Gone are the days when concierge medicine was considered for ‘VIPs’ only.
As direct primary care (DPC) continues to push forward into the mainstream, it has contributed much to boosting healthcare access to patients from all kinds of backgrounds.
While some believe that the presence of retainer medicine models only furthers the disparity of healthcare access between low to high-income patients, data shows otherwise.
Troy Burns, M.D., founder and medical director of ProPartners Healthcare, a DPC practice in Overland Park, Kansas, shares his personal observations of how concierge medicine has positively impacted American healthcare over the years.
“When I transitioned to entirely membership-based direct primary care in 2013, there were only 50 practices. 10 years later, there are over 1,500 across 48 states, and it’s more affordable, allowing people more choices.”
At ProPartners Healthcare, patients can avail of personalized primary care for only $30 to $125 a month, depending on their age. That’s a lot more attainable compared to the average cost of traditional insurance plans these days, at $328 a month.
Primary care is a patient’s first point of contact in healthcare and what direct pay practices have brought to the table is increased access to preventive, proactive care - removing the barriers of being “uninsured”, “under-insured”, “high-deductible insurance”, etc.
The industry is witnessing healthcare reform at its rise. More and more physicians and their patients are seeing the value of retainer-based medicine.
Erin Sullivan, an affiliate faculty member at Harvard Medical School’s Center for Primary Care, notes that there are “approximately 1,000 [DPC] practices in 48 states serving approximately 300,000 U.S. patients”.
American healthcare is seeing a steady growth of direct primary care and concierge medicine practices across different states because of the quality, convenience, and accessibility they provide.
Case in point, FindMyDirectDoctor.com, the largest directory listing platform for all DPC and concierge medicine providers in the U.S., is host to more than 2,200 DPC only health providers, and ~13,000 concierge providers.
This is an exponential win not just for concierge medicine, but for American healthcare as a whole.
Moreover, membership-based healthcare advocates, like FindMyDirectDoctor.com, addresses some of the most pressing issues in healthcare today, including:
DPC and concierge medicine practices often have smaller patient panels, allowing for more personalized attention and easier access to appointments.
This is particularly beneficial for vulnerable populations, such as the elderly, those with chronic conditions, as well as those who reside in low-income or rural communities.
While having smaller patient panels may seem counterproductive in terms of addressing healthcare inequality and healthcare access, Erin Sullivan, in her Scientific American interview, begs the following questions:
“The question [to] think about is ‘Does a physician with a smaller patient panel provide higher-quality care or more preventive care? And if they do, does this generate significant cost savings for patients and health systems over time?”.
By eliminating the need for insurance claims and billing, direct primary care reduces administrative costs and passes the savings on to patients.
This makes quality care more accessible to individuals and families who may be struggling to afford traditional healthcare.
As of 2023, there are 25 million Americans who have no health insurance.
For patients who are unable to afford health insurance (uninsured) or for patients that have a plan that does not cover all their medical needs (underinsured), a DPC or concierge medicine subscription could be an alternative to ensure that they still have access to some form of healthcare.
Digital healthcare platforms such as FindMyDirectDoctor.com has successfully connected over 10,000 uninsured patients with health providers who offer free market, cash-pay services.
FindMyDirectDoctor.com has potentially contributed to a whopping $120.4M in healthcare savings over 2 years, reducing ER visits/hospitalizations by $20.4M and preventing $100M in chronic illness-related costs.
Read more about: Direct Primary Care for Uninsured Patients: Does It Work?
DPC practices are more likely to be located in underserved areas, providing essential care to communities that have been historically neglected.
By addressing the social determinants of health (such as buying power, cultural competencies, and accessibility), direct primary care physicians can help mitigate the impact of systemic inequalities.
Marilyn Santiesteban, a Texas resident, came down with a bad cold in the middle of the pandemic.
The bad bout of colds left her severely dehydrated, and thanks to a suggestion of a friend, she received an intravenous infusion from a concierge medicine practice in her vicinity.
Santiesteban was very satisfied with the convenience and personal experience she had that she switched from her traditional provider to concierge care.
“Sometimes you just get tired of being another cog in the machine. You want someone fully focused on you and your issue—no interruptions.”
Santiesteban adds, “For everyday testing, bloodwork, even physical therapy, I loved the convenience [of concierge medicine].”
Membership-based healthcare encourages patients to prioritize preventive care, such as regular check-ups, screenings, and lifestyle modifications.
