Last Updated: September 2020 Edition
By Michael Tetreault, Editor-in-Chief, Concierge Medicine Today/The DPC Journal
As the Editor of several free market healthcare trade publications, including Concierge Medicine Today and our sister publication, The DPC Journal, the conversations, interviews, events and observations over the years operating and writing for these publications provide us with a unique perspective on the past, present and future of these niche markets that rightfully each serve Patients and Physicians in advantageous and life saving ways.
It should be known that we are not affiliated with any Doctor’s office, medical group(s) or association(s), etc., which affords to us to critique and observe these subscription-based healthcare delivery models with an unbiased opinion and neutral context upon which to outline our opinions. Which albeit, we may have different perspectives on than what you might be comfortable hearing about at niche industry conferences. Notably, we have also observed these events are often marked by great collegial networking but or at times, uncritical enthusiasm or excitement.
It’s not lost on me that Concierge Medicine is a polarizing term. But, that’s okay. And, I welcome anyone who is willing to learn to have a conversation about it.
Conversely, we’re also aware of the rising young Doctors need for independence to start and strike out on their own in DIY-DPC. And at times, we see seasoned DPC Physicians whose rising enthusiasm to break away from bureaucracy and control to start a Direct Primary Care (DPC) practice is as much a statement against all things that hold the Physician and Patient away from each other as it is a personal mission to serve the Patient.
Each of these subscription-based healthcare delivery models are doing great things.
As we look to the future, particularly the future of DPC, we see closures going unreported and Physician’s moonlighting and DPC practices vanishing. While another may pop up quickly somewhere else, that’s great. However, these DPC practices we are observing over the past several years now are in need of business training and leadership development education that is simply not being taught in medical events, CME curriculum, medical meetings, industry events or webinars of any real value to the Doctor.
A recent story entitled Thousands of Doctors’ Offices Buckle Under Financial Stress of COVID, written by Laura Ungar in Kaiser Health News (KHN) should be sobering to all of us that proves this futuristic hypothesis.
At both CMT and The DPC Journal we have been talking about and addressing the lack of business education and support for Doctors and Physician-CEOs now shuttering their doors, forgoing the terms of their real estate leases and so on for years.
There’s truly little in the way of support to course correct the ship by medical groups, medical associations or even medical event CME organizers and medical office managers when these practices run into financial trouble. It’s clear that even in the niches of Membership Medicine, particularly the closures in DPC over the past few years that are not tracked, that still little support is being directed towards Physician’s when they face closure.
Laura Ungar at KHN further proves this out as well when she writes on November 30th, 2020 … Although no one tracks medical closures, recent research suggests they number in the thousands. A survey by the Physicians Foundation estimated that 8% of all physician practices nationally — around 16,000 — have closed under the stress of the pandemic. That survey didn’t break them down by type, but another from the Virginia-based Larry A. Green Center and the Primary Care Collaborative found in late September that 7% of primary care practices were unsure they could stay open past December without financial assistance. And many more teeter on the economic brink, experts say.
We start with all of that to emphasize that there are not perfect business models in healthcare.
As enthusiastic and excited as DPC is, it’s not the pathway for every Physician. I get it.
Furthermore, Concierge Medicine isn’t the path either for some Physician’s either. We understand that too.
But as someone wiser and who has obviously sold more books than I have recently said, ‘The goal is not perfection, the goal is progress.’
The Subtle Differences Between Concierge Medicine and DPC. Both have a place in healthcare for different patient demographics.
First, if you haven’t heard of these terms in healthcare, you’re not alone.
They’re relatively new.
Concierge Medicine, sometimes called Concierge Care, boutique medicine or private medicine has been around since the mid-1990’s. It’s actually much older, decades in fact but that’s a story for another day.
Jim Eischen, Esq., we think said it best at the former American Academy of Private Physicians conference (April 2015) at a physician meeting in Phoenix, Arizona when he said from the podium …‘let’s focus on substance, not labels.’
Direct Primary Care, otherwise know as DPC or direct care is much younger than it’s familial subscription-based healthcare delivery business model in healthcare, despite reports in the media citing the same dates as Concierge Medicine.
These terms are often globally referred to in our publications, events, Physician interviews and books as “Membership Medicine.”Or, as some outside of healthcare but business title, part of the subscription-based service economy.
This article today is not meant to persuade or convince you that one subscription healthcare delivery business model is better than another. Each have pros and cons. Each provide unique services to Patients and have different features and benefits that bend to the Patient and Physician being more closely connected.
