HealthcareOT: UM Medicine's new subscription concierge medicine program
UM is piloting a new, membership fee based health management program called "Victors Care". Basaically, the premise is that by paying an annual premium you will see a network of doctors who attend fewer patients and can offer more personalized service. Benefits are listed, on their website, as reduced office waits, faster scheduling, 24/7 physician access and others.
However, several high level UM medicine admins are pushing back on the service for several reasons...chief of which is their premise that this program will allow people to "jump ahead in line" of others.
Fee based subscription medicine is a growing trend in the US as doctors are looking to shore up sliding profits due to decreases in contract payouts for many services.
https://khn.org/news/michelle-andrews-on-subscribing-to-primary-care/
Detailed article in the Michigan daily on this issue
"Michigan Medicine at the University of Michigan is currently launching Victors Care, a concierge medical care model aiming to deliver tailored health care access to a limited number of patients. These patients will receive specialized, convenient and optimized care with purchase of an annual membership fee to cover primary care services without copays or deductibles.
Though concierge medicine has been practiced at a number of health facilities nationwide — including Michigan Medicine competitors like Stanford Health Care, Virginia Mason and the UNC Physicians Network Carolina Continuity of Care Program — the University will institute the care approach for the first time in April.
Mary Masson, institutional positioning director at Michigan Medicine, said Victors Care is one example of ways Michigan Medicine aims to improve medical care.
“Victors Care is a pilot program, developed after requests from patients for a service similar to what exists at institutions across the country,” Masson wrote in a statement to The Daily. “This is just one of a number of ways we're seeking to improve access to and efficiency of care we provide. Others include use of e-visits when appropriate, opening a new facility in west Ann Arbor and the planned opening of another, in Brighton this fall, which will significantly expand our capacity and access.”
However, this concierge medicine program — often referred to as boutique or retainer medicine — has drawn criticism from University physicians."
Credit: Michigan Daily, 3/7/2018, Author: Alexa St. John
Perhaps a robot with a BP cuff and glucose monitor at Walgreen's.
As an employee of MM it's weird that this is the first I'm hearing about this. My main concern is obviously patients with lesser means being left behind. All patients should be treated equally regardless of financial status.
I agree that money shouldn't mean more access to healthcare, and people shouldn't be penalized for PRE-exsisting conditions through no fault of your own.
However, if people are deliberately making themselves sick by smoking/drugs/overuse of alcohol/stuffing their faces with fast food everyday, then yes those people should be required to pay alot more.
Come on man. This tired ass trope of folks with hourly jobs or a shitty lot in life being chain smoking, drug shooting, drunk McDonald's fiends needs to die.
I don't know whether the marketplace is the answer (I have strong doubts), but there's no doubt that constraining the supply of healthcare causes its own set of problems. That's certainly true in places like Canada and the UK, where limited resources to pay for healthcare causes lengthy delays in certain kinds of services.
On the other hand, the Netherlands seems to have created a very interesting hybrid that balances the opportunities for universal care under a socialized system with the incentives of a market-driven model. Patient outcomes in the Netherlands do not support the worst nightmares of either side of the argument, and cost-per-case is in line with most other western democracies.
Yeah. I personally would be fine with any system that provides a reasonable level of minimum care to everyone and effectively controls costs. The Netherlands model you describe sounds good to me, and I am sure there are plenty of other models that I would also be satisfied with. So I find it endlessly frustrating that the US can't seem to either pick a system that's working well someplace else and emulate it, or adopt a functional system of our own design.
I realize our political system has reached the point of almost perfect dysfunction, and there are plenty of reasons for that which I won't get into. But I still believe that if substantially all Americans viewed health care in the way ak47 describes, as a basic human right to which everyone should have access even if they can't pay for it, then we would have figured out a way to make that happen by now. But we haven't. So what does that say about whether there is consensus around providing universal care? Unfortunately I think it says we don't have a consensus.
It's certainly unlikely that any prominent opponent of universal care would be so crude as to come right out and say that if a person can't afford to pay then that person doesn't deserve care. And in fact, even in the U.S. we have already imposed some limit on the parameters of that viewpoint. Emergency rooms have to treat people who can't pay, for instance--so even as chronic conditions are neglected and preventive care is denied, at least a patient who presents with an acute crisis receives treatment. So, I suppose I oversimplied the point above. It's probably more fair to say we have a division between people who consider it unacceptable to deny care to someone who needs it, and people who are willing to let others go without essential care so as to ensure their wealth preserves a level of access they demand. We can't agree on a path because we have different destinations in mind.
Netherlands is the perfect model for the US to emulate, but a certain party won't even consider it even to the detriment of most of the US population.
