Healthcare Gets Personal

Paging Dr. Concierge

The mantra here is pay more, get more. For those seeking more time with their primary doctor, assistance in navigating the medical and insurance world during an illness or simply a multi-day intensive medical check-up, personalized healthcare can be the answer.

You may already have excellent health insurance, but you can’t really use it proactively, let alone get sick—there’s too much at stake on a daily basis. Visiting the doctor for non-emergency, preventative care might not even cross your mind. After all, the process can be aggravating: scheduling an appointment takes weeks, waiting rooms are crowded, and consultations rarely start on time. Some physicians spend only a few minutes with you, making it difficult to get a thorough understanding of your condition and treatment. And if you or your family members are managing a longer-term illness, navigating the healthcare system of specialists, lab tests, and insurance claims is a nightmare.

Enter personalized healthcare services, the busy professionals’ answer to navigating the increasingly convoluted world of medical care. Personalized healthcare, also referred to as concierge medicine in some circles, is an umbrella term that includes executive health clinics, private health advisors, and retainer-based primary care. This burgeoning niche in the health care industry can not only eliminate common frustrations, but enable you and your family to cultivate a close relationship with your doctor, thereby reducing your chances of illness and hospitalization, and get greater access to medical assistance during emergencies. And all of these benefits come on your schedule.

healthcare comparison

Who you can cover

In addition to yourself, you can cover your spouse and children, your parents, or even key employees. But remember, you still need good health insurance. None of the three executive health care services is meant to replace your general health insurance, which is critical for catastrophic events and long-term medical treatment.

What are your options?

Executive health clinics offer comprehensive physical examinations and health counseling in a carefully coordinated one- to three-day schedule; private health advisors help you make more informed medical decisions, provide assistance during emergencies, and take care of administrative matters for you; and retainer-based primary care allows you direct contact with your physician for extra services. You can use these personalized healthcare services individually, or in conjunction with one another. Some services are hybrids that offer a combination of benefits; for example, retainer-based physicians may conduct comprehensive physical exams that match those of executive clinics. Other doctors may offer advocacy similar to a private health advisor.

Retainer-based doctors

There are approximately 500 retainer-based practices in the U.S. associated with organizations such as Society for Innovative Practices Design (SIMPD) and MDVIP, a company that develops and supports retainer-based medical practices, plus another 1,000 or so practices that have established themselves independently.

What you’ll pay: $1,000 to $25,000 a year, depending on location, local market conditions, patient age and the physician’s patient load as well as the frequency, and breadth of any included physical exams. Expect scaled pricing for couples and families. Physicians who see a smaller number of patients will likely charge a higher annual retainer. Practices in the $1,500 to $3,000 range will typically charge additional fees for office visits.

What you’ll get: Extended time with your doctor, since the fee system allows them to carry a lighter patient load. Office visits range from 30 to 60 minutes, or longer. You get to discuss your health in the thorough manner you would a legal issue with your attorney. More costly programs include house calls and your personal physician’s direct assistance when you visit a specialist, go to the emergency room, or have an extended hospital stay. Count on same- or next-day appointments that start on time and 24/7 access to your doctor by phone and email.

Extra services: Many practices compile your medical records in an electronic format—CD, DVD, flash drive, or online—so that you have ready access to your health history.

Additional costs: The annual fee may include a comprehensive annual physical but other consultations can be charged separately. Some practices accept insurance or Medicare for covered treatments, while others do not (but they will help you with claims paperwork). Also, annual fees are typically not covered by health insurance. Flexible spending accounts may help you defray the cost, but in most cases, you’ll pay for these services out-of-pocket.

Executive health programs

Mayo Clinic

Leading hospitals across the country including the Cleveland Clinic, Johns Hopkins, Mayo Clinic, UCSF, and Stanford offer health programs for busy executives that coordinate medical consultations and lab tests into one to three very full days.

What you’ll pay: $2,500 to $3,500

What you’ll get: A focus on assessing your current health and your risk for future problems, such as heart disease or cancer. At the Mayo Clinic your schedule would include an extensive questionnaire about your past and current health issues; a one to two hour initial physical exam; a range of tests including blood count, blood chemistry, coronary risk/lipid panel, and urinalysis; prostate cancer (PSA) test for men; mammogram and pelvic exam for women; chest x-ray; resting electrocardiogram and cardiovascular evaluation; and, perhaps most importantly, very thorough individual health counseling. Dr. Donald Hensrud, the clinic’s former director for more than a decade, said that what sets the program apart from the typical exam is the “time for discussion and exploration of your health that leaves no stone or pebble unturned.” At the end of your stay, you’ll receive a full report that you can (and should) discuss with your regular doctor.

Additional costs: The cost can rise substantially if you select optional tests such as a full body scan, carotid artery ultrasound, or an angiogram.