It’s not easy doing either one.
Don’t let anyone tell you different.
Furthermore, don’t let anyone tell you what you’re worth or that ‘You should just pick the [salary] figure what you want to make each year and go from there …’
Don’t let people tell you that some prefer to think of DPC as the less expensive or generic alternative to Concierge Medicine or that any reference to Concierge Medicine in healthcare is only targeted for the ultra-wealthy Patient.
Most of the Doctors that I’ve known in my career and I have known a great many will tell you they went into one model or another based on a great deal of research, wise counsel and great ideas that they wanted to see become a reality. Fewer, went into one model or another because of frustration with bureaucracy.
Regardless of the reason, there’s inherent value and truth in either path.
What you’re about to read is what I hope is an open minded editorial which I welcome readers to share their insights and experiences as well. Furthermore, I always welcome an open open minded conversation to anyone willing to have a discussion about the pros and cons around each of these subscription-based healthcare delivery models. If at the end of our discussion, neither path is in your future, then we’ve done our job as well.
It’s not lost on me that Concierge Medicine is not for every Doctor, nor every Patient.
It’s also not lost on me that Direct Primary Care (DPC) is not for every Doctor, nor every Patient.
There’s similarities to be sure. There are also polarizing differences. The goal of each however is to provide a lifeline for Doctors and Patients that allows them to have a closer, more transparent and convenient connection with one another.
Most of your peers as you know move into medicine for the same reason most physicians do. Because their family was connected to medicine somehow. It tends to move along like that line. A sort of family business or as some might say, a patrilineal descent into the career known as medicine. It’s what your father or mother did. Or maybe there was a friend of the family who was in medicine that you encountered at a young age that forever changed what you wanted to do. It’s simply who you are, you’re a Physician, first and foremost.
It’s also important to note that most future and current Doctors were introduced to medicine as an act of love for human kind. I love that.
I know that might sound suspicious to some people given how they think of healthcare today as multi-tiered, impersonal and fraught with bureaucracy and high costs.
Though I have no illusions, there will always be a rift between people’s understanding of what concierge medicine is and does and the rest of what healthcare could be and should be. I believe personally that concierge medicine has become the conscience of our healthcare marketplace and the stories we share, show and tell her now for years at CMT prove that to be true. These Physician’s are truly doing great work and will continue to do so in the future.
I’m also open to discuss Concierge Medicine, subscription-based healthcare delivery, DPC and even the impact of retail healthcare and the concept of patient fatigue with anyone who will listen.
A common misconception out there is that every Concierge Doctor who does it is in it for the money. That’s just simply not true. That argument has created a removed perspective.
What the doctor-patient relationship currently looks like today is a relatively new experiment in our human history. When we’re long gone and Millennials, Gen Y and Z’s are using Google glasses and asking their grandkids if they texted or video chatted with their Doctor we’ll soon see the Patient-Physician relationship hopefully in a far more connected place than Patients are experiencing today.
To say that Patient Fatigue and the stress of the unknown for a Patient is not an issue both mentally and physiologically for the Patient and Physician to deal with in the future is to also understand why these subscription models in healthcare today exist.
Horst Schulze, former executive at the Ritz Carlton and now respected author and speaker says it best in his book, Excellence Wins: A No-Nonsense Guide to Becoming the Best in a World of Compromise, “An organization can’t please every human being every time. But it never hurts to try.”
He also says later in the book, “No sound on earth is as sweet to a person’s ears as their own name.”
Those words reverberate in the hearts and minds of the Concierge Medicine Doctors that I know and have known.
I respect a Doctor who pursues his or her passion to help people.
But I’m naturally drawn as most people are to find, follow and befriend a Physician who has the kind of personable qualities that we all look for in a friend. I want to find a Physician for myself and my family who looks you straight in the eye and says “How can I help you today … “ or “It’s okay. We’re going to get through this together …” Furthermore, what we all want is a Physician who isn’t distracted and doesn’t let his or her circumstances or station in life dictate his or her bedside manner.
Author and speaker Jeff Henderson said “Every relationship has a climate—sunny, stormy, or even icy. And the current climate dictates the forecast. The problem is that many of us are unaware of the emotional climates we carry around with us.”
We shouldn’t have tribalism in healthcare. Sure it’s nice to celebrate and commiserate the hardships of our journey with friends and colleagues but the one thing I see both critics of Concierge Medicine and advocates of it have in common is that they all want to see the Patient and Physician brought back together in a way that’s satisfying to both the Doctor, the Patient and ultimately, the community.