The left needs to re-craft their argument to align it with what the Dutch did.
That's very close to a political comment which would get nuked into oblivion by the MOMs.
Personally, and this is as close to a political statement as I'll make, I don't think either party is terribly interested in correcting the problem. The posturing by both (and the same, tired, unworkable, and plain ridiculous "solutions" they offer) is exhausting, and decided long ago to quit listening to any of it.
. . . truer words have never been spoken. I have a laundry list of issues which immediately spring to mind which will remain unarticulated here,
My primary care doctor has offered a concierge service for a few years, but I'm too cheap to pay for it. That said, I haven't had any problems getting appointments or seeing someone at the practice.
Good thing I'm specializing.
Primary care docs don't get the respect or the pay they deserve.
No they really don't.
If I were going into medicine I'd pursue a field that circumvents insurance as a whole. Cosmetic surgery or something akin. Otherwise the pain, time and cost of medical school/internship isn't all that attractive versus the rewards these days.
Otherwise the pain, time, and cost of medical school/internship isn't all that attractive versus the rewards these days
Eh. Find another field where you are guaranteed $140K+ (and much more likely to start in the $200Ks) upon finishing residency. Regardless of how well you finished in your class, regardless of what school you went to.
Is change coming? You bet. But as long as you plan accordingly, current medical students will be fine.
you are not guaranteed a $140K salary, physician reimbursement has been decreasing steadily for years. But for argument's sake, let's say you will make $140K; first, you probably won't see this income level until you have completed training and are in your mid 30's. Second, you will be servicing a student loan debt of $250-500K, what kind of a lifestyle will you have when you will be bringing home less than $100K after taxes?
Seriously, you are better off being a Nurse or a Physician's Assistant. There have already been studies showing it is more cost-effective to be a Nurse Anesthetist vs an MD Anesthesiologist.
Primary care is soon to be replaced by Dr. Amazon, Dr. Google and Dr. Watson from IBM
This is coming to specialists already.
My wife is a PCP for Kaiser. Retinal exams and ECGs are interpreted remotely already.
One of our friends went to a "Future of Medicine" conference in DC, and the advances in image interpretation hooked to AI makes it very likely that pathology and radiology will very much be on the chopping block in the near future.
My wife's primary care doc dropped out of the network she was in and started her own concierge service for many of the reasons you mentioned mo1997. The practice she was in had been bought out and each doctor was expected to see more and more patients. The doc said she was stressed and had to rush each patient in and out.
My wife now pays $69/month, and she likes the service so far, even though it is more expensive (my wife has had some fairly serious health issues and likes the idea of having a doctor that is more available and attentive should she need it).
I have for the past few years. My PCP became a part of MDVIP and it's been a revelation. Now, instead of trying to manage a practice with ~2500 patients (give or take) he's managing a portfolio of 1/10th that many.
The quality of care that he's able to provide has risen dramatically as a result. Getting a VERY comprehensive, annual physical as a part of the deal has been fantastic (it is done in two parts, and includes several exams not normally included in annual "wellness").
Additionally, my personal and family history of heart disease - along with several other risk factors - has meant that the added, highly personalized care has made a tremendous difference in my overall health and long-term prognosis. In short, he has the ability to spend whatever time is necessary to ensure I have the best odds possible for good health.
I highly recommend it for anyone with complex, long-term health issues or risk factors for major health problems later in life. It's not cheap, and most health insurance doesn't cover the annual membership fees; but I've found the value to be more than worth the cost.
Good feedback...I wonder if this may become a mainstream benefit offered by employers in the future?
From what I've seen, many companies, often through their insurers, are establishing employee wellness programs that have some similarities to concierge medicine. Some of these programs (including the one offered by my employer) include 24/7 access via a private, internet chat room to a medical professional.
That said, it's not like being with a "real" doctor, in an office setting. Nor does it offer the kind of long-term benefits of working with the same physician who gets to know the patient well.
The cost is not insignificant, either. I'm paying approximately $1500 out-of-pocket each year for MDVIP. I doubt whether most employers would offer it as a standard benefit - but perhaps as an option.
Unless the concierge model is somehow decreasing the need for people to see doctors or increasing the supply of doctors, and I haven't seen anything to suggest it is, the problem of too many people and too few doctors that your problems were driven by won't be alleviated at all. You've just paid to get out of that system, and as more doctors move to the concierge model it will in fact leave less doctros available to a still large pool of people excarcebating the problems that already exist. This model is only a positive if you are comfortable with being able to pay your way out of a crappy system and not worrying about the impact on others. Which when it comes to your health and the health of your family I totally understand, but this isn't a model that will lead to improved care overall, it will lead to improved care for 10% of the population and likely to worsening of already existing issues for the other 90%.
