Why Is better for your healthcare, the current model of high deductible insurance or direct Concierge Care ?

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 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, they 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

Periodic

Predictable

Affordable

To be encouraged

Specialist/Hospital Care

Rare

Difficult to predict

Extremely expensive

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 of preventive care is only present in a limited number of the higher cost insurance plans. It remains isolated to specific aspects such as immunizations and pap smears along with other specifically identified procedures. 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 and personalized approaches to 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.

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

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 the cost is less than the deductible for your insurance.

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.

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

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 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.

 

 

 

 

 

When you compare the complex process shown in the figure above, with the simple process below it becomes very clear why medical care costs so much.

 

 

 

 

The figure below shows how simple the same pneumonia 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 prospective. The translation……. lower costs, and physicians are able to spend time with patients, vs filling out insurance forms and paying extra staff.

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, no long waiting times because the patient population per physician is much smaller which also translates to mean receiving more time with your provider.

You receive more information to make better deliberate 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/ 2 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.

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