In my personal opinion, there’s no room for tribalism in healthcare. There’s no room for the criticism of Doctors following their entrepreneurial inclinations that will help their community become healthier. Whatever form, brand or term that may be.
Today the tribalism in healthcare is evident. As an observer of this space and other healthcare delivery innovations, it’s easy to see.
Professional tribalism is an attachment of health professionals to their respective medical, nursing and allied health groupings instead of collaborating and identifying as cross professional team members (Weller, 2012).
For critics of Concierge Medicine, the tribalism can get pretty esotheric. Oxford Dictionary defines the adjective esoteric … as intended for or likely to be understood by only a small number of people with a specialized knowledge or interest.
I’d like to see that tension remember the common ground. It’s the patient. He/she, they’re right there. They’re sitting right there. And we all agree that the Physician and Patient need come closer and closer together.
The British Medical Journal (BMJ) researchers even went so far as to study tribalism in healthcare recently.
The Results: At baseline, there were few significant differences between the professions in collective orientation, most of the personality factors, Machiavellianism and conservatism. Teams generally functioned well, with effective relationships, and exhibited little by way of discernible tribal or hierarchical behaviours, and no obvious differences between groups (F (3, 31)=0.94, p=0.43).
Conclusions: Once clinicians are taken out of the workplace and put in controlled settings, tribalism, hierarchical and stereotype behaviours largely dissolve. It is unwise therefore to attribute these factors to fundamental sociological or psychological differences between individuals in the professions, or aggregated group differences. Workplace cultures are more likely to be influential in shaping such behaviours. The results underscore the importance of culture and context in improvement activities. Future initiatives should factor in culture and context as well as individuals’ or professions’ characteristics as the basis for inducing more lateral teamwork or better interprofessional collaboration.
Most of the Doctors that I’ve known in my life and I have known a great many, struggle in some way with how to design a practice, a career in medicine that focuses primarily on the Patient-Physician relationship without a lot of hassle.
It’s a process. There’s no perfect model, despite the rhetoric of some who are more tribal in their beliefs than others.
As a Physician you strive to make a difference each day. You struggle with the time you can’t spend with your Patient. You are fatigued by the bureaucracy, the control but yet an internal voice drives your vision to truly care for your patients inside an unfair ecosystem.
Concierge Medicine is only one way to help Physicians find a lifeline in their career and help with Physician Burnout. It’s not the only way.
Direct Primary Care (DPC) is another great way, but it’s also not the only path. For the few …. the conversation around the differences between Concierge Medicine and DPC illustrates that central paradox between Do no harm … and Treat Others as You Want to be Treated.
When wrestling with this, I believe it’s important to remember that many of our most influential Doctors had a love of medicine at the beginning of their journey that inspired in them to save the world and help humanity.
My personal hope is that more Doctors will continue to wrest with their own frustrations about the delivery of medicine while at the same time not become tribalistic and develop an optimism that fuels their vision to ultimately marry The Hippocratic Oath with The Golden Rule.
So which ever path you choose, Concierge Medicine, DPC, hospitalists, executive in healthcare, advisor, etc., make the decision that’s right for you. Don’t be persuaded that one path is the only way. Someone recently said and we don’t know who so the credit here is not ours, The goal is not perfection, the goal is progress.
Communicator and author, Andy Stanley recently asked this question in one of his Podcasts to listeners which I think resonates with today’s article. He said, “Is it more important to be fair . . . or to do good? Do for one what you wish you could do for everyone. Because if we all did for one what we wish we could do for everyone, it might change the world. But certainly, it would change one person’s world. It may even change your world.”
Let’s Get Started
This monthly fee for a primary care doctor is another popular and emerging business model in our free market economy that has gained tremendous popularity since 2008.
A lot of people like to compare Concierge Medicine to Direct Primary Care (DPC) and say … ‘DPC is the less expensive alternative.’
In most DPC doctors’ offices, Patients pay one low monthly fee, sometimes as low as $49-$99/mo. directly to their DPC physician for all of their everyday health needs. Like a health club membership, this fee (avg. $50-$99/indiv.) provides Patients with unrestricted access to visits and care. Patients can use the services as much or as little as they want. Many DPC practices are open seven days per week and offer same-day or next-day appointments. At many clinics, physicians are on call 24/7.
