Evaluation of a Concierge Primary Care Setting

MDVIP was one of the pioneers of the modern concierge primary care practice.  A study published in Population Health Management examines the care of over 10,000 MDVIP patients versus 10,000 control patients over a three-year period.  (MDVIP Study)   In these concierge practices, people have enhanced access to primary care services and tend to receive more coaching on wellness and good health behaviors.  The practice also provides a variety of online and other tools to help people address health issues and maintain good health.  Physicians in the practices have greatly reduced patient panels so that they can spend more time with each patient and be available on relatively short notice for visits and consultations.  Patients pay an extra annual or monthly fee to belong to the practice.  MDVIP currently has about 700 physicians covering 250,000 patients.  Both the physicians and the patients tend to be older.

The analysis included a matching of patients on a variety of characteristics to ensure that health status or other factors did not skew the results.  MDVIP patients tended to be older and higher-income that control patients, before adjustment.  Even after adjustment it should be noted that there may be an issue about the applicability of this model to all populations, as the controls were matched to MDVIP.  In all years of the analysis, MDVIP patients had higher average annual medical costs than did non-members, but the gap narrowed from $86 in the first year to only $2 in the third year (these numbers do not include the additional fee the members paid to be part of the program).  Much of the difference in expense was driven by greater medication costs, suggesting that the MDVIP doctors were ensuring that diseases were being treated.  While health spending is clearly overall higher, the authors said that an increasing percent of members were experiencing net savings, including the member fee, over the study period.  It may be that an even longer term analysis will show total net spending reductions.  By the end of the study, there was less ER and urgent care use, and low hospitalization rates, among MDVIP members.

Quality measures were not explicitly included, which is puzzling, but just the nature of the interaction likely improved patient satisfaction and it would be surprising if most quality measures were not higher in this population.  This kind of primary care should produce better quality, even if it doesn’t produce a lot of savings on shorter time scales.  And in the end, we should be most concerned about delivery of health services that improve health.