During the development of Curus’ holding company Total Life Concierge and its healthcare delivery concept, there was lengthy discussion about how concierge medicine was in its very embryonic stage in the United States. One of the topics of discussion was the potential adverse impact on the primary care delivery system if doctors who normally treated 1500 -2000 patients yearly reduced their practice load to a maximum of 600 patients per year. In fact, in certain communities, based upon the annual fee up to $24,000 per annum patient, loads were being reduced down to 50-100 patients annually.
It was Curus position then and now that as this process evolves it would begin to be pushed back. We thought that pushback would initially come from regulators. Most medical schools in this country are subsidized with state higher education subsidies. In fact, this was one of the driving motivations for Curus to build a service model on managing the patient’s navigation through the healthcare process and instead of shrinking patient access to primary care physicians.
Interestingly, the University of Michigan recently announced a program entitled Victors Care described in article in “The Detroit News”, on April 9, 2018, as “a high-end form of retainer – based medicine called concierge care”. In that model, a physician’s practice is capped at 600 patients and an individual joining will pay $2,700 a year for access to their primary care physician. In response to this announcement, 300 University faculty and physicians signed a letter protesting the program. The university’s medical school dean defended the program as being effective in creating a larger potential donor base for the university. According to the News article, the Dean of UM Medical School, Marschall Runge stated, “The program itself is not likely to create much of a margin, but the philanthropy will. And we don’t have any other area in which we intend to use those funds.”A Michigan Medicine neurologist who had signed the letter of protest responded, “There’s no evidence that this benefits people in a zero-sum way, where these people are benefited and nobody else is harmed.”
The reality is that there is a two-tiered healthcare system evolving in the United States. This trend seems irreversible and the question that emerges is how best to be a part of the upper tier of that system? We could get into a philosophical and political discussion of whether this evolving process is fair. However, Curus mission is to ensure that our members have the best possible health navigation and advocacy services while avoiding the politicization of the healthcare delivery system that is now occurring.
The problem with “concierge medicine,” as it is presently configured, is its inherent limitations.
In situations where a person requires the services of a specialist the patient falls back into the same routine health care process as patients who are not being treated by a concierge PCP. Their primary doctor’s referral patterns are relatively restricted based upon pre-existing relationships or system affiliation.
For example, at the University of Michigan Health System the incentive is for the PCPs to refer within the U of M network. Thus, even if you are a member of Victors Care, the pattern of care delivery will be the same. You will be referred, most likely, only to a doctor within the U of M system. The University of Michigan Health System is an outstanding healthcare delivery system; yet as with all healthcare, they have areas of specialization with extraordinary excellence and other areas that would not be rated in that peer group.
Because Curus has remained patient centric and unaffiliated with any specific delivery system, we have maintained the ability to refer members to the leading specialists countrywide without regard to any system affiliation pressures.
The reaction of some of physicians at the University of Michigan is going to repeat itself in other health systems, insurance carriers including CMS (Medicare) and regulators as they begin to evaluate the cost of training physicians that are subsidized by various state and federal government entities.
Stay tuned. It is going to be interesting to see where this evolution of the U.S. healthcare system will take us?
Curus is not rendering medical advice in “Health Points”.
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