WHEN DR. LOUIS MINSKY first went to medical school, it was because of a desire to interact with patients. After more than 10 years of practicing medicine, instead of feeling good about helping his patients stay healthy, he was burned out by paperwork and complicated rules and regulations. As he began considering other options, he knew that he didn’t want to lose that direct contact.

“I had been thinking of alternative methods of practice and trying to decide how to maintain a family practice the way I had grown up with my family doctor in the small town I was born in,” he says. “There was just a piece missing to run from room to room to room all day and not be able to just stop long enough to have that special moment with a patient.”

Minsky was contacted by personalized health care company MDVIP, which offered him the best of both worlds. In 2011, he officially transitioned his practice to what is often called the “concierge model,” in which patients purchase a membership from their physician for comprehensive primary care, including basic medication, lab tests and follow-up visits in person, over email and by phone.

While this plan replaces the traditional fee-per-service model paid for by health insurance, most consumers couple their membership with a high-deductible insurance plan to cover contingencies like specialist visits and emergencies.

MDVIP touts itself as the country’s largest physician network, with over 800 affiliated primary care doctors who practice personalized preventive health care. In the MDVIP practice model, the company says, physicians partner with patients to keep them healthy and help them achieve their wellness goals.

Minsky describes it as a more personalized experience for the patient.

“In family medicine, to me, one of the biggest enjoyments is being able to know patients,” he says. MDVIP forces a cap on the number of patients a practice can have—usually 600 or less compared to an average of 2,500 in a traditional practice. Patients also get comprehensive preventive care programs and customized wellness plans, along with annual physicals that include bloodwork and screening tests.

“We don’t really have a waiting room,” says Minsky. “We’re usually ready for patients when they get there, and we’re able to spend time saying hello and catching up on what may have happened since the last office visit, and then you’re able to delve into the problem at hand and come up with solutions and remedies.”

Rather than the usual 25-30 patients a day, concierge doctors spend a minimum of 30 minutes with about six to eight patients. Their practices take on a slower pace, patients are encouraged to call them on their cell phones, text or email if they have a problem, and it’s common to get an appointment on the same day. Some doctors even make house calls.

This type of personalized service does come with a price tag: $1,650 for an annual “membership” with an MDVIP doctor and up to $2,000 with other doctors. (Concierge doctors also take all forms of insurance and Medicare.)

DOING A BETTER JOB
Dr. Curtis Chastain has been practicing medicine for 26 years and has been employed by Our Lady of the Lake Regional Medical Center for 23 of those years. After starting to offer executive medical physicals in 2002 in an attempt to identify patients at risk for serious medical illnesses such as heart disease and cancer, he saw the potential for a different way of doing things.

Six months ago, he sent out letters to all of his patients letting them know he was moving toward a membership-based model. For $2,000 a year, they could stay with him and start getting more personal attention or he would help them find another doctor.
As of May 1, Chastain had 200 members signed up and he expects to reach 400 by the end of the year. (Chastain is not with the MDVIP network.)

“I don’t find myself less busy, but I find myself more content with each encounter,” he says. “I walk out and I feel better about myself and I feel like I’ve done a better job.

Doctors aren’t the only ones happier. According to a study published in The Open Public Health Journal that compared patient satisfaction data from MDVIP with that of conventional practices, 97% of patients of MDVIP-affiliated practices were satisfied with their physician relationships versus 58% for conventional practices.

Another study in the American Journal of Managed Care showed dramatic reductions in hospitalizations and lower readmission rates for MDVIP members—2% readmission rates for heart attacks, congestive heart failure and pneumonia as compared to the national average of 16-24%. This represents a savings of $2,551 per patient and $34 million a year for commercial insured patients.

WEIGHING THE COST
Chastain encourages patients to view the membership fee, which can seem unaffordable, as their insurance deductible. “I think the hardest part is this is just a deviation from the norm, and this is all we’ve ever known is that insurance is supposed to take care of this,” he says. “It’s hard to sort out the reality that you really are paying out of your pocket even if you do use insurance.”

David Landers has been a patient of Chastain for almost 20 years.

“I’m close to retirement, and when you’re comfortable with a doctor it’s hard to leave,” the vice president of business development at CB&I says. “Once you become his patient, it’s not a question of starting over every time you go to the doctor. They’re very computer literate and they have all your records right there. He knows when you were sick and what you were sick with.”

As for the additional cost, Landers says he believes it will even out as he gets older and develops more issues with his health. “You certainly have a choice, and I made the choice and I like it. My wife is looking to do the same thing with her doctor.”

Minsky’s patient Joanne Moreau says she was surprised when he transitioned to MDVIP but felt like her family needed to make a commitment to their health care. Her husband was involved in an accident many years ago and also has cancer, so quality of care was especially important for him.

“Once we went with MDVIP, [Dr. Minsky] helped us navigate the health care system, which eventually required radiation therapy and different treatments for my husband,” she says. “We have 24/7 access. I can send an email or a text. My husband can call at 9:30 at night.”

Moreau adds that having a physician who knows their history and really cares about their health has been life-changing.

“We’re not willing to gamble with our health,” she says. 

ONE-ON-ONE TIME
Dr. William Lovell was the first doctor in Louisiana to sign on with MDVIP; he recently renewed his five-year contract. He says the Florida-based company’s model represents a fundamental shift in the way doctors practice medicine.

“From a physician’s standpoint, you have to sort of relearn how to visit with patients for an extended period of time,” he says. “We were trained to do that originally … Patients are sort of dumbfounded when they’re finished telling their story and we’re still asking questions. It’s a whole new relationship.”

It’s this ability to listen and allow patients to open up that is making the difference. In the concierge way, doctors almost double as therapists, getting to the root of problems and ultimately practicing preventive medicine.

“When patients see their primary care doctor and they spend five minutes, half of them don’t fill their prescriptions and the other half don’t come back,” says Lovell, whose patient load is about 400. “I don’t get that any more. We’re able to follow up with patients, and when patients spend that kind of time with the doctor, relationships change. I had patients that I’d been seeing for 20 or 25 years, when given the opportunity to tell me what’s going on in their life, you learn so much more. It’s humbling really.”

Where this one-on-one time really makes a difference is in the realm of chronic disease. Lovell says he has several obese diabetic patients who, once educated about their disease, were finally persuaded to change their lifestyle.

 “In five years, we have maintained well over the majority of our patients we started with,
but there’s a lot of community interest. The potential for growth is certainly there.” 
Dr. Louis Minsky

“I’ve had a couple diabetics now over the past five years lose 50, 60 pounds, going to the gym, exercising regularly, a couple have gotten off insulin,” he says. “They just feel and look better.”

Lovell realizes that not all patients can afford or even desire to use this type of service, but he believes the concepts of concierge medicine could benefit every patient. “We have some real hurdles to overcome when it comes to infrastructure, meaning manpower,” he says. “There are not enough providers who can do this for all the patients that need it. Not everybody wants it, but it’s better medicine.”

Minsky says the drawback for him from the beginning was knowing he would have to limit his number of patients. He’s had a waiting list at times and often refers patients to MDVIP doctors when they relocate to other areas. “In five years, we have maintained well over the majority of our patients we started with, but there’s a lot of community interest,” he says. “The potential for growth is certainly there.”

For the time being, Minsky is happy to return to the good old days of practicing medicine and plenty busy taking care of 600 patients.

“It’s so fun to come to work every day and know that you’re going to practice the medicine that you went to medical school thinking that you were going to be able to practice,” he says. “When I walk away at night, I’m able to go home, spend time with my family, run around the lakes or other personal things that were being taken away in my traditional practice role.”