Membership Medicine

Practicing as an in-network provider can be the path of least resistance in terms of new patient acquisition. But if you want your dream practice, a membership medicine practice is worth the effort.

In-Network

It’s understandable that some practitioners choose to be in-network with insurance companies when they first open their practices. A new doctor hasn’t yet established a patient base, and when you’re in-network, you don’t have to work as hard to bring new patients indoor doors. The insurance company sends people to you by listing you as an in-network provider. 

All you have to do is hang out your shingle, and the patients (and insurance checks) start rolling in. It seems too good to be true and eventually, you start to understand why it is.

Less Money, More Hassle

There’s a lot of overhead involved when you’re an in-network provider. You have to hire someone to do your billing and to chase down missing payments. And let’s not forget the copious paperwork; sending corrected claims, sending requested progress notes, and filling out paperwork for pre-authorization. Doing all of this costs time and money. If you run a busy practice, the details can start to fall through the cracks. By the time you figure out why the insurance companies aren’t paying up, you’re drowning in overdue paperwork.

When the checks finally do start coming in, you might wonder if there are some missing zeros somewhere. There aren’t. As we’re all aware, insurance companies reimburse for “customary and reasonable” expenses. But that number is reasonable to them, not necessarily to you.

In addition, almost every doctor I’ve ever spoken with is fed up with insurance company “paper-pushers” interfering with the clinical care of their patients. Often, the insurance company employees responsible for approving or denying claims have little to no clinical training. To keep it in perspective, let’s not forget that most insurance businesses are publicly traded companies trying to make a profit. While you’re trying to look after your patients, they’re trying to look after their bottom line.

Membership Medicine

If the above paragraph sounds too familiar, there’s a solution; membership medicine. This practice structure cuts out much of the insurance company hassles and puts care decisions back into the hands of practitioners and their patients. You charge a fee; it can be yearly, monthly, quarterly, whatever works best for you and your patients, and that fee covers a variety of treatments, services, and procedures. Patients are encouraged to keep a catastrophic policy with a high deductible, but most of their routine care is covered by the membership fee.

There are many ways to structure a membership medicine practice, and they go by a few different names, but what they all have in common is eliminating the headache, expense, and interference from insurance companies. However, a membership medicine practice has its own challenges.

Education, Promotion, Connection

Building a membership medicine practice takes work. Once you extricate yourself from the insurance companies, they’ll no longer send patients your way. And there are a lot of people who won’t even consider seeing an out-of-network practitioner. Who can blame them? Consumers pay an exorbitant amount of money for health insurance and they want to use it! People think medical care is expensive, and they’re right. When a third-party (insurance company) is involved, prices are artificially inflated to handle the costs associated with dealing with them.

When you eliminate insurance companies from the equation, it’s entirely possible to provide a high level of care. Often you can provide a higher level of care than you could when you were in-network. You aren’t under pressure to see more patients in less time in order to make a living. And the insurance companies no longer get a say in what’s best for your patients.

Some patients don’t understand this. All they hear is “out-of-network” and they simply find someone who’s in-network. It’s up to you to educate your patients on what membership medicine is; the benefits and the costs.

Transitioning from a traditional practice to a membership practice is less scary than starting day one as a membership practice because some of your existing patients will stay with you through the transition, particularly if you’ve properly educated them on the advantages.

But you’ll lose some patients and the insurance companies won’t be sending you new ones, so you have to promote your practice yourself. Start by setting some marketing goals. Understand who your patients are and how your practice can give them solutions to problems. For example, a common patient complaint is the lack of time a practitioner spends with them. In a membership medicine practice, patients get the time and attention they want and need, neutralizing this issue. 

If you go out-of-network, you’ll have to connect with your community in a way you didn’t before. Put yourself out there, go to health fairs, give workshops and lectures at schools, churches, and community centers. These are the places where you can introduce yourself and your type of practice to potential patients.

Is It Worth It?

This may sound like a lot of work compared to letting insurance companies send patients to you. So is it worth it? That depends. If you like freedom and flexibility, a membership medicine practice is absolutely worth it. Under this model, you can make more money in less time, eliminate interference in clinical decision-making, and eliminate a lot of paperwork and overhead.

If that sounds better than what you’re dealing with now, perhaps you should explore membership medicine further.

For more information on building community connections, I encourage you to read my new book Community Connections! Relationship Marketing for Healthcare Professionals. If you want more valuable information about how to Connect with YOUR Community, you can find FREE healthcare practice marketing content, PowerPoint Presentation Jumpstart Kits, workbooks, blog articles, and my FREE “Practice Marketing Planner” Now!