“The distinctions between concierge medicine, private medicine, and direct primary care may be ultimately meaningless, since some doctors call themselves whatever they feel sounds better, and there are so many practice variations, many overlapping, that it often isn’t clear which is which.” ~Neil Chesanow, Medscape/WebMD, May 2014
“This primary care business model [DPC] gives these types of providers the time to deliver more personalized care to their Patients and pursue a comprehensive medical home approach,” said a spokesperson at former Qliance Medical Management based in Seattle, Washington. “… The provider’s incentives are fully aligned with the Patient’s incentives.”
With DPC, there are no insurance co-pays, deductibles or co-insurance fees. DPC doctors do not typically accept insurance payments, thus avoiding the overhead and complexity of maintaining relationships with insurers. This can save significant overhead expense as managing insurance relationships can consume as much as $0.40 of each medical dollar spent.
DPC practices typically have monthly membership fees under $100 and serve a population of households earning $70,000 or less, according to The Concierge Medicine Research Collective. Monthly Concierge Medicine membership fees usually are slightly higher, about $135 per month and can include more in-office services. Despite the cost advantage, the DPC model may be hampered by low awareness among health plans and primary care physicians, resistance from some insurers, and resistance from competing hospitals and specialists. Although, significant efforts are underway to accelerate the DPC movement, so this disadvantage may disappear as awareness grows.
In a report published by the California HealthCare Foundation, five large DPC clinics in the U.S. using a DPC healthcare service model serve over 500,000 lives. These charge either direct fees paid to the doctor, the physicians practice, or via self-insured employers and health plans.
Overall, Concierge Medicine and DPC style clinics are thriving in major metropolitan markets. Of great benefit to the consumers, prices are dropping dramatically due to increasing competition among physicians entering the marketplace, retail medicine pricing, price transparency demand from Patients and continued uncertainty about the implications of the Affordable Care Act.
DPC (DPC) is a term often linked to its companion in health care, ‘Concierge Medicine.’ Although the two terms are similar and belong to the same family, Concierge Medicine is a term that fully embraces or ‘includes’ many different health care delivery models, DPC being one of them.
The data, the patient interviews and the industry service offerings and trend lines say something completely different.
The distinguishing factor differentiating DPC and Concierge Care is not price … it’s insurance participation of the doctor, monthly billing (seen at most DPC clinics) and the amount of services offered. In both Concierge Care and DPC, people have inherent value. There’s no class order … no first class or second class, just people for whom doctors serve each day. They’ve built clinics for children, families and people who are sick … and it is these visioneering physicians who are drawing attention to the cost of healthcare across the country and designing ways for it to be available and affordable for anyone.
Concierge Medicine patients skew upper middle class, with typical household earnings between $125,000 and $250,000 a year. They also tend to be Baby Boomers, generally in their 50s to 80s, according to doctors interviewed.
- Annual fees at most Concierge practices vary from $101-$225 per month. Patients prefer to pay annually vs. monthly.
- A greater breadth of primary care services covered by an annual retainer contract fee structure.
Many concierge doctors also bill insurance or Medicare for actual medical visits, as the monthly “access fee” is only for “non-covered” services. This results in two subscriptions paid by patients — the concierge medicine fee, and the insurance premium. Importantly, a few concierge practices do not bill insurance for medical visits, as the monthly fees cover both access and primary care visits.
DPC practices, similar in philosophy to their Concierge Medicine lineage – typically bypass insurance and go for a more ‘direct’ financial relationship with Patients.. They also provide comprehensive care and preventive services for an affordable fee. However, DPC is only one branch in the family tree of Concierge Medicine.
Similar to concierge health care practices, DPC removes many of the financial barriers to accessing care whenever it is needed. There are generally no co-pays, deductibles or co-insurance fees. DPC practices also do not typically accept insurance payments, thus avoiding the overhead and complexity of maintaining relationships with insurers, which can consume as much as $0.40 of each medical dollar spent (Sources: Dave Chase and California Health Foundation).
Under most Patient-physician contracts in DPC and concierge medical clinics, Patients (and workers at employer groups, small and mid-size businesses) pay no co-pay for services. In addition to the services that the doctor provides on-site and inside the practice, individuals and companies maintain lower cost insurance plans to accommodate major medical expenditures and more intensive procedures. In that sense, the model for healthcare is similar to that being pursued by many internal medicine, specialty physicians and family practitioners, who are today, reducing their Patient load by two-thirds, dropping insurance wrangling and adopting a DPC model paid with an (almost) all-inclusive, monthly, quarterly or annual subscription fee.
