What you need to know about the popular—and alternative—approach to medicine.

By Julia Malacoff
November 04, 2018
Photo: Forward

It's no secret that many are frustrated with today's health-care system: the maternal mortality rate in the U.S. is rising, access to birth control is under threat, and some states have it really bad.

Enter: concierge medicine, a different-and not totally new-approach to healthcare that's gaining popularity thanks to the fact that it puts the patient in the driver's seat. But what is it, and how can you tell if it's right for you? Keep reading to find out.

What is concierge medicine anyway?

"Concierge medicine means you have a direct relationship with your doctor," says James Maskell, a functional medicine expert and founder of KNEW Health, a community-based health plan. "Unlike most medical systems where the doctor works for the hospital system, and ultimately the insurance company, a concierge doctor is typically in private practice and works for the patient directly." That means you generally get more face-time with (and access to) your doc.

The way they work is a bit different too: "Most concierge practices have a range of included services for the extra monthly or annual fee paid to the practice directly, outside of insurance." So while some people who use concierge medicine have additional health insurance just in case, others do not. Much like choosing a low or high deductible plan with regular health insurance, people often choose to add additional insurance based on their health status and level of disposable income.

But lots of people would prefer to be safe than sorry: Many who use concierge medicine opt to take out catastrophic or disability insurance in case of a major accident or serious illness to ensure they're covered. These plans tend to be less expensive than regular health insurance, but can still add up on top of the cost of concierge health care.

What are the benefits?

The biggest upsides of concierge providers? Longer visits and more personalized attention. People like that. And because of those benefits, more and more versions of concierge medicine are popping up. Parsley Health (New York, Los Angeles, and San Francisco), One Medical (9 cities nationwide), Next Health (Los Angeles), and Forward (New York, Los Angeles, and San Francisco) are just some of the options available at the moment.

"They all offer a much-needed change from the traditional medical model of 15 minutes with the doctor and rare same-day appointment availability, sending many people to urgent care or the ER, or leaving them with their symptoms for days (or months even)," says Dawn DeSylvia, M.D., an integrative physician in Los Angeles. (Related: When You Should Think Twice Before Going to the Emergency Room)

Concierge medical clinics offer timely access to care, dramatically shorter wait times in the office, and longer visit times with the provider, in which the patient's true health care needs are more fully meet and treated, says Dr. DeSylvia. Those are pretty huge pros. Making appointments is generally done via an app, online, or by calling the doctor's office directly.

Plus, with concierge medicine, you may have more choice over the treatments and tests administered, and, for some, this may mean better health long-term. "Many people don't have adequate insurance coverage or access to medical providers and information and therefore may lack the knowledge to identify health problems and prevent major illness," explains Joseph Davis, D.O., a reproductive endocrinologist in New York City. "Concierge medicine allows doctors and patients to have a closer relationship and ready access to knowledge and experience. This can help prevent illness by identifying and treating it early."

Are there any downsides?

So you're getting more personalized care, more control over which treatments you want, and less time waiting around for your doctor to be available. That's awesome. But one of the biggest cons of concierge medicine is the price. "Concierge medicine is always more expensive than health insurance, as they do bill your insurance where they can, but then charge an extra cash fee for non-covered services," says Maskell.

In some cases, that may mean it's not a good financial option for those with pre-existing or chronic health conditions. "Concierge care typically only covers primary care type services, and so for the severely chronically ill, the majority of the services will be provided by their health-care plan," explains Maskell. Things like prescription medications and tests that need to be performed in a hospital environment often need to be billed to traditional health insurance.

And just like regular health insurance, there are different price options-from $150 a month for services like Parsley Health (which is meant to be used in conjunction with regular health insurance) to up to $80,000 a year per family for the most exclusive personalized concierge medical practices. Of course, there are plenty of options in between those price points.

That said, if you have the means, adding concierge medicine on top of your regular insurance can be a good idea for those with existing health conditions. Leland Teng, M.D., who runs the first hospital-based concierge medicine program at Virginia Mason in Seattle, says that it's particularly beneficial for those who have complex medical conditions, travel frequently, or have otherwise busy schedules. Patients are able to contact their doctor from anywhere in the world via cell phone at any time, and they're also able to schedule house calls as needed.

How to decide if it's right for you

Interested in trying out a concierge medical plan? Do this first.

Go say hi in person. If it's possible, visit the concierge medical provider you're considering. "Go and meet the doctors offering it," Maskell suggests. Do you have a good rapport with them? Do you feel comfortable in their office? How does it compare to the doctor's office environments you're used to? If you got really sick, would you feel okay going there? It's important to consider the answers to these questions before making the switch.

Find out what they're offering. These days, there are lots of different types of concierge medicine. "Some offer ongoing primary care with your own doctor, and others are more akin to kiosk medicine, offering science-based cutting-edge medical tests and treatments, where you can literally walk in and tell them what tests you want, and what treatments you would like to receive that day," says Dr. DeSylvia. Based on your health status, you'll want to decide which approach is best for you.

Figure out how much you spent on medical care last year. What did it cost you out-of-pocket for medical last year? Maskell recommends considering this before considering your budget further. Is your current health insurance plan working for you? Did you spend less or more than what you'd be paying for the new concierge service? For some, money may not be as big of a concern, but if you're trying to *save* money by switching to a concierge practice, understanding what you've spent on medical care in the past is essential.

Set your budget. Once you know where you stand, decide how much you want to spend now. Some concierge providers are really expensive, while others aren't. Some require monthly payments; others work yearly. Ask questions until you understand all the potential costs of the provider you're considering.


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