Which Is better for your health care, the current model of high deductible insurance or direct Concierge Care ?

by Dr. Alan Kadish

This is not a trick question ! With your current high deductible (1) insurance I want you to explore your options to maximize your return on your health investments.

Concierge medicine is a term that will become standard in the medical industry shortly. It offers better solutions for your health care, it’s important to first understand the difference between concierge care and that of the specialist/hospital care model. Both are necessary players to insure our health but can and should be utilized very differently.

Concierge medicine should be the foundation of your health care plan. Your concierge care provider is responsible for your overall wellness and can be thought of as a conductor who sees your whole medical picture and is the first contact person.

Any time you have a health concern, your first contact should be to your concierge care provider. He/she is familiar with your medical history and desires and can help you make the best decisions regarding your health. Generally with most health issues, your concierge care provider can diagnose and treat the problems you’re experiencing efficiently and with little delay. And most importantly……..provide the key component, preventive care, to minimize your need for repeat health care interventions or illnesses.

Specialist and hospital care should be for serious life-threatening emergencies. If you’re severely injured in an accident, for example, the ambulance crew will stabilize you and bring your swiftly to the emergency department. As another hospital/specialist based example, if you’re diagnosed with a condition requiring surgery, radiation, or other invasive treatments, the specialist or hospital will have the appropriate equipment for your care. This is when the “catastrophic” insurance is really needed. As anyone who has been to the hospital can attest….the cost is steep, even for minor short term diagnosis and treatment

 

                                                       Considerations

                Concierge Care__________________Specialist/Hospital Care

    Periodic________________________Rare

                    Predictable______________________Difficult to predict

                      Affordable_______________________Extremely expensive

                   To be encouraged__________________To be avoided , if possible

  “Health” insurance is essentially geared toward specialist and hospital care. It’s very similar to automobile insurance as it’s designed for the more severe costly, rare, unpredictable, and extremely expensive problems. It’s essential when you need emergency care such as an operation or costly medications, especially IV chemotherapy treatments as an example, along with the care provided by specialists and the hospital.

The concept and payment of real preventive care is only present in a limited number of the higher cost, gold level, insurance plans. It remains isolated to specific aspects such as immunizations and pap smears along with other specifically identified procedures and not the newer laboratory tests, with exception.

It is not intended, nor will coverage be provided for most of the obvious needs for real prevention, such as: lifestyle considerations, your exposures both vocationally and at home, genetic testing and predisposition planning along with personalized approaches toward you…… as a unique patient.

These time-consuming health interventions generally result in much better patient outcomes, but are not seen as cost effective for the masses. Time and money collide in this scenario.

The main issue is that one needs to be proactive, willing to change and invest in both time and finances, for their health if they want optimal results. This is clearly not the procedures that fit the one size should work insurance approach.

I appreciate that there will always be a significant segment of our population that will not be inclined to participate in preventive care. Their use of the system for disease intervention is the current model. For these individuals and families the use of concierge medicine does not fit their needs.

Concierge care is intended as an ongoing, highly predictable and relatively inexpensive approach to maintaining and improving your health. It doesn’t make sense to pay for concierge care using insurance. For most of us, even after a full year of care, the cost is less than the deductible for your current insurance policy.

Direct concierge care practices eliminate insurance overhead, which can extend health care to more Americans, lower the cost and increase the quality for those who choose to embrace and recognize the benefits of better than average health.

Insurance the real costs…..is not only the overhead of an additional layer but also the heavy hand of regulation that tells the physician who and how many times a certain set of tests can be run, not based on the patient, but the “accepted” norms.

As a patient you will seldom see the behind the scene letters and calls asking/begging for exceptions. This many times futile exercise, is time and costly for every medical office and occurs frequently. Only a limited number of offices will even put forth the efforts due to the high request rejection rates.

Patients are not always falling into the “insurance norms” and I do agree that overutilization does occur and is not appropriate. But should the insurance company be the dictator. What happened to the practice of patient centered medicine ? Obviously we no longer are embracing this concept, except when utilizing concierge medicine.  

Medicine is not in the hands of your insurance based physician, but rather a bureaucrat who has determined the optimal dollars payback for perceived health care intervention, based on the statistics of the masses and the cost “effectiveness” to the insurance company.

Ever wonder who pays for the office worker to code, file and keep current with the ever changing medical codes…. and then play the chase the insurance company clerk for reimbursement game…..yes it’s the patient ultimately.

No Obama care only made for more obstacles and hoops to be jumped through. The next evolution in the process is the requirement to have the coder “certified” and then “covered” by insurance.

Think like a lawyer and add her to the mix of trying to “overcharge” the system and all the “extra” fees that the practice would need to bear. To really understand this system follow who gets more clients and where the money flows……certainly not toward real health care….for the patient.

