Part I: PPACA Opens Market Opportunities for More Personalized Medicine

Editor’s note: Today’s blogpost is the first of a two-part series on how the Patient Protection & Affordable Care Act could open market possibilities for more personalized medicine. The article it originates from was initially published in the April 2012 issue of Medical Liability Monitor, the industry’s premier source for consistent, reliable coverage and fresh perspectives on medical professional liability insurance and risk management issues.

If one believes the healthcare industry prognosticators, the future of medicine will be more efficient and cost effective, but less personal and shepherded by accountable care organizations (ACOs) that will tie provider reimbursements to quality metrics and reductions in the total cost of care for an assigned population of patients. Gone will be the days of customized care and services. Gone will be the days of the small, independent primary care physician practice.

The industry’s move toward an ACO model was galvanized by the Patient Protection & Affordable Care Act (PPACA) of 2010, which is laden with incentives to lower the overall cost of healthcare via increased administrative efficiencies. The PPACA encourages a market consolidation and the concentration of power in fewer organizations, like larger, regional hospital systems.

Will the ACO delivery model be a death knell for the independent physician practice and nurture a culture of depersonalized healthcare? Or will it create a demand for primary care physicians who practice boutique, personalized, concierge-style medicine?

“There has been a push toward what I call ‘big box’ or ‘factory medicine,’ which is unfortunate because I think it takes a lot away from the art of medicine and leaves little room for the strengths of the individual provider,” said Wayne Lipton, founder and managing partner of Concierge Choice Physicians (CCP), a New York-based company that helps primary care physicians implement a hybrid model of concierge healthcare. “The larger the group, the less physician autonomy there is. A hybrid concierge model enables small groups, middle-sized groups and individual physicians to keep practicing without succumbing to the economic pressure to aggregate into mega units. It also emphasizes the one-to-one relationship, establishing value between the patient and doctor rather than the patient and an entity.”

The CCP program has more than 200 physician offices in 20 states with members caring for more than 300,000 traditional and concierge patients. CCP provides marketing and support services for all the varied aspects of designing and implementing a hybrid concierge program. The hybrid concierge model maintains the individual integrity of the independent private practices, and CCP does not impose uniformity on its member practices. The company does not offer its members an alternative vehicle for insuring their medical liability, although it is open to making one available in the future.

“We currently don’t offer our members an alternative to traditional medical liability insurance companies,” Lipton said. “We are a service provider. We don’t own the practices; we don’t run the practices. One of the challenges to providing liability insurance would be that we have members practicing in 20 states, but I would love to be able to do so as our membership gets larger.

“The great thing, from a liability standpoint, is that we have selectivity when deciding who we work with. The physicians we work with are the ones who are most appreciated by their patient base and have the greatest relationships with their patients, so they have remarkably low exposure. Our doctors are a much more beneficial group to cover than a broader, less select group of doctors.”

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