“I have decided to adopt a blended model of concierge medicine. My current patients may continue their medical care at our clinic, and a well-trained and capable nurse practitioner under my supervision will be seeing them. When necessary, I will be brought in with the nurse practitioner to discuss and formulate the medical management plan. Those patients who sign up for the concierge service be seen by me and get to enjoy extended appointment time during their visits, have access to me via telephone 24 hour/7 days a week, same day appointments, and get detailed in-depth yearly physical that focuses on disease prevention and wellness. My motto is “Preventive Healthcare, A Smart Approach to Healthy Life”. I believe that a healthy body and stable mind gives the opportunity to live an enjoyable and rewarding life.” ~Dr. Mary Thomas, Baton Rouge, LA
According to a spokesperson at now closed, Qliance Medical Management based in Seattle, Washington, DPC is a ‘mass-market variant of Concierge Medicine, distinguished by its low prices.’ Simply stated, the biggest difference between ‘DPC’ and retainer based practices is that DPC generally takes a low, flat rate fee whereas concierge models plans usually charge a slightly higher annual retainer fee and promise more time spent with a doctor. Also, services in concierge models tend to more service-focused and added-value oriented versus just providing access and more convenience to the practice.
“We ask people to do really hard things: gluten and dairy free diets, mold remediation, massive amounts of targeted vitamin and mineral supplementation based on labs, calorie counting and exercise logs, meditation. When they are willing to do these things they usually get better. When they don’t, they are wasting our time and their money. We coach them with a lifestyle coach included in their membership, we follow up with them via snail mail cards, phone and email, and we do everything to give them tools for success but if they are not willing to make the changes, we tell them that the relationship is not working and they need to seek another doctor.” ~Dr. Ellie Campbell of Campbell Family Medicine in Cumming, GA
“This primary care business model [DPC] gives these type of providers the time to deliver more personalized care to their Patients and pursue a comprehensive medical home approach,” said Norm Wu, CEO of Qliance Medical Management based in Seattle, Washington. “One in which the provider’s incentives are fully aligned with the Patient’s incentives.”
“If Concierge Medicine is about super servant-hood, then it has nothing to apologize for. People deserve to have access to a physician who spends the time necessary to gather appropriate insight about patients. People deserve transparency. They deserve answers to difficult questions. People deserve accurate information, especially when it concerns their health. Simply searching the web in today’s convoluted environment leads to inaccurate assumptions, misinterpretations, harms reputations and undermines the confidence that patients have in their physicians and local medical facilities they trusted. Concierge Medicine has been around for more than 20 years and it works to solve many of these problems. It has redefined healthcare delivery.” ~Michael Tetreault, Editor-in-Chief
“Many direct primary care practices do not build in concierge medicine service components, such as 24/7 care, cell phone text messaging, and instant or same-day appointments,” Tetreault says. “And yet, some do.”
Concierge practices composed exclusively of concierge patients (most practices include a mix of concierge and traditional patients) generally limit their panels to 600 or fewer patients per physician. “Direct primary care practices, because they charge a lower fee, need more patients on their rosters,” Tetreault explains. “They typically have under 1000 patients.”
The distinctions between concierge medicine, private medicine, and direct primary care may be ultimately meaningless, since some doctors call themselves whatever they feel sounds better, and there are so many practice variations, many overlapping, that it often isn’t clear which is which.*
Still confused by this semantic hair-splitting? Join the club. Even concierge and direct primary care physicians may be confused about which type of doctor they are.*
DPC and Membership Medicine:
- DPC is primary and preventative care, urgent care, chronic disease management and wellness support through a monthly care fee patients (or an employer) pay to cover the specific primary care preventative care services.
- DPC practices are distinguished from other retainer-based care models, such as concierge care, by lower retainer fees, which cover at least a portion of primary care services provided in the DPC practice.
- Monthly fees at direct practices vary from $25-$85 per month or less. Patients prefer to pay monthly vs. quarterly or annually.
- DPC patients typically come from the Generation X and Millennial population and earn a combined annual HH income of less than $100k.
- A DPC health care provider charges a patient a set monthly fee for all primary care services provided in the office, regardless of the number of visits.
- No insurance plan is involved, although patients may have separate insurance coverage for more costly medical services.
- Because the insurance “middle man” is removed from the equation, all the overhead associated with claims, coding, claim refiling, write-offs, billing staff, and claims-centric EMR systems disappears.