As a UM doc I can tell you that every UM doc I know thinks this is a terrible idea. Over 300 have a signed a letter to the dean urging him not to do this. It is completely at odds with the ethics we teach our own students.
I can completely understand the conflicting values this must create for you as a physician. However, the benefits to your patients cannot be overlooked. As I wrote below, I'm sold on the model and the (much higher) standard of care it offers. I'll continue to use it as long as I need it and can afford it.
I also concur that many, many patients can't afford to pay for concierge medicine. The obvious risk is that we get "haves and have-nots." Truthfully, though, we have that already in many ways. While ACA eased part of the burden, as doctors and medical practices consider whether they will continue to accept Medicare, with its continually declining reimbursements, and ever-escalating policies and requirements, that day is sadly coming anyway.
This is an extremely fatalist position. Thing isn't great, thing is likely getting worse, let's accelerate the worsening and leave the most vulnerable behind because we can't do anything about it anyway. The conflicting values you speak of are: I have an ability to pay more for something than someone else, and therefore I will buy that thing for more money. Great for cars, bad for healthcare.
How about the costs to the patients? You as one person may be doing better, but everyone else that does not participate is incrementally worse...have enough of these programs and peel off enough of the country's PCPs (which are already in short supply) and you can see where this is all a problem.
My PCP is a Michigan Health doctor and my level of care seems just fine, and if having not an hour long phsysical, and getting rushed in and out of labs, means that some guy on Medicare also gets to see a doctor, that is a societally beneficial outcome that I will continue to support.
I think that is a bit of an over-statement. Some medical ethics support the idea of not rushing patients through visits, being more readily available for appointments, building a personal relationship that might help you notice lifestyle/other issues that may impact health, etc.
On the other hand, there is the ethical concern of treating all patients and the poor as well. That is important.
It seems like an ethical quandry and not clear cut.
Plus, it seems odd that the ethical concern of treating the poor would have so much more weight than other ethical considerations.... in the environment of a top-tier research hospital primarily serving a mostly affluent population in a college town. We're not talking about doctors that chose to work at a community hospital on the south side of Chicago here.
Go look at the number of locations that have primary care clinics
http://www.uofmhealth.org/our-locations
Is Muskegon affluent? Flint? Lansing? Jackson? Ypsi?
And everyone supports not rushing patients through visits, having available appointments, etc. The whole point is that we're increasingly designing a health care system where unless you are in the top 10% of income, you don't have a chance at this standard of care.
Whether affluent or not, doctors can always help the poor and other people even with conceirge medicine.
As for stratified healthcare, well, we have had that FOREVER in this country. Any non-government free market (even if most people are paid by government funds) will give better stuff to richer people.
The only way to mitigate that is universal health care. AND, that would not eliminate it. Only mitigate it. There would still be some inequality.
(Many public goods are not equal. Government run schools and roads are better in priavet areas. Even the military and military contrators are awarded based on connections and an uneven playing field.)
The only way to minimize this is that universal health care idea.
Personally, I am for universal health care, but we have a free market. And, as such I don't see anything unethical with concierge medicine. This is what you get when medicine is private. Accept it or change it. Don't just complaint that it is "unethical" but keep supporting the system.....
The ethical dilemma is not about leisurely primary care. This concierge system allows those that pay more to get in line way ahead of all other patients that go to UM if they need a specialist and if they need to be seen in the ER. The fact is that many specialists at UM have a wait list of greater than 3 months to get an appointment (try getting in to see an endocrinologist or a neurologist ). Its not about who we treat as much as it is when we treat. A patient should not be allowed to jump the line at a state supported university medical center because they are willing to pay more.
If that's the plan at UM, I'm totally against it. The UMMS is a public institution, part of the larger university. It's not DisneyWorld, where paying extra means you get to skip the long lines for a ride on Space Mountain.
Neither, for that matter, is it Stanford (which is mentioned as a comparison in the OP), which is a private institution. The Regents should put a stop to this nonsense, but it doesn't sound as though they will.
LOL. 20 years ago, when I was just a young BBA grad, I worked on a project for Anderson Consulting on the same exact thing. Healthcare innovation doesn't exist, it just gets more expensive.
This seems like a very slippery slope to me. The realities seem to be that Primary Care docs are getting out of their "conventional" practices for a number of reasons, many of which I can fully understand: Too many patients to reasonably manage at the level they would like, too much paperwork for reimbursement, shrinking reimbursements which equals more work for less pay, which then drives the vicious circle to needing more patients....This OR go the concierge route. Way less patients so complete patient management becomes possible: less paperwork, "membership fees" make up for the lack of reimbursement, more personalized medicine.
