What is Concierge Medicine?
written by
Veronica Max, APRN, FNP-C
TLDR: Concierge medicine is a direct relationship between a patient and a primary care provider in which the patient pays a monthly or annual fee (“membership fee”) in exchange for healthcare services. Think of it as "having a doctor on retainer," that you can contact for any health or wellness related need.
Healthcare in America is a disaster — complicated and seemingly concerned with a million things other than you, the patient.
Concierge medicine is a response to a system with long waits, poor treatment, and doctors who feel like strangers. It’s an alternative to traditional primary care where you can choose 1-on-1, personalized healthcare, often at rates that will surprise you.
The most important thing to keep in mind as you evaluate different options is that not all concierge practices are the same. Terms, costs, and benefits vary widely.
How Do Concierge Medical Services Work?
Imagine having a close, personal friend on speed dial who is a highly qualified healthcare provider, one who knows your medical history, your preferences, can tailor their advice to your precise situation, and takes your calls anytime.
This is what it’s like to be a member of a high caliber concierge practice, and it completely changes your healthcare experience.
So how do you get started?
Getting started with most concierge healthcare practices is simple. To join, you'll pay a monthly or annual membership fee.
Next, you’ll complete intake paperwork and schedule your initial evaluation. A good concierge service will do a full workup on you, usually with extensive tests and evaluations, to get a good understanding of you and your medical issues and/or wellness goals.
Once they have a good understanding of you, you're all set to start taking advantage of the benefits.
While benefits vary by practice, you can typically expect:
Minimal or no wait times:
Most patients see a provider the same day or immediately the next day for urgent issues.
Plus, most practices are already pros at telemedicine.
And it's not just telemedicine—in-person appointments also tend to happen within 24 hours. Some doctors will even make house calls.
Direct access to your healthcare provider (via phone, text, video, email):
In a concierge practice, there's more direct access to your doctors and providers.
They'll often give out their cell phone numbers and personal emails for quick questions, prescription refills, or off-hour needs, which enables you to quickly get the care you need.
Quality time with your doctor:
One of the biggest benefits of concierge medicine is that concierge doctors usually take on a smaller patient load than regular primary care providers do.
Concierge providers may have a patient load in the low hundreds. The membership fee allows doctors to drastically shrink their panel size, usually from 2,500+ patients to somewhere between 400-600 patients. This gives them the opportunity to spend real time with their patients that a typical primary care doctor wouldn't be able to.
Relaxed, unhurried appointments are the standard. You will have an opportunity to fully express your concerns and ask questions, and your provider will actually listen.
This is how your concierge doctor can surpass regular "sick care" and actually help prevent you from getting sick to being with. Your doctor will provide education on different topics related to your health and wellness. This often includes diet and exercise, sleep, light environment, and emotional health. The dynamic is much more personal and personalized, resulting in a better, more effective care (i.e. healthcare NOT sickcare).
Aligned incentives:
Providers in the traditional, insurance-based healthcare system only get paid when you’re sick. You come in for an appointment, then they bill you or your insurance for the visit.
They quite literally make MORE money the more ill you are.
Concierge doctors get paid through your monthly membership fee. They aren’t incentivized through insurance billing.
Instead, they’re incentivized to keep you healthy and out of their office, but also happy with the care you receive when you do see them.
Concierge Medicine Vs. Traditional Primary Care
The primary differences between concierge and traditional medicine hinge on the payment model. As they say, follow the money, and in traditional medicine, the Payor is a 3rd party — your insurance company.
They are incentivized by their own profits, which means keeping their expenses low by denying care, and only treating you for an illness the doctor can prove you have.
Doctors working within the insurance paradigm are paid based on the number of patient visits where they can diagnose (but NOT prevent) disease.
To boot, they often don’t get reimbursed for video visits, phone calls, texts, or emails with patients (I know this seems illogical and inefficient, but that's the truth of the modern insurance business).
This means that a primary care provider needs an average patient load of at least 2,500 patients just to make ends meet.
Large patient loads mean:
Long waits for appointments
Rushed in-person visits
Slow response times
Algorithm-based “standardized” care
Reactive, disease-based care
Poor customer service (if you can call it “customer service” at all!)
The type of care that is provided and how it is delivered is determined by what’s best for the insurance company and your doctor.
At best, your interests are #3 on the list.
This is nothing like concierge medicine, because you are employing your doctor directly. They are responsible to you.
This shifts their focus so that decision-making centers around what is best or most convenient for you, the patient. You are now priority #1.