To get a sense of how the cost of medicine are driven one should consider a typical flow chart of how the Insurance Care model works vs. the Concierge Care process.

The figure below shows the typical process that occurs in insurance-based care settings when a patient comes in for a possible pneumonia. The red boxes indicate insurance processing, the yellow boxes are tasks completed by the patient, and the blue boxes show the actions of the health care provider.

 Insurance Based care  for an Upper Respiratory illness   

 insuranced based

Concierge Based care for the same Upper Respiratory illness

 

concierge medicine schema

When you compare the complex process shown in the figures above, one can see very clearly why medical care costs so much.

The figure below shows how simple the same upper respiratory illness visit can be, with concierge care. Costs and complexity of the health care encounter are dramatically reduced.

The efficiency is clear from both the patient and the physician perspective. The translation……. lower costs, and physicians are able to spend time with patients, vs filling out insurance forms and paying extra staff.

At the Center we will provide you with the necessary forms to submit to your insurance company, if you wish.

Direct concierge care enables your physician to provide better care for patients. One of the key aspects to this type of practice is the higher familiarity with a you as a patient. There are no long waiting times because the patient population per physician is much smaller. the translation means you receiving more time with your provider. You’re able to review more information to make better  decisions about a your health care.

It’s beyond obvious that for the last 10+ years medical school graduates for primary care position has declined to ~ < 25 % of the students in 2012 The current estimates are that there will be an increasing shortage of primary care providers approaching a shortage of 91,500 doctors by 2020(6) by 2020 and a projected shortfall of 130,000 physicians by 2025.(3) Some already estimate that due to Obama care we are at a 20,000 doctor shortage level currently.(5)

Family health practices across the nation are closing because they can’t stay financially afloat without pushing the boundaries of 30-40 patients per day, per physician. (6)

Years ago most medical students chose primary family care as their professional specialty, that percentage is now in the low and declining digits. (3) This migration is fueled by growing dissatisfaction with the insurance-laden business models in primary care that make specialization options more attractive. Hard to pass up less paperwork and an increased income. (7)

The result? The average primary care office visit “face time” is now seven minutes and rarely longer than 15 minutes. In order to see the 25-35 patients in person per day required to sustain a conventional clinical practice, providers must manage between a patient group of 2,500 and 3,500 regular patients, to survive.

Contrast this with a busy day for a concierge provider. The number of patients per day is less than 1/ 4 which allows the physician adequate time to examine patients, explore multiple diagnostic and treatment options, along with addressing your concerns.

Concierge physicians are not required by the insurance company reimbursement requirements for in office visits. This allows for flexibility to offer phone and/or secure email consultations. The translation for you the patient….. convenience , no waiting in a room of ill patients, a more appropriate approach to care with full access to tests and other procedures as needed.

Not surprisingly physicians report increased satisfaction and renewed commitment to provide the quality of care that initially inspired us to dedicate our lives to medicine. (8)

This, concierge medical approach allow physicians and patient to both derive the maximal benefits from interactions and really treat patients with quality and respect, while embrace the concept of preventive care.

As an experienced (30+ year) physician this model is allowing my patients the optimal balance between quality care, convenience, utilization of the most current means of diagnosis and lowered stress, all while maintaining a cost effective model.

Isn’t it about time you explored the opportunities concierge medicine offers, at the Center ?

Call us at 503-688-9510 and we will look forward to assisting you in joining our practice and focusing on getting you back to or staying optimally healthy.

 

References:

(1) http://www.forbes.com/sites/brucejapsen/2014/02/22/obamacare-deductibles-hit-patient-pocketbooks-and-hospital-finances/

(2) http://www.cbsnews.com/news/obamacare-deductibles-deliver-hefty-sticker-shock/

(3)http://management.fortune.cnn.com/2013/04/01/medical-students-residencies/

(4) http://health.usnews.com/health-news/news/articles/2013/06/14/primary-care-doctors-still-in-short-supply-in-us

(5) http://www.nerdwallet.com/blog/health/2014/01/17/primary-care-shortage-obamacare-physician-salary-specialty/

(6) http://www.washingtontimes.com/news/2013/feb/7/doctors-feel-ill-winds-blowing-as-they-look-closel/?page=all

(7)https://www.aamc.org/newsroom/reporter/april11/184178/addressing_the_physician_shortage_under_reform.html

(8) http://www.thehappymd.com/blog/bid/285923/Concierge-Medicine-will-get-Massive-Boost-from-Obamacare

 

Copyright Center of Health™ 5/2014  For permission to reprint this article, please contact the author.

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Dr. Kadish is an unusual physician often referred to as a "doctor detective". His expertise is the evaluation and treatment of complex disorders, typically after other physicians have been stumped, is renowned. He provides care for all family members and has additional training in autistic spectrum disorders and chronic complex diseases.

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