Concierge Care/Direct Primary Care Are on the Rise/New Twists on House Calls

Some primary care physicians are betting on higher demand for private, on-demand health care for those who can afford it. This kind of practice is often referred to as concierge care. MDVIP and PartnerMD, for example, are national support systems for primary care physicians who provide a higher level of personalized care to patients for an additional fee. These fees to the patient are typically about $2,200 per person per year but can run from $1,500 to $10,000 depending on the program. (These membership fees are not covered by insurance.) Patients are typically guaranteed same day or next day as well as after-hours availability by phone. The support networks help the physicians in implementing and operating under this business m model. Some physicians shift to only serving patients who are paying to receive the concierge level of service (generally capped out at 600 patients). Others operate on a hybrid system, with 25% to 50% of their patient load being concierge-level, and the rest under traditional arrangements. (Either way, this is a significant change from a traditional practice, where primary care physicians may have up to 4,000 patients on their lists—many of whom have to wait weeks to see their doctor, and only get 10 to 15 minutes of attention per visit.) Participating doctors are freed up to serve much smaller patient lists, thanks to this extra level of fee income. This means they can spend more time with each individual. On the other hand, it creates a void for patients who are seeking a good doctor. Some doctors are especially anxious to serve fewer Medicare or Medicaid patients, where fee schedules are much lower and the regulatory/paperwork burden are very high.

For 2023, Concierge Medicine Today estimated there were between 10,000 and 25,000 physicians in the U.S. operating concierge practices. A Merritt Hawkins survey found that 7% to 10% of physicians questioned planned to transition to concierge or cash-only practices. Even in nations where universal health care has been in place for years, such as the UK and Sweden, private health care is extremely popular among patients who can afford it.

Elsewhere, health care is taking a page out of the Uber business model in the form of in-person visits on demand. A number of startups are offering health care in the home or office, similar to old fashioned house calls. Treatments run the gamut of minor procedures from flu shots to stitching lacerations to treating strep throat to pregnancy tests. Some firms partner with major insurance companies such as Humana, Anthem and Cigna. California-based Heal sends a doctor in under an hour for a modest flat fee. As of mid-2022, Heal was available in eight U.S. states: Georgia, Illinois, Louisiana, New Jersey, New York, North Carolina, South Carolina and Washington. Pager, which is based in New York City, offers a platform to connect patients with nurses and doctors via text, voice and video chat. Other examples include MedZed (with operations in California, Washington, Maryland and New Jersey) and DispatchHealth (available in 24 U.S. states and the District of Columbia) which was formerly True North Health Navigation.

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