This translates to:
Smaller patient loads (400-600)
Same-day appointments and next-day appointments
Relaxed visits
Fast response times
Virtual and in-home visits
Personalized, relationship-based care
Preventative care to keep you from getting sick in the first place
These differences are what lay the foundation for concierge patients to get a far superior customer experience.
The Pros and Cons of Concierge Healthcare
We could spend all day talking about the pros of concierge care, but it is NOT a perfect solution for everyone, and it’s important to openly discuss the cons, to give you all the information you need to make the right decision for you.
Cons
Out-of-pocket membership fees: The most notable negative to going with a concierge practice is often the cost.
Concierge medicine practices can be very expensive, which makes it prohibitive for some patients.
As an example, Peter Attia, MD and author of Outlive, is known to charge his select group of patients over $100K per year.
However, there are many concierge practices that offer the same or similar services at a price that is far less.
For example, at UltraPersonal Healthcare, most patients only pay $125/month for adults and $60/month for children.
Insurance not accepted (though you can still use your insurance plan for labs, imaging, medications): Most concierge doctors do not accept insurance (though some hybrid practices do exist).
Further, insurance companies will typically only reimburse for out-of-network services defined by a diagnosis and service code. This means that most insurance companies will not reimburse for monthly membership fees.
However, you can still use insurance to pay for lab tests, imaging, medications, and other services outside of your concierge doctor’s office (like specialist visits).
If you have an HSA or FSA, you can often use this to pay for your membership fees.
You get out, what you put in: Hiring a concierge doctor/joining a concierge membership means you’re going to have to “re-learn” how to use primary care.
Historically, going to the doctor has been a hassle. Since you couldn’t get in touch with your doctor virtually, you probably waited until you were really sick before making an appointment.
Having a concierge healthcare team on speed dial completely transforms the primary care relationship.
Care can be proactive, rather than reactive.
When you’re sick, you can text your doctor at the first signs of an illness rather than waiting until you’re deathly ill.
When you’re well, you can schedule your annual or bi-annual check-in knowing that your appointment is going to happen on-time, in a warm environment, with a caring provider who will take the time to equip you with the knowledge you need to make sure you stay healthy and reach your wellness goals.
This is only possible if you’re willing to utilize the service you’re paying for.
Concierge options vary by geographic location: While concierge medicine is becoming increasingly popular, it’s possible that the options in your area may be limited.
However, the good news is that you don’t have to limit your search to your city. Given the widespread adoption of virtual medicine by concierge doctors, you can expand the search to include your entire state.
A conservative estimate is that at least 30% of primary care services can be provided virtually.
Now that you have a clear eyed view of the downsides, what are the benefits of concierge medicine?
Why do people do it? What's the best argument for it?
Pros
Relationship-based care. One of the biggest gripes with the traditional healthcare system is that people often end up feeling like a number.
Many patients see a different doctor at the same practice each visit, which means they don’t have a consistent provider who knows them and is familiar with their life and medical history. And even if they are lucky enough to see the same doctor, they seem unfamiliar with your medical history and ask you the same questions each visit.
Who can blame them when they only spend 10 minutes with you and see 50 patients per day (or more)?
With concierge medicine, smaller patient panels means your doctor has more time to spend with you. Your doctor knows you by name, perhaps they even know your family as well. They have in-depth understanding of your unique health history and health goals.
You get the opportunity to build a safe, trusted relationship with your healthcare provider and as a result, you feel comfortable sharing information you otherwise might not share.
This is the ultimate doctor-patient relationship and it is essential to proactive, wellness care.
No waiting. Ever called your doctor trying to get an appointment and been told it’ll be a few days? Maybe a few weeks?
One recent survey showed the average wait time to get a primary care appointment was 26 days. In some areas, patients waited an average of 46 days.
Or just as common is waiting in the lobby 30 minutes past your appointment time. And then another 10 minutes in the exam room.
A study by Vitals found that patients wait for an average of 18 minutes and 13 seconds for a physician, after they arrive on time for their appointment.
Concierge medicine removes these hassles. Most concierge practices guarantee same-day or next-day appointments for sick care and boast empty “waiting rooms.” You get appointments quickly, and your appointments start on time.
Convenient healthcare on your terms. Many concierge practices give you 24/7 access to care for urgent issues.
This does not mean voicemails, call centers and long-delayed replies.
It means conversations with an actual person--by phone, text, email, video visit, or in-person--depending on what’s most appropriate and convenient, regarding your health and treatment.