Concierge Medicine/Boutique and Retainer-Based Care:
Throughout the past several years of surveying the market (2007-2015), discussing the question with numerous doctors, interviewing industry business leaders, private equity investors, business consultants, key industry physicians and membership medicine leadership nationally — Concierge Medicine Today finds that there are slightly less than 6000 actively practicing Concierge Medicine physicians across the United States, with another 6k-8000 practicing in some form or model of “Membership Medicine” under the radar.
- Annual fees at direct practices vary from $101-$225 per year. Patients prefer to pay annually vs. monthly.
- Concierge Medicine patients skew upper middle class, with typical household earnings between $125,000 and $250,000 a year. They also tend to be Baby Boomers, generally in their 50s to 80s, according to doctors interviewed.
- A greater breadth of primary care services covered by an annual retainer contract fee structure.
- Many concierge doctors also bill insurance or Medicare for actual medical visits, as the monthly “access fee” is only for “non-covered” services. This results in two subscriptions paid by patients — the concierge medicine fee, and the insurance premium. Importantly, a few concierge practices do not bill insurance for medical visits, as the monthly fees cover both access and primary care visits.
“In polls, we’re asking the actual physicians, ‘Do you consider yourself a concierge doctor or a direct primary care doctor, or do you consider yourself both?’” Michael Tetreault, the journal editor, says. “Most say that they consider themselves a concierge doctor. But they still don’t understand the differences. A lot of doctors consider themselves to be both.”
Direct primary care providers help keep costs low by avoiding unnecessary referrals and by referring mainly to specialists willing to offer significant discounts. Despite this advantage, the DPC model may be hampered by low awareness among health plans and primary care physicians, resistance from some insurers, and resistance from competing hospitals and specialists.
NOTE: The DPC Journal and their research and data collection arm, have found that there are four (4) distinguishing factors that differentiate Concierge Care from its demographically diverse and often misunderstood companion, DPC … and it is NOT price …
- Insurance participation of the doctor/practice;
- DPC, most commonly, attracts a Gen. X and Millennial demographic under the age of 45.
- Monthly billing (seen at most DPC clinics), compared to annual and quarterly retainers offered at most concierge clinics, and;
- The amount of services offered.
The Direct Primary Care Coalition (DPCC) Defines DPC As:
Direct Primary Care (DPC) is an innovative alternative payment model for primary care being embraced by patients, physicians, employers,payers and policymakers across the United States.The defining element of DPC is an enduring and trusting relationship between a patient and his or her primary care provider.
Empowering this relationship is the key to achieving superior health outcomes, lower costs and an enhanced patient experience. DPC fosters this relationship by focusing on five key tenets:
- Service: The hallmark of DPC is adequate time spent between patient and physician, creating an enduring doctor-patient relationship. Supported by unfettered access to care, DPC enables unhurried interactions and frequent discussions to assess lifestyle choices and treatment decisions aimed at longterm health and wellbeing. DPC practices have extended hours, ready access to urgent care, and patient panel sizes small enough to support this commitment to service.
- Patient Choice: Patients in DPC choose their own personal physician and are reactive partners in their healthcare. Empowered by accurate information at the point of care, patients are fully involved in making their own medical and financial choices. DPC patients have the right to transparent pricing, access, and availability of all services provided.
- Elimination of Fee-For-Service: DPC eliminates undesired fee-for-service(FFS) incentives in primary care. These incentives distort healthcare decision-making by rewarding volume over value. This undermines the trust that supports the patient-provider relationship and rewards expensive and inappropriate testing, referral, and treatment. DPC replaces FFS with a simple flat monthly fee that covers comprehensive primary care services. Fees must be adequate to allow for appropriately sized patient panels to support this level of care so that DPC providers can resist the numerous other financial incentives that distort care decisions and endanger the doctor-patient relationship.
- Advocacy: DPC providers are committed advocates for patients within the healthcare system. They have time to make informed, appropriate referrals and support patient needs when they are outside of primary care. DPC providers accept the responsibility to be available to patients serving as patient guides. No matter where patients are in the system, physicians provide them with information about the quality, cost, and patient experience of care.
- Stewardship: DPC providers believe that healthcare must provide more value to the patient and the system. Healthcare can, and must, be higher-performing, more patient-responsive, less invasive, and less expensive than it is today. The ultimate goal is health and wellbeing, not simply the treatment of disease.
*Source: Neil Chesanow, MedScape, WebMD, May 19
There is a problem with the perception people have of Concierge Medicine and its younger, [typically no Medicare or insurance participatory, monthly subscription] companion model, Direct Primary Care (DPC).