I think most primary care docs genuinely want to do the very best for their patients but the system, as is, doesn't allow it. Thus the advent of the concierge doc.
I have no problem whatsoever with a private practice to go this route. Free country...form your business and make a go of it.
For a public institution to take this step is VERY troubling to me, though. Such institutions exist to serve everyone, equally, regardless of economic status.
The supporters of this program are claiming that the added income they anticipate will allow for continued and even improved care for "the masses". Color me suspicious. This ain't no fundraiser. The added monies are going to be kept in the concierge side of the business and, in my opinion, will increase the feeling of the wealthy getting superior medical care at UM. That is a horrible image to have.
UM has long been a champion of healthcare, especially with Motts and all it does for our children. I say let private docs take care of the demographic that they want to, keep the institution TRULY focused on caring for the most in need.
where money heals!
This is bullshit. Capitalist pigs!
Let's start with Michigan's current proposed program. Right now it's one doctor. I understand the slippery slope argument, but right now it's one guy so let's catch our breaths.
Next, let's not kidd ourselves about money. The fact that you have insurance already means you have greater access to care than someone without. So, if you accept the premise that insurance is not universal (I'll get to that later), then you've already accepted that access to care is dependent on other things (e.g. having money, a job, etc).
Now it's time to face the real problem - insurance companies (or at least the private, for-profit ones). They want your premium dollars and don't want to ever pay a cent for your care. Why do you have to pay deductibles, copays, and coinsurance? All made up words to prevent you from getting your premium dollars. Most insurance companies are purely money-making machines. And what insurance companies expect from doctors is beyond ridiculous. Meaningless box-checking. Seeing patients every 15 minutes, no matter the complexity. Endless red tape, denials, pre-authorizations. The talk of "burnout" in medicine is very real and it lies at the feet of insurance companies (in addition to bureaucrats and administrators). The doctors I know who are leaving the insurance-model are not doing it to make more money. They plan on making the same or less. They are doing it to save their sanity and would otherwise quit medicine. They are doing it to be able to actually take care of their patients. And, honestly, they are doing a damn good job of it now that insurance companies are out of the way.
There are multiple new models including concierge-style, direct patient care and in-betweens like MDVIP. This is a good thing. Our healthcare spending in this country is unsustainable. There's a lot of blame to pass around, but when UnitedHealthcare is making a billion dollars a quarter then maybe there's a problem. When politicians don't allow Medicare to negotiate drug prices, that's another.
It's time to try new things. I also don't think anyone should be left behind. I'm not going to get political except to say that both parties are to blame and both have particularly bad ideas. However, would it be unreasonable for all of us under 65 to be able to purchase Medicare? Would it be unreasonable for Medicare to negotiate drug and device prices? That's not "socialized" medicine and would bring down costs fairly rapidly. It would also bring down profits for insurance and pharmaceutical companies and there's a reason they spend a half billion dollars or more lobbying every year. My advice is to talk to the people who are actually caring for patients (doctors, nurses, PAs) and ask them what they think of insurance companies.
March 10th, 2018 at 12:00 PM ^
I've been and remain an investor in the healthcare space for some time; and, I've worked with a number of concierge providers. Given the current state of our healthcare system, I think concierge practices offer many benefits, particularly for those who are willing to pay for it. Should it be available to everyone? Sure, why not? Is it, no...and - honestly - that's not really the battle I want to or intend to fight because - as many have noted - most health reforms simply "reposition the chairs on the Titanic."
Having said all that, one fantastic company for those in major urban areas is OneMedical. I am very close with the team at OneMedical and think they do a great job. Also, there's a Michigan connection: The CEO of OneMedical, Amir Dan Rubin, attended SPH for graduate school and remains a close advisor to the school (the school's top-ranked MHSA program). He's a great, great guy and a wonderful ambassador for the University.
#It is an open joke (and fact) of my hospital that the "VIP" floors (with nice flatware, younger, perkier nurses) may be "less safe" than the non-VIP floors (cloistered rooms harder to manage, isolated floor that interns less likely to go to, young perky nurses less experienced than grizzled vets RNs).
--Similarly, for conceirge PCP patients, maybe outcomes not different for most (non-complicated) patients (or "clients" haha...sad).
#There should be ways to make this palatable / "ethical":
--Maybe have each conceirge doc spend 20% of their time providing conceirge level care to medicaid patients? Particularly complex medicaid patients that are quicksand to the typical PCP's day/panel?
--Simiarly, I have no problems with our VIP floor and silly silverware, it helps subsidize care / research for the rest of the hospital.