Unlocking the Next Healthcare Frontier (Pt 1) - How Concierge Medicine is Unleashing a New Era of Healthcare

Concierge medicine has rapidly gained global traction, particularly in the U.S., where patients now have access to primary care through a premium membership fee. In this deep dive into the U.S. healthcare landscape, we explore the flaws of a dysfunctional healthcare system, paving the way for the rise of the concierge medicine model.

State of US Healthcare | Costly & Dysfunctional

Both stakeholders, patients and providers, are dissatisfied.

Patients

1. Over 70% of Americans believe the healthcare system is failing. This shouldn’t be the case for a country with a per capita health expenditure of >$12K.
2. A patient in the US waits on average agonising 21 days for a primary care visit. According to a survey, the wait time for four specialities (including obstetrics/gynaecology, cardiology, orthopaedic surgery, dermatology) is 27 days.
3. The situation doesn't end there; after enduring this lengthy wait, patients are typically given only 7-10 minutes of the doctor's time, reflecting a lack of personalised care.
4. While this may not be a causation, it undeniably correlates with what truly matters, i.e., health outcomes.

Providers

1. Over the past year, Medicare reimbursement rates for physicians have been reduced by 3.3%. Additionally, payments have declined by 26% since 2001 when adjusted for inflation. These decreasing reimbursement rates are putting physicians in a difficult position, forcing them to choose between providing quality care and sustaining their livelihoods.
2. Coupled with this, physicians experience professional burnout at alarming rates. An alarming 57% of family medicine physicians (a 10% increase over the past 5 years) and 60% of internists (a 14% increase over the past 5 years) are experiencing burnout, while 83% of physicians report being overburdened or operating at full capacity.

On cue, Concierge Medicine

Concierge medicine is stepping up where the US primary care system is falling flat. In this model, the patient directly pays a membership fee for seamless primary care services. It is a combination of exclusive, personalised care with unmatched accessibility and convenience.

The concierge medicine market is projected to reach $10B by 2028, driven by factors such as physician burnout, a shortage of primary care doctors, and the increasing prevalence of chronic diseases, reshaping the healthcare landscape. It is proving to be a fix for burned-out physicians and dissatisfied patients.

Patient

With concierge medicine, patients now have improved access to personalised healthcare, resulting in an enhanced overall experience.

For instance, consider Specialdocs Concierge in comparison to the traditional model:

Provider

a) Reduction is administrative work

On average, doctors in the US are reported to spend up to 20 hours a week on paperwork and administrative tasks, often reducing the time available for patient appointments. Since patients pay directly, providers are not reliant on insurance payouts, which reduces administrative tasks and eliminates concerns about reimbursements.

Operating within the concierge framework removes much of the bureaucracy, putting patient care at the forefront.

b) Stronger provider/patient relationship

By spending less time on bureaucratic tasks and seeing fewer patients under the concierge model, doctors can dedicate more time and personalised attention to each patient. This fosters a greater sense of comfort and engagement for patients, resulting in higher satisfaction and improved outcomes.

c) Financial upside

The concierge model offers providers both revenue stability and visibility, due to the annual membership fees of concierge programs, which can exceed $4K.

Various Concierge Models

There are various concierge medicine models:

Full Conversion Model:

• Here, physicians completely transition to a membership-based practice, discontinuing care for patients who opt not to enrol. While the physician can manage and control workload, it requires letting go of 85% of the practice’s previous patient population and requires sufficient membership uptake to ensure financial viability.

Hybrid Conversion Model:

• In this model, the physicians offer dual services, offering a concierge program for members while continuing traditional care for non-members. While this model keeps the non-member patients, it often leads to lower conversion rates and can increase the overall workload for the physician

Segmented Conversion Model:

• Here, the physicians retain their full patient population while introducing a concierge revenue stream, with physician-extenders managing non-member care. This approach is low-risk and scalable.

Rise of Concierge Medicine in US | New Age & Legacy Players

Concierge medicine is gaining traction both among established legacy players and emerging new-age providers.

For legacy players, offering concierge services has several benefits:

1. Supplementary revenue stream: The model generates direct income through membership fees, often exceeding $4K annually. These fees are in addition to copayments, deductibles, and other charges not covered by patients’ insurance plans.
2. Physician recruitment and retention: Concierge medicine serves as a strategic tool to attract and retain top physicians within their systems.
3. Lucrative patient referrals: These physicians typically bring affluent patients into the hospital network. These patients often have private insurance, which reimburses hospitals well, and they do not contribute to bad debts or require charity care, thereby driving profitable referrals and enhancing hospital revenue.

Northwestern Medicine in Chicago, Penn Medicine in Philadelphia, University Hospitals in the Cleveland area and Baptist Health in Miami are among the large hospital systems offering concierge physician services.

There are several new-age companies innovating in this space. Some examples:

1. Sollis Health

The company offers on-demand access to a wide range of concierge medical services, specialising in ER and urgent care. Members benefit from 24/7, year-round access to unlimited visits and on-demand virtual care. The service includes care coordination, allowing members to connect with a network of specialists, as well as access to advanced hospital services, including imaging and other critical diagnostics. The company has raised $80M in total and has over 17K members.

2. Transcarent

1. Pre-op: Providers assess treatment plans, offer second opinions, consult orthopaedics, and review diagnostics to ensure appropriate care.
2. Post-op: Virtual physical therapy minimises complications and streamlines recovery.

In the US, the concierge model is predominantly doctor-led, operating independently and often disconnected from the broader healthcare system. These models position themselves as replacements rather than extensions of traditional care pathways, marking a departure from hospital- and insurer-driven frameworks. This reflects a systematic pivot toward privatisation and individualised healthcare delivery.

The emergence of concierge medicine highlights critical gaps in the US primary care system, which serves as the essential gateway to accessing specialised and tertiary care. Structural inefficiencies - such as limited access, overburdened providers, and time-constrained patient interactions - have created a vacuum that concierge models aim to fill by offering personalised, accessible, and high-quality care.

This trend sets the stage for broader disruption across the healthcare continuum, from primary to tertiary care. Companies like Transcarent are already expanding on this concept, integrating concierge-like principles into comprehensive solutions that reimagine how care is delivered and accessed across all levels of the system.

While concierge medicine has made its mark in the U.S., its application in a vastly different healthcare system like India's presents unique challenges and opportunities. In the next section, we’ll explore how this model could potentially scale and adapt to India’s diverse healthcare landscape