Understanding Primary Care Options for Adults 65+

By Neil Patel, MD, Chief Health Officer

 Can you remember the last time you were able to schedule a same-day appointment with your doctor? Checked in and immediately bypassed the waiting room? Felt like you had plenty of time to discuss your health concerns with your primary care practitioner (PCP)? 

If you are 65 or older and answered no to any of these questions, it might be time to look for a new provider. 

According to the National Institutes of Health, the average primary care exam lasts 18 minutes. That's not much time for someone who values a close connection with their primary care practitioner (PCP).

Good primary care is essential to our overall health and well being – especially as we age and our health needs begin to change – but the system is not always set up in a way that’s easy, convenient or straightforward for older adults. Patients want greater access to their provider and a more seamless experience. They want to be treated as a whole person with individualized needs, rather than a problem to be solved. They want to be ‘seen’ and ‘heard,’ treated with the respect and dignity they deserve.

Trying to find the right medical provider can be difficult, but a better primary care experience is within reach. That’s why it’s important to consider primary care options that meet the needs of older adults, including understanding the differences between concierge, telehealth and relationship-driven primary care. Let’s take a look at these models.

Concierge care  

Concierge care (also called concierge medicine, retainer-based medicine, boutique medicine, platinum practice or direct care) is membership medicine where patients pay an annual fee in exchange for an exclusive, direct relationship with their doctors. Patients often have access to a PCP 24/7 and same-day appointments while receiving highly personalized, comprehensive care. In return, doctors carry a smaller patient load. The annual fee allows them to reduce their reliance on insurance reimbursements to keep the practice running.

Concierge fees can vary widely, running anywhere from $1,500 to $20,000 a year. For Medicare beneficiaries, it’s important to keep in mind that Medicare does not cover membership fees for concierge care. You are responsible for 100% of the fees for concierge care; after you pay the membership fee, you may get some services or amenities that Medicare doesn’t cover. For many people, these costs are simply out of reach. In addition, a concierge physician can manage acute needs or chronic conditions, but patients will still pay for visits to the hospital or emergency room, major surgeries and visits to other specialists.

While concierge care might be a great alternative for patients who are frustrated with their care provider or who suffer from chronic illnesses that might benefit from a higher level of care, concierge doctors make up just a small percentage of the medical field so the provider selection may be limited. 

Bottom line: there are better options for Medicare enrollees, particularly those who want to make the most of their plan.

Telehealth

COVID-19 caused the offices of many care providers to temporarily close, making it difficult for older adults to get access to the care they needed. While the pandemic slowed down many things, it accelerated the adoption of telehealth – the ability to visit with a healthcare provider without an in-person office visit – and transformed access to healthcare services. In fact, a 2022 J.D. Power U.S. Telehealth Satisfaction Study found that 67 percent of people surveyed used telehealth in the past year, as opposed to 37 percent in 2019, before the start of the pandemic. Around 57 percent of people now say they prefer virtual visits to in-office appointments for mental healthcare.

Telehealth services can be used in a variety of settings and purposes, including routine check-ups, behavioral health, and treatment of chronic conditions, giving patients the ability to connect with a doctor via video rather than visiting a physical location. The result is a more convenient and cost-effective way to reach older adults – particularly those who have substantial healthcare needs, mobility and transportation limitations, and may benefit from fewer trips outside of the home with less exposure to illnesses.

While telehealth is convenient and cost-effective, it does have drawbacks. It’s simply not possible to conduct every type of visit remotely – some diagnoses or medical tests require hands-on care and assessment. Another drawback to telehealth is that patients often see a different care practitioner for each visit. Good primary care should be rooted in a relationship and trust that stays with you over time, working with you to anticipate and address the normal changes the body goes through as you age. That’s not really an option in most telehealth models. 

The rise of telehealth is just a start in reconsidering our approach to modern healthcare, but it doesn’t provide a comprehensive healthcare solution. 

Patina: Relationship-driven primary care

A few years ago, I had an opportunity to build a primary care practice from the ground up for people 65 and older. A chance to rethink the care experience to better address patients’ needs and frustrations within the current system. A patient-centered primary care experience that encourages active collaboration and shared decision-making between patients, families, caregivers and providers. The result is a Patina – personalized, convenient primary care just for adults 65+.

First step? Assemble a team of professionals who are experts in care for older adults and will work with you, the patient – and your family, if desired – to design a care plan that helps you maintain your health and independence as you age. Even when a patient is relatively active and fit, primary care is still essential for ongoing health and longevity. And when patients are actively engaged in their healthcare, they tend to manage chronic conditions more effectively, reducing the need for expensive emergency care services or worse, deteriorating health and quality of life. 

Patina primary care incorporates these and many of the same principles as concierge care and telehealth – but delivers these services to anyone with a participating Medicare or Medicare Advantage Plan, with no additional fees. Think of it as the best of both worlds: the personal relationship and trust of concierge medicine with the convenience and access of