Aside from being just remarkably convenient, it feels like having a doctor in the family you can reach out to for anything you need, anytime.
Care coordination and navigation. We call it “quarterbacking” – facilitating communication between your doctors and specialists so that everyone cooperates in one healthy direction for you.
This creates your very own healthcare team out of a group of typically silo’ed individuals.
Some concierge practices, including UltraPersonal Healthcare, will even assist you in scheduling specialist appointments if needed or find the most cost-effective place to get imaging or fill medications near you.
In short, we help you navigate the complexities of the medical system outside of our practice, and don't just leave you to figure it out on your own.
Healthcare not sickcare. Remove the constraints of the traditional, insurance-based healthcare model and you create a completely new paradigm: help people get so healthy they don't even need to see their doctor.
Concierge medicine is about disease prevention, health optimization, and even longevity medicine--helping you live longer.
With a traditional doctor, you may have a 20-30 minute physical with the same basic tests and screenings every year. Then, you’re told “no news is good news”, and unless something is really wrong, you never hear back about your labs. It often feels like a check-the-box approach for patients.
With a concierge doctor, annual physicals go above and beyond what most patients have ever experienced. They typically last at least 60-90 minutes, and some practices offer advanced tests and screenings.
At UltraPersonal Healthcare, we typically start with routine tests and screenings. Based on those initial results and your unique health and family history; we may recommend additional tests and screenings to gain deeper insights into your health.
A concierge doctor will always take the time to review your test results in detail, not just for what is abnormal but also what is optimal for wellness and longevity. You will walk away from your appointments with a level of education and understanding about your health that you have never had before.
What’s Included With Your Concierge Membership
Concierge doctors provide the same medical services as any primary care physician. They treat all types of health conditions and can provide and order laboratory testing and imaging services.
Exact services may vary slightly from practice to practice, but generally you can expect:
● Wellness exams and physicals (including pelvic exams and PAP smears, well child checks)
● Sick and injury visits (ie. strep throat, lacerations, etc)
● Chronic condition management (i.e. high blood pressure, diabetes, hypothyroidism, etc).
● Health optimization and longevity medicine
● Blood draws
● Routine in-office procedures, which may include suturing, incision and drainage, biopsies etc.
● Specialist and second opinion consultations
● Routine labs and screenings
● Access to advanced tests and screenings, such as: genetic testing, micronutrient testing, comprehensive stool testing, telomere testing, mycotoxin and heavy metal testing, DEXA body composition, CT Calcium Score, full-body imaging, and much much more.
Things that typically are NOT included in membership:
● Medications may or may not be included depending on state regulations
● Vaccinations
● Imaging, such as X-Rays or MRI’s
Do Concierge Doctors Accept Insurance?
Most concierge doctors do NOT accept health insurance.
The high quality of care provided by UltraPersonal Healthcare and other concierge practices is simply not possible within the traditional model of insurance-based care.
If you do have insurance, you can use it to pay for medications, labs, and radiology ordered by UltraPersonal Healthcare Providers (however, UltraPersonal Healthcare’s special negotiated rates for lab work and imaging mean it will likely be cheaper to pay out of pocket vs using your insurance).
How Much Does Concierge Medicine Cost?
Almost all concierge medicine practices are membership-based and require an annual or monthly fee, which can range from $100/month to $120,000/year–varies by the service, your location and who you see.
For example, at UltraPersonal Healthcare, our Premium Service is $10,000/year and includes home visits plus an advanced suite of longevity and health optimization services (genomic testing, micronutrient testing, telomere analysis, etc).
If you don’t mind making the trip to one of our office locations (instead of a home visit), you can get the same quality of care for just $125/month for an adult and $60/month for a child.
How to Find a Concierge Medicine Provider
Here are 4 steps to finding a concierge doctor near you:
Start with your personal references. Who do your friends know, like and recommend?
Do a Google search for “concierge doctors near me”. Once you locate providers, be sure to check out the reviews. Read both good and bad reviews, making note of how the practice responds to negative reviews.
Browse their website. What services do they offer beyond traditional primary care? What is their care philosophy? Do they fit your budget?
Give them a call! If a big concern for you is responsiveness, note whether or not they answer the phone and/or how long it takes them to call you back. This is a great litmus test.
Schedule a call or “meet and greet” with a provider. Consider this a speed date. Does this person exude the qualities you’re looking for in a healthcare provider? Can you trust this person? Do you feel safe with this person?
To learn more about UltraPersonal Healthcare’s take on healthcare, check out our additional resources.