Leveraging a concierge model allows this practice to fund charity care and creatively address social determinants of health in underserved communities.
Social determinants of health (SDOH) are widely known to have profound effects on overall health.1 Variables such as wealth and income, educational attainment, dietary habits and food access, cultural influences, access to parks and sports, cleanliness of the local environment, number and quality of relationships, and the presence of meaningful spiritual expression all affect a community's health in significant ways.2,3 Certain SDOH may even have a greater impact on health than commonly performed clinical services such as cancer screenings.4
Yet most clinics don't address SDOH in a meaningful way. Doing so requires a major shift in the way we think about disease diagnosis and treatment, and the way we allocate resources. This article describes an innovative practice model in which an outpatient clinic can creatively and effectively address SDOH in a primary care setting.
KEY POINTS
- In the authors' concierge practice, each full-price patient funds their own primary care and that of two low-income patients.
- The funding model allows family medicine clinics to meaningfully address social determinants of health in a local, low-income community.
- Traditional practices can incorporate aspects of the model by focusing on a specific neighborhood and a specific SDOH to start.
THE PRACTICE MODEL
Healing Grove Health Center clinics are located in low-income neighborhoods and hire staff from the communities they serve. They are place-based clinics, focusing on the specific needs of the local community. Each population has a unique set of strengths and struggles, and our clinics leverage the strengths to tackle the struggles. Originally, we had one clinic in San Jose working with Spanish-speaking immigrants. This is the most mature site and will be the focus of this article, but we have since added three sites in other counties in California.
The clinics are concierge-direct primary care (DPC) hybrids, with concierge patients paying $200 per month. Each full-price patient funds their own primary care and that of two low-income patients. The goal is to have 300 concierge patients plus 600 low-income patients per physician, resulting in a panel of 900 patients.
The concierge fees cover the clinic rent, supplies, and salaries for the physicians and a small staff consisting of a receptionist, patient navigator, and medical assistant. The clinics are organized as nonprofits and also receive donations and apply for select grants. As funding allows, we employ staff who work full time addressing SDOH. We also have a network of volunteers. Our clinics can bill insurance (e.g., for certain procedures that aren't covered under the membership fee), though sometimes this requires more staff time than it is worth. The nature of the funding model allows our clinics to be creative and responsive to our patients' unique needs.
Read the full article
Get immediate access, anytime, anywhere.
Choose a single article, issue, or full-access subscription.
Earn up to 5 CME credits per issue.
