COVERAGE: Can "Concierge Care" Cure What Ails the Poor?

The terms "concierge medicine" "Palm Beach" "poverty" and "free medical care" don't necessarily go hand in hand but a group of Florida "VIP" physicians are starting an interesting initiative aimed at showing that close doctor-patient collaborations with an emphasis on wellness and good management of chronic disease can work for the poor and sick, not just the rich and healthy.

Now we aren't advocating charity as the solution to the nation's 47 million uninsured (although we sure don't object to helping people out until we get a comprehensive national solution) but we do like good management of chronic diseases before they become acute crises. The pilot program described by the South Florida Sun Sentinel and brought to our attention by Health Leaders Media is intriguing.

The newspaper reports that Project Access, a Palm Beach County Medical Society program that connects patients to free care, is teaming up with MDVIP, a concierge practice, to take care of 25 very low-income people, and they hope to expand it to cover several hundred. It's being paid for by a mix of volunteer labor and subsidies from the medical society.

In a concierge practice, patients pay a yearly fee to have access to their physician. The physicians in turn take on far fewer patients, meaning they have more time to spend with their patients than the rushed office visits that have become all too common. According to this report, members of this concierge practice pay $1500 to $1800 a year to join.

The doctors in this pilot care project aim to show that their way of practicing medicine, with its emphasis on wellness, communication and web-based medical records, is efficient and cost effective. Pilot group patients are uninsured and are at 200 percent of the federal poverty level: $20,800 annual income for an individual or $42,400 for a family of four. The medical society sought participants who are ages 45 to 63 with chronic conditions, such as diabetes and hypertension.

"Our style of medicine results in fewer hospital and emergency room visits," Ed Goldman, MDVIP chief executive officer, told the Florida paper. That saves money.

With the U.S.population growing older (and fatter) chronic disease is a huge challenge for the U.S. medical system and we aren't meeting it well. Many estimates, including work by the Dartmouth Atlas, show that chronic care eats up about 75 percent of the nation's health spending. We don't spend enough on prevention and management, meaning we end up spending way too much (and unwisely) on crisis care. Palm Beach concierge medical practices won't be the answer for the nation as a whole, but if they've got any lessons to teach us, we're listening.