Abridged Overview of Membership Medicine Models: the Mindset, Biases and Opportunities
One of my mentors wisely noted, "When you have a heart for your community, you don’t have to compete on price. Without community, you’re a commodity."
By Editor, Concierge Medicine Today | Listen to the Latest Industry Podcast Episode
Over the years, the culture and economics within most concierge medicine practices has evolved significantly but the marketplace narratives have often remained negative and unchanged. That's okay and to each their own as they say.
Take for example plastic surgery and aesthetics.
Initially, these medical specialties and their business models faced significant headwinds, public relations challenges, similar to those I’ve observed in the concierge medicine space in its early days.
According to Aesthetic Surgery Journal, plastic surgery for example, has often been associated with vanity, largely due to media portrayals depicting individuals as excessively focused on their appearance. These representations hindered the communication of the psychological benefits and transformative potential of these procedures. Exaggerated cases in media created a skewed public perception, making it difficult for practitioners to emphasize the psychological and reconstructive advantages of their services. However, empirical evidence has gradually shifted societal attitudes towards a more positive understanding of plastic surgery (Dunn, 2018). Citation: Dunn, K. (2018). *The Psychological Impacts of Plastic Surgery: A Look at the Journey of Patients*. Aesthetic Surgery Journal.
Concierge medicine has similarly struggled with perceptions of elitism, being viewed as a service exclusive to the wealthy. The introduction of retainer fees led to pockets of backlash, with critics often arguing that it commodified healthcare and created a bifurcated system. This sparked discussions about equitable access to care and concerns about prioritizing profit over quality (Wong, 2015). Citation: Wong, S. (2015). *Concierge Medicine: Pros and Cons of the New Healthcare Trend*. Journal of Medical Ethics.
As someone far wiser than myself recently said (about business in general, not healthcare): "For some reason, profitable organizations are viewed as evil in today's society. While it’s true that some organizations engage in unethical practices, I believe that’s the exception rather than the rule. Call me naive, but I believe a thriving world is one where we have successful, profitable organizations, and vibrant communities rely on them."
Price conscious brands in healthcare, such as concierge medicine have worked very hard over the past 20-years (or more!) now to overcome the cognitive bias’s and public relations challenges rooted in perceptions of vanity and elitism in healthcare by highlighting their benefits to patient well-being. And, I’m proud to report that from my experience engaging with both the media and physicians all these years that the cognitive bias against concierge medicine has softened, with patients now showing more curiosity than resistance. Sure, media coverage will routinely remain negative, maybe report a little imperfection and won't be entirely positive about change in the healthcare marketplace, I have certainly observed that it is less adversarial now than it used to be!
"I’ve met more Physicians (in all the membership medicine models, concierge included!) who have hearts of gold and the emotions of steel over the years, and I can tell you that they’re the salt of the earth. They’re some of the best people on the planet!" ~Editor, Concierge Medicine Today, speaking to a group of physicians in October, 2024
Yet despite the growing recognition of concierge medicine's value over the past two decades there are still some who do the real work in healthcare that want to stifle progress and claim the moral and ethical high ground based on things like price and fairness when it comes to healthcare. “It’s about believability. Would it work for me? Could it work for me?" says a former CEO and industry consultant in concierge medicine space we talked to at Concierge Medicine Today. "Physicians now have many examples of colleagues experiencing the benefits of concierge medicine for themselves and their patients. In those areas, we see momentum continuing to build.”
What you might not know is that inside most 'membership medicine' practices (regardless of terminology, price or location), is that today, each day begins with the mission of transforming patient frowns into smiles and doctors are creating memorable experiences FOR patients. You see, inside most of these subscription-based healthcare delivery practices, it’s no longer just about fulfilling the internal needs of the practice; it’s about recognizing the vital relationship between patient and physician, removing every obstacle in a moral, legal and ethical way that may hinder that relationship and understand the critical role that patient experience and hospitality plays in healthcare today!
This shift in mindset has been proven to enhance satisfaction and foster trust among doctors, staff, and patients alike.
Now, I’m not naïve to the fact that today primary care for example, typically has a uniform reimbursement model they try to follow with complex codes. But is it fair that you and I can visit three different primary care offices for the exact same ailment(s) and (maybe if we're lucky!) see only three codes in common among the eleven different codes on five separate and confusing bills?
Of course not! I highlight this disparity to raise awareness about fairness in healthcare, as today’s patients are more informed, smart and discerning customers. Hospitality in healthcare is a process, but the patient should never feel processed. Nor should we villainize the Physicians out there in concierge medicine for example that want to help their patients feel seen, heard, welcomed, respected and significant!
There’s no arguing that Patients today expect consistent quality without fluctuating costs, unlike the tiered pricing seen in aviation. However, if variable costs are to be implemented in healthcare (and they already are!), I think it is crucial to help patients (i.e., your customers) understand what they are paying for. After all, it is their money, right? Editor's Note: For references on this topic, please consult studies from the Journal of Air Transport Management and the American Journal of Public Health.
