Part II: PPACA Opens Market Opportunities for More Personalized Medicine

Editor’s note: Today’s blogpost is the second 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.

(continued from yesterday)

Lipton supports the PPACA’s goals of offering healthcare to a wider percentage of Americans and deflating the overall cost of healthcare delivery, but he questions the efficacy of the ACO model it encourages. He believes the cost savings of the ACO model will not be derived through efficiencies of scale, but rather reductions in the actual delivery of care.

“I don’t think the ACO model is an absolutely positive thing, but it does attempt to insure more people and control costs. The unfortunate thing is that it also encourages a depersonalization of medicine. That group model emphasizes the use of lower-level providers, like nurse practitioners and physician assistants. It doesn’t emphasize the physician-patient relationship, where the doctor knows the ‘wellness state’ of the patient and his or her medical history.”

The hybrid model’s flexibility is designed to meet the varying needs of physicians and patients. It allows physicians to continue seeing all their patients, while offering those who want a concierge option that choice. Physicians limit their hybrid concierge practice to between 50 and 200 patients, a much smaller number than typical for primary care, and far less than a full concierge model of 300 to 600 exclusive patients, charging their concierge patients an annual fee generally around $150 a month for membership.

“I think the hybrid concierge model will have tremendous opportunity in the future as groups and entities realize that not everyone is going to want to fit into the box of what the ACO requires,” Lipton said. “I think the hybrid concierge model can be successfully married to the ACO approach. We are not at the point yet where ACOs are established enough or comfortable enough to consider that next step, but they ultimately will be because it is another vehicle for increased revenue and increased patient options.”

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