Believe it or not, people are quite positively familiar with what Concierge Medicine is. However, they don’t always understand why some folks rally negatively against it based solely on price.
Let’s unpack this for a moment.
Both are great options for Patients. But there are subtle differences. Sometimes, geography plays a role too.
One example might be like saying that one brand of vehicle, lets say the Honda Civic for example, is the only vehicle that everyone should choose and is the best way to get people to the destination.
Or, let’s look at another example we’re all familiar with.
According to Joshua Kennon or Kennon and Green Co., he says: It is a cognitive bias that causes you to allow one trait, either good (halo) or bad (horns), to overshadow other traits, behaviors, actions, or beliefs. In psychology, horns effects and halo effects happen all the time.
Amazon PRIME and Netlfix. Sure, each have different price points. Each deliver amazing content and are built by incredible people. But one service bills monthly and the other bills annually. Each include certain benefits. Amazon PRIME lets you enjoy free shipping with every order. Each operate independently however. And, each have unique and inherent value in the eyes of the person who is paying for that subscription, the consumer [eg the Patient].
The same is true for those who learn to understand the difference and similarities between Concierge Medicine and Direct Primary Care (DPC).
Is it possible to solve this problem?
We think so.
We’re coming together, Concierge Medicine Today and The Direct Primary Care Journal with this educational insight to show our communities, Physicians and Patients who want to learn more [and are open to learning new things] that each of these subscription-based business are unique and have incredible value in the eyes and minds of the Doctors and the Patient. While they aren’t the same they do share similar services.
We invite you to download the Infographic below and you will learn how to clarify, explain and understand in greater detail the differences and similarities between these two subscription-based healthcare delivery models in your sphere of influence and people you meet.
Great Doctors and great people in our past have designed these business models to be independently unique enough for different people and different demographics. We can all learn from each other and we should. Ultimately, we are all working toward the same goal and travelling towards the same destination. But sometimes we might have different paths that we want to take to get there. And with the goal at the end of the day being a destination we all agree on which is to ‘Bring the Patient and Physician closer …’ Who wants to argue with that?
“There Should Be Absolutely, Unequivocally, No Necessary Tension or Conflict Between DPC and Concierge Medicine. Each Physician is doing what they feel is right for the Patient and at the end of the day, ‘the Patient comes first.’ There’s nothing wrong with that. While these two models are similar in their subscription programming, they each have uniquely different things that make them attractive to different audiences. They are simply different vehicles taking Patients to the similar destinations. These are Physicians following their hearts and guess what, they’re uniting heart and hands together and helping Patients like we’ve never understood before. Yes, they may have some things in common but they are also BOTH beneficial and special to those Patients that seek them out around the country. Each Physician should be respected [by Physicians] for their differences and their shared values. Never should we denigrate the practice of medicine and those Doctors who choose a path different from your own. The world has high expectations and seemingly impossible goals and harsh realities placed upon Doctors, we don’t need Physicians disparaging or discouraging one model from another within this small and growing free market healthcare delivery space. As Truett Cathy, the CEO of Chick-fil-A once said, ‘If someone is breathing, they need encouragement.’ Let’s be a group of healthcare educators that is known more for who and what we are for versus who and/or what we are against. Let’s be a group of people in medicine that is full of like-minded Physicians in the business of delivering great Patient care and that encourages other Doctors to follow their passion, however unique or different it might be for that local community of Patients.” ~Editor, Concierge Medicine Today and The DPC Journal
So today, as we add to, write about daily and discuss the different types and specialties and Doctors and other healthcare practitioners who are seeking educational resources, advice or even looking for a career change … they frequently ask us about the difference between today’s “Membership Medicine” [eg. two primary subscription-based healthcare delivery models] which are commonly called ‘Concierge Medicine’ and its younger cousin, ‘Direct Primary Care (DPC).’
Today, we feel it’s important to take an educational, not editorial approach.
While each have unique patient demographics, some similarities and quite a few differences, we have observed there’s not one that’s better than another. Great Doctors practice within each model. Stating or even saying editorially that one is better than another, closes the minds of Doctors seeking a career lifeline. It also will close the minds of the Patients you serve, in essence saying, ‘It’s my way or the highway. I’m right, you’re wrong, case closed. I’m not open to your opinion.’
Stated another way, that would be like saying every patient is exactly the same and should be treated the same way, every time, every day, no matter what.