Private health advisor

Companies such as PinnacleCare, Healthcare Advocates and Health Advocate work with clients who want dedicated assistance finding the right specialists, scheduling laboratory tests or dealing with an insurance paperwork.

What you’ll pay: Healthcare Advocates has plans that start at $300 a year with a la carte charges depending on your needs, while PinnacleCare runs $7,000 to more than $25,000 a year, depending on if you are in good health, or confronting chronic illness. A family of four pays $10,000 annually at PinnacleCare.

What you’ll get: Help navigating the insurance quagmire, and more. Health Advocate can correct insurance billing mistakes as well as explain an illness in-depth to better prep you for a visit with a specialist. Many PinnacleCare Advocates have clinical medical training. They’ll compile your medical records (the company launched online health records in the spring of 2008), interface with physicians, hospitals, and insurance companies on your behalf, and be your personal “first responder” if you need medical assistance when traveling. The company has relationships with hospitals nationwide in order to expedite appointments and lab tests. Chairman and co-founder Bruce Spector says that PinnacleCare sets itself apart by providing more independent, objective referrals than some local physicians are able to make. The company also helps clients evaluate multiple medical opinions and the complexities of managing a serious illness.

Extra services: Plans are available for management teams and family offices.

Additional costs: One-time administrative set-up fees. The family of four with a $10,000 plan will pay an extra $5,000.

Five things to know when shopping for personalized healthcare

Personalized healthcare options range widely in cost, from a low of $1,000 to $3,000 for basic retainer-based programs to anywhere from $10,000 to more than $50,000 for the Full Monty. Here’s what you can expect to spend for various services:

Behind the numbers
Retainer-based primary care
$1,000 to $25,000 annually
Insider Tip: Office visits may be extra on lower price plans; higher end plans include house calls.
Executive health clinic physical exam
$2,500 to $3,500
Insider Tip: The price rises if you select optional tests such as a full body scan, carotid artery ultrasound, CT or an angiogram.
Private Health Advisor
$300 to $25,000+ a year, plus set up fees of $5,000 (with PinnacleCare)
Insider Tip: If you’re caring for a family member with a serious illness, PinnacleCare offers a $25,000 six-month plan to help you evaluate second opinions, coordinate appointments, and manage all of the critical steps to recovery.
Due diligence questions
For retainer-based primary care physicians
1.How much is your annual fee and what services does it include? What are the components of your physical examinations?
2.How many patients do you see at any given time?
3.Do you accept insurance? Are you in my insurance plan’s network? What is your fee schedule for various services?
4.Do you guarantee same-day appointments at your office? Do you make house calls or meet patients at their own offices? If I have to go the emergency room, how can you help me?
5.What is your approach to preventative care?
For executive health clinics
1.What is your program’s schedule of consultations and exams? How much time will I have for consultation with a physician?
2.How many different physicians will I see during the course of your program? What are their specialties? How will you help me collectively assess everything we learn about my health during the program?
3.What specific lab tests does your program include? What optional tests are available and what are the associated costs?
4.How do you help patients follow through on the conclusions and recommendations you make from your program’s consultations and tests?
For private health advisors
1.What kind of experience and credentials do your client advocates have?
2.How will you help me determine which membership plan is right for my needs?
3.What process or tools do you use to help clients evaluate the pros and cons of different healthcare options—for example, selecting between different medical procedures or specialists?

The big players

Retainer-based Primary Care
MD2 International was founded in 1996 in Seattle, and is largely credited as the first retainer-based practice. The company now has offices in Bellevue, Portland, San Francisco, and Chicago.

MDVIP is the largest national developer of retainer-based practices, helping established physicians convert their practices to retainer-based models.

SignatureMD develops retainer-based practices and provides health advocacy services to help clients identify the best specialists and manage insurance claims.

Society for Innovative Medical Practice Design is an association of physicians advocating new approaches to health care. SIMPD offers an online directory of retainer-based practices.

Executive Health Clinics
Cleveland Clinic offers day-long examinations at the hospital’s location in Cleveland, Ohio, and four-day programs in conjunction with Canyon Ranch resort in Tucson, Arizona.

Johns Hopkins Executive Health Program in Baltimore provides a comprehensive standard exam, as well as many optional tests and consultations.

Mayo Clinic Executive Health Program has served patients for more than 30 years. Exams are offered in Minnesota, Arizona, and Florida.

UCSF Executive Medical Assessment in San Francisco covers a baseline set of tests and consultations in one day, with additional exams available as recommended by your physician.

Stanford International Executive Health Program provides comprehensive physical exams and access to Stanford physicians.

Private Health Advisors
Health Advocate provides advisory services to individuals and companies, helping members to prepare for medical exams, make informed decisions, and file insurance claims properly.

PinnacleCare offers a number of higher-end advocacy packages for individuals, families, and management teams, designed to expedite critical services and increase access to the best physicians and facilities.