Back on point. Discerning patients today are indeed discouraged and they’re keenly aware of the differences that exist among individual physicians and patients will ALWAYS go where they feel they will not be treated like just another number or chart in the drawer.
Currently, concierge medicine and unique other forms of a low-cost subscription practices offer unique opportunities and challenges for doctors navigating a competitive healthcare environment, particularly regarding pricing strategies. If we were to sit down with you today, I would share that I don’t view concierge medicine and other forms of low-cost subscription practices as competitors at all. Instead, I see them as two distinct paths patients and Physicians can choose, and having choices in business (and in healthcare!) is beneficial FOR all. And isn’t doing good always good for business? But, if you were to ask us here at Concierge Medicine Today, how we would describe the landscape, options and business models of the membership medicine marketplace today, here’s what we would tell you:
Classical Concierge Medicine, Bespoke, or Luxury Ultra-High-End Concierge Medicine Practices: These are ultra-high-end private medicine programs (often but branded as 'concierge' medicine) typically range from $10,000 to $50,000 annually per patient or family. Each practice is unique and may operate differently so inquire and ask questions. Usually these practices will also provide an exhaustive list of services, which may be included in the fees, but not always. They are not intended to replace your health insurance and are not to be considered as a replacement for your health insurance nor cover your hospitalization fees or services. Limited in their sheer number across the U.S., they do exist to serve their clientele well and likely represent less than probably 4-7% of the industry’s overall membership medicine offerings according to sources at Concierge Medicine Today.
Contemporary Concierge Medicine (Most Common): These practices are the most common in the healthcare marketplace today. In summary, they are a subscription-based or membership healthcare delivery business model (typically primary care, family medicine and some specialties which have routine patients -- not the one and done type) and are primarily marketed or for middle-income consumers that desire more preventative and relational dialogue with their Physician. These practices and business models have emerged in the past 20-years and are today the more common and inexpensive version of a concierge medicine practice. Think of it like Concierge Medicine 2.0. Inexpensive options which are quite commonly available in the marketplace today operate with price points ranging from $100 to $750 per month per patient. These practices may still accept insurance or still participate in Medicare but the subscription fees you pay are for services not covered by Medicare nor thought of to be a replacement for your health insurance. Additionally, hospitalization fees or services are the patients responsibility. According to industry sources, these more contemporary practice models most likely account for roughly 70-75% of the available concierge medicine subscription choices for Patients in the marketplace today.
Direct Primary Care (DPC): Do not confuse DPC with a concierge medicine practice, which is often quite common when you run into the membership medicine family tree of options. Today, DPC is typically considered the budget-conscious option for the patient or individual, direct primary care (or DPC) usually ranges in cost for each patient between $8 and $99 per month. Currently, there are an estimated 1,500 to 2,500 practices across the country by 2025. Typically, these practices do not participate in Medicare, nor have payor relationships (but not always).
I am of the persuasion that a Doctors office is a special place in our community. It’s a place of trust and should be (but usually isn’t) a refuge for us all to get relief from our pain, struggles or daily challenges. Why should we belittle the weight our Physicians’ words and expertise by putting them in a box each day that feels more like a penalty bench than a thriving community life center? I know that sounds pie in the sky, but I speak from experience when I say that ‘My Doctors words carry weight with me. His/her words are probably the top five most influential voices in my life behind my wife and kids!”
If we have Doctors routinely switching jobs to other jobs, they dislike a little less, that will (and I’d argue already has!) impacted the health of our communities. Once again, I’m reminded of this statement a Physician (now retired) once told me: “Instead of viewing the status quo PCP model as the center of the universe. Maybe we should take some plays from the Retail Clinic playbook before we become obsolete.”
I’ve met more Physicians (in all the membership medicine models, concierge included!) who have hearts of gold and the emotions of steel over the years, and I can tell you that they’re the salt of the earth. They’re some of the best people on the planet! Sure, there’s an egotistical, self-centered, vulgar doc or three out there but for the most part, I don’t think we’re giving Physicians at-large (especially the frustrated, overworked, underpaid and burned out ones) enough freedom to explore their entrepreneurial tendencies and ideas. Instead, typically collegial opinions want to squash their ideas and keep them in line. I just don’t see this behavior today in our healthcare marketplace at-large as the future I want for the healthcare of my kids and grandkids. Do you?
In closing, for most doctors I’ve met or run into over the years, concierge medicine, albeit in the contemporary or classic version, is a practice model they proudly offer to their patients and communities. They recognize that it fosters more consistent communication and a closer relationship between patient and physician, which is an opportunity only made possible by choosing a different path. For a few peers and colleagues who would negate the good they’ve done I can’t write or say anything that would change their mind. But I will leave you with this: “It’s no longer about being the best Doctor in the world anymore, it’s about being the best Doctor FOR the world, FOR your Patients and FOR your local community.”
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