Health Policy$ense

Retainer-Based Medicine: Where is the Research?

Effects on utilization, costs, outcomes unknown

About 10 years ago, my primary care physician decided that she would no longer take insurance, and left the practice.  Patients could pay directly to continue in her care in her new practice, or see another physician in the existing practice.  I chose to stay in the practice with another physician.

About three years ago, I received a letter from that physician inviting me to become a VIP patient in his practice.  For about $150 a month, I could retain his services and receive even more personal attention through same-day visits, wellness counseling, and email access.  If I declined this invitation, I would no longer be able to see him, but he would provide a list of other practices I could call.  I found another primary care physician.

So I read with more than just professional interest a new thought-piece on “retainer-based medicine” (RBM) by LDI Senior Fellow Guy David, posted on the Medica Research Institute blog. In it, he reviews the construct and context of this practice model, which, in its multiple forms, involves direct payments from patients to physicians.  He provides an excellent framework for understanding the two prevalent forms of this model, concierge medicine and direct primary care, as shown below.

The entire piece is well worth reading, both for the clarity of its presentation, and for its insights into the potential drawbacks and advantages of RBM. He notes that there is little evidence on key aspects of RBM, and calls for research on its effects on patient outcomes, physician satisfaction, downstream utilization and cost, and communities at large.  These answers are sorely needed.

Oh, and by the way, I am quite happy with my new primary care physician, who is in my HMO network.  But she’s not taking any new patients, in case you were wondering…