A model for health-care reform: opting out.

• Author: Rundles, Jeff

"Concierge" medical practices could help change the face of primary care as physicians establish closer relationships with their patients--and distance themselves from insurance

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Nearly everyone in the debate over health-care reform agrees on a few simple principles: that in a country as wealthy as the United States it is a travesty that 45 million people lack health insurance; that health-care costs are out of sight and rising; and that something needs to be done.

At the forefront in the battle for reform is primary care. Primary care physicians--family practice doctors, pediatricians, internists, OBGYNs--are essentially the gatekeepers in the system that has evolved over the years, called managed care.

People with private and company-sponsored health insurance, and those in the Medicare system, are required to visit their primary care physician for nearly every medical need, and that doctor is then charged with offering treatment or referring the patient to a specialist. Under managed care, observers say, primary care physicians handle as many as 2,500 patients, upwards of 25 a day, and the model is set up as "sick" care, rather than focusing on "wellness."

While it isn't a groundswell yet, thousands of primary care physicians nationwide and some in Colorado (no one has authoritative statistics) are simply opting out of the "sick" model of practice in overcrowded conditions, and moving to a "wellness"-based practice with fewer patients that allows doctors to spend more time with each one and a concentrate on managing health.

This type of primary care practice is generally referred to as "concierge" medicine, "boutique" medicine or, as the largest group to launch such practices calls it, "Personalized Prevention Care." It takes many forms, is manifest in franchise models and in go-it-alone efforts and eschews any direct involvement with health insurance or allows insurance on a limited basis. At its core, concierge medicine is the ultimate rejection of managed care.

OPTING OUT

After 11 years of coping with what he calls a dysfunctional health-care system, Denver primary care physician Dr. Fred Grover Jr. has decided to opt out of managed care, taking the go-it-alone route to a wellness-based "hybrid concierge model." He practices in the Cherry Creek area under the practice title "Revolutionary M.D., Advanced Prevention and Wellness."

Like most physicians making the switch, Grover sent his existing patients a letter describing his reasons for making the transition and invited them to join him. The new practice launched in late spring. He does not accept insurance and charges $1,500 a year per patient for his concierge plan (with discounts for additional family members). For those who can't afford the annual plan he...