And you know as well as I do, that’s just not true.
We don’t have the liberty to paint with such a broad brush.
Therefore, we don’t paint a halo on one and horns on the other. That’s not fair to anyone, let alone the Doctors working in each field or the patients they serve. Each business model, while having similarities, also have drastic differences. It’s up to the Doctor and your own intelligence to pick which subscription-based business model will work for you and your community of Patients.
To that end, I think it’s important to understand the psychological principle of the Halo and Horn Effect as you decide which business model is right for you. But please, don’t be so quick to criticize something you don’t understand until you’ve done a deep dive into learning more about it.
According to Joshua Kennon or Kennon and Green Co., he says:
It is a cognitive bias that causes you to allow one trait, either good (halo) or bad (horns), to overshadow other traits, behaviors, actions, or beliefs. In psychology, horns effects and halo effects happen all the time. Attractive people are, on average, though to be more intelligent even though this isn’t true. Overweight people are thought to be lazy, which is not necessarily the case.
The power of the horns effect and halo effect comes from the fact that it is closely related with several other mental models and, working together, you get a magnified influence. On one hand, you have mere association at work. On the other hand, you have the mental model of implicit personality theory, which states that individuals believe traits are inter-connected so that the presence of one traits means the presences of others, which isn’t true (e.g., a girl who dressed provocatively might not sleep around and someone who speaks slowly might not be unintelligent).
For added perspective, MBASkool is a one-stop management knowledge portal and a B-School community for all MBA students, professionals and MBA institutes, with the motto “Study Learn Share” and wrote the following:
HR (Human Resources) Definition: Halo & Horn Effect
Halo & Horn Effects, both of these effects come under the category of the first impression error. To elaborate these terms signify the error one makes by forming an opinion about a person/ situation, just by keeping the first impression in mind.
When we meet someone, and the first impression of him is very positive, then we tend to ignore the negative characteristics in the person and concentrate only on the positive characteristics. We start seeing the person in the halo of the positive first impression. This is called Halo effect. For example, if the interview starts with a very positive statement from the interviewee, then the interviewer tends to form a positive impression about the interviewee due to halo effect.
If our first impression about a person is negative, we tend to ignore his positive characteristics and concentrate only on the negative ones. We tend to see the person in the light of the negative first impression and hence there is higher probability that we will not like the person. This is called horn effect. For example, if an interview starts with a negative statement from the interviewee, there is higher chance that he would be rejected due to horn effect.
So, In Summary, What Can or Should You Do?
We can appreciate what Joshua Kennon write in 2011 when he said this about protecting yourself against the Horns and Halo Effect.
How to Protect Against the Horns Effect and Halo Effect
The best defense against the horns effect and halo effect is to always adhere to one rule: Every idea must stand on its own merit regardless of who proposes it.
That is easier said that done.
Consider the case of the average Republican, who is supposedly pro-tax cut.
A few months ago, President Obama proposed a 50% payroll tax cut that would have been one of the greatest middle class tax cuts in the history of the United States. They opposed his jobs bill, which included the tax cut, in large part because it would have been a political “win” for him. In the far-right mind, the “horns” of Obama’s personality overshadowed their own self-interest.
So if we go through life evaluating every proposal and every situation on its own merits, its own rationality, and its own opportunity costs and outcomes.
This is exactly why John Stuart Mill would read books, articles, and other evidence that he knew to be wrong in order to, ” [see] that no scattered particles of important truth are buried and lost in the ruins of exploded error”. He had built a system that compensated for the horns effect and halo effect, allowing him better cognition.
It is important that you realize the horns effect and halo effect are not without merit. While you should strive to remove them from your cognition, they should still influence your behavior. I wouldn’t want to be around people who lie, steal, or cheat even if they are good at their job or otherwise pleasant. There is nothing wrong with being cautious when an otherwise bad person says something that might seem to make sense; the proverbial “devil in a Sunday hat”.
A good idea is a good idea even if it is proposed by the town drunk. A bad idea is a bad idea, even if it is proposed by the town hero. Never forget that and act accordingly. This is one of the reasons that mature thinkers don’t take offense when someone attacks their positions or ideas – they are not extensions of the person, but rather must stand on their own. There is nothing I enjoy more than assaulting my own beliefs from all sides to see if it can withstand the force. That approach is why I get more and more rational with each passing year, and my real-world results reflect that. There is nothing original in this approach. Anyone is free to adopt it.
Categories: DPC News