U-M fuels debate on retainer-based health care

The University of Michigan has become the focal point in a national controversy over a revolutionary shift in medicine — away from traditional insurance-based health care, to a new model where patients pay directly, and in advance, in exchange for the promise of better quality care.

Michigan Medicine this week introduced Victors Care, a high-end form of retainer-based medicine called “concierge care.” Starting at $225 a month, patients get unlimited primary care appointments, shorter waits, “executive” physicals and long talks with their doctors — no insurance accepted.

The public university’s practice will be capped at 600 patients, stoking controversy at a time when primary care doctors are in short supply. More than 300 university faculty and physicians signed a letter protesting the program in March, saying Victors Care creates a two-tiered system of health care where the rich get priority over the rest.

Resisting the system

A 2016 American Medical Association study published in the Annals of Internal Medicine found that for every hour an ambulatory care physician spends seeing patients, that doctor spends two additional hours on paperwork.

IHPI member Scott Greer, a professor of health management and public policy and global public health at the University of Michigan, said the trend toward retainer-based medicine is fueled by dissatisfaction from both doctors and patients. The problems began well before the federal Affordable Care Act of 2010, he said, emerging with the managed care revolution of the 1990s when employers demanded that insurance companies rein in skyrocketing health care costs.

“Any doctor is likely to be spending more than half their time dealing with electronic health records, whose benefits they might not see,” Greer said.

“A lot of doctors in the U.S. would like to declare independence of the entire system and practice medicine the way they think it should be practiced for their patients.”

Patients also have “a lot to dislike” about American health care, he added.

“You pay a helluva lot of money, and in return you get you get distracted organizations, you get bills you don’t understand, you are increasingly suspicious of a lot of people who should be caring for you,” Greer said. “If you have the money, it’s really attractive to say ‘I want to go back to square one and pay a doctor to make me feel better.’ ”

One of the largest networks of retainer-based practices, MDVIP, includes nearly 1,000 doctors across the country, including 17 in Michigan, with six in Metro Detroit. They offer personalized medicine for an average retainer of about $140 per month, with an average practice size of 300 to 600 patients.