chronic diseases yield huge benefits: fewer complications, fewer ER visits).

CM is obviously not "the" solution for all the maladies in private practice, it would be unfair to judge emerging business models against such a high standard. But it may prove to be a very appealing proposition for some physicians and some consumer segments. We are probably just seeing the tip of the iceberg, a latent rebellion against a system that forces uniformity in practice patterns against the diversity of preferences of both physicians and patients. Despite the controversy around it, CM will probably continue to evolve and even permeate beyond its current boundaries of primary care.