Study shows preventive care benefits

The rapidly growing concierge medicine industry has drawn supporters and opponents, but one thing appears clear in a study: it works.

The study by concierge medical group MDVIP found hospitalization admissions were 72 percent lower for MDVIP patients between the ages of 35 and 64 than for non-members. The study, published in the December issue of The Journal of Managed Care, also found Medicare patients’ hospital admissions dropped by 79 percent.

The savings on hospital costs over one year amounted to more than $300 million, the study found. And the longer the patients were MDVIP-practice members, the greater the reduction in hospitalizations.

In 2006, MDVIP members were 42 percent less likely to be hospitalized than non-MDVIP patients, the study found. By 2010, MDVIP members were 62 percent less likely to be hospitalized than non-MDVIP patients.

Dr. Andrea Klemes, the company’s medical director, said MDVIP’s model allows doctors to spend more time with patients and focus on disease prevention and wellness.

Doctors have identified thousands of at-risk or higher-risk patients, preventing complications and even disease, she said.

Dr. Jeffrey Cain, president of the American Academy of Family Physicians, said direct primary care practices do a good job of taking care of patients and provide a high level of satisfaction for patients and their doctors.

“If you have access to a concierge doctor and can afford one, you’re buying increased access and time,” Cain said. “If that improves your relationship with him, that will improve your health care. That’s a good deal for patients.”

Cain said that patients with health insurance and good primary care are healthier, and their health costs are lower.

One way to achieve that is through the direct primary care model, he said.

“But as a society, we worry that if we move too much to these systems that we would have patients that would be left out, that we would have a two-tiered health care system,” Cain said.

The academy has estimated that at least 40,000 more family physicians will be needed by 2020 to meet the needs of underserved populations and the aging population.

The academy, which has close to 111,000 members, thinks a better approach to health care is the patient-centered medical home, Cain said. This model increases access to care, communication among providers and patients, and coordination of care and services.

The hope for the future is that the country now has a better understanding of primary care’s value than 10 years ago, Cain said.

Private insurers and government programs such as Medicare and Medicaid have begun moving toward systems that reward doctors for keeping patients healthy and preventing illnesses, Cain said. The AAFP also hopes these changes will narrow the pay gap between primary care physicians and those in specialty practices, whose pay averages 50 percent or more a year.

The best outcome is to move the health care system to models that reflect some of the same values as direct primary care: more time with the doctor, making it easier to get an appointment and more coordination of care, Cain said.

Dr. Mark Murrison, president of MDVIP, said concierge medicine is gaining momentum for a number of reasons, including an emphasis on wellness and prevention.

There’s a growing understanding that the current approach, waiting for people to get sick and then treating them, isn’t working, Murrison said. People are less healthy than ever: 65 percent of Americans are overweight or obese, and half the country is expected to be pre-diabetic or diabetic by 2020.

Those are controllable conditions that are now left largely untreated upfront, Murrison said. Consumers are taking more responsibility for their care, and they want a relationship with a doctor.

Consumers also are realizing that the Affordable Care Act, or ObamaCare, and the country’s aging population mean there will be even more demand placed on doctors, Murrison said. So more people are looking to ensure they will have a stronger relationship with their doctors.

Murrison discounted concerns that concierge medicine will worsen the shortage of primary care physicians.

There are more than 200,000 primary care doctors in the United States, he said. MDVIP is the largest concierge medical company with around 640 practices, and there may be 2,500 doctors in concierge practices nationwide.

That amounts to a little over 1 percent of all primary care physicians, he said.

“It’s not making a huge dent in the broader availability of primary care doctors,” he said.

Concierge medicine is just one of the solutions emerging in the health care industry, Murrison said. Others have emerged or will in the future.

For example, people in their 20s and 30s, who rarely have chronic illnesses, may not need to see the same doctor over and over, Murrison said. For those patients, a retail-based clinic may be fine.