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Uninsured patients positive toward concierge practice

But a study finds some don't understand how it works or why they must remain enrolled if they're healthy.

By — Posted May 24, 2011

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Patients appreciate programs that adopt the retainer or concierge model to provide primary care to the uninsured, but they don't always understand how they operate, according to a study in the May-June Journal of the American Board of Family Medicine.

"Our study population expressed gratitude and other positive opinions about the retainer-based program for uninsured patients. ... Significant gaps in patient understanding about the program were identified," the authors from the Dept. of Family Medicine at Oregon Health & Science University in Portland wrote about the institution's Access Assured program.

"Uninsured Patient Opinions about a Reduced-Fee Retainer Program at Academic Health Center Clinics" is available online (link).

Retainer practices, also called concierge or boutique practices, are often presented as options for patients who are insured or have the means to pay for care but want extra attention and services. However, some practices have been geared toward uninsured patients, giving them an affordable way to access care.

Most charge patients a monthly or annual membership with an additional fee for appointments.

For this paper, researchers interviewed 20 patients who had renewed after a six-month membership in the Access Assured program at OHSU's family medicine clinics, and another 20 who did not.

Participation in Access Assured requires the uninsured to pay $150 for a six-month membership, or $275 for a year. Membership includes unlimited office visits, online appointment scheduling and telephone medical advice. The cost of appointments with a physician is on a sliding scale based on income.

Previous papers have documented that Access Assured is financially viable. The most recent one found very similar opinions among members who continued with the program and those who let their memberships lapse.

Many in both groups did not comprehend why they should continue paying a monthly fee if they were not sick, and some failed to re-enroll in a timely manner because they were unaware their membership was expiring. Some were confused by the terms of the program and did not understand benefits and sliding scale fees.

On the plus side, patients valued telephone and email access and maintaining continuity of care with their chosen physician even without insurance. They were grateful to access the same care that people with insurance receive.

Eleven members who did not re-enroll cited economic stress. Three did not re-enroll because they qualified for Medicaid or employer-sponsored health insurance.

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