This proactive approach can help identify and manage chronic conditions more effectively, reducing the risk of costly complications.
According to concierge medicine doctor Dr. Rob Lamberts, “People are more than just physical bodies, and should be considered on all levels, including economic.”
The Group Health Cooperative in Seattle, Washington saw a 29% drop in ER visits, as well as improved outcomes in chronic care patients who are diagnosed with diabetes and heart disease.
By fostering a more personal, collaborative relationship between patients and physicians, DPC empowers individuals to take an active role in their care.
This increased engagement can lead to better health outcomes, improved patient satisfaction, and reduced healthcare costs.
On that note, here are some ingenious solutions implemented by concierge medicine to help address healthcare inequality in the U.S.:
Because many concierge medicine practices are private medicine start-ups, physicians are able to penetrate everywhere from low-income to rural/suburban communities.
These communities are usually populated by individuals who normally have little to no access to personalized care.
For instance, the Iora Health model (acquired by One Medical / Amazon), founded by Dr. Rushika Fernandopulle, offers concierge-style care to low-income patients in several cities across the United States.
Iora Health’s main focus is to build relationships between patients and health providers, as well as extending care coordination services to help patients navigate the healthcare system.
The healthcare industry has witnessed recent iterations of concierge medicine that are on the more affordable side of the spectrum. Many practices are now offering scale fees to cater to a wider range of patients.
From basic subscriptions which cover routine check-ups and preventive care only to more premium memberships that offer high-end care, you bet there is a concierge medicine practice out there that fits every kind of health requirement or preference.
This pricing strategy ensures that patients who need care are able to afford it.
Dr. Marsha Rowe, a concierge medicine doctor making waves in the retainer medicine space, established a concierge medicine practice in an underserved community in California.
Dr. Rowe's practice offers sliding scale fees and prioritizes cultural competency, with a focus on addressing the unique needs of her patients.
A best practice we can take away from Dr. Rowe is that it helps to hire providers who reflect the diversity of the community you serve. This can help address the cultural and linguistic disparities that often contribute to healthcare inequality.
Addressing healthcare inequality with concierge medicine has also succeeded in a way that it helps patients navigate the complex world of American healthcare.
This is particularly useful for patients who may not have the resources or knowledge to advocate for their own health.
Having a primary care physician in your corner can also help patients with streamlining care across different specializations. More often than not, primary care physicians have a network of specialists they can refer you to should any need arise.
The healthcare industry is also currently undergoing major regulatory clarity in the concierge medicine segment. Bipartisan bill H.R. 3836, or the Medicaid Primary Care Improvement Act, was recently passed in November 2024.
This is a major development in addressing healthcare inequality in concierge medicine.
H.R. 3836 clarifies that Medicaid programs are allowed to offer DPC services without requiring patients to secure a federal waiver from the Centers for Medicare & Medicaid Services (CMS).
Another bipartisan bill in the works is H.R. 3029, or the Primary Care Enhancement Act. Once passed, this bill shall finally allow patients to use their HSAs to cover their DPC fees.
These are major achievements for American healthcare because it helps streamline the quality of care across patients, regardless of how they are able to pay for their healthcare.
This closes the gap between patients in traditional healthcare and those who have decided to make the switch to retainer medicine arrangements.
What sets concierge medicine apart from other healthcare models is how it leverages technology to expand access to healthcare, boost patient experience, and improve health outcomes.
Tech-forward facets, like telemedicine and mobile health applications, are effective solutions to breaking down barriers to healthcare access, like transportation or child care challenges.
Another great thing about retainer medicine set-ups, like direct primary care and concierge medicine, is that they push doctor-patient relationships as a main priority of healthcare.
It does not matter whether a patient is uninsured or falls under the chronic care category — having a primary care physician they can rely on, always one call or text away, does wonders to a patient’s health.
Read more about: The Role of Technology in Concierge Medicine
Concierge medicine has traditionally been associated with luxury and exclusivity, but it also holds promise for addressing healthcare inequality.
By prioritizing accessibility and inclusivity, innovative healthcare models, like DPC and concierge medicine, can make American healthcare more equitable.
The goal is to create a system that provides high-quality care to all individuals, regardless of income or social status.
While there are challenges and limitations to consider, the potential benefits of retainer-based medicine, such as DPC and concierge medicine, make it an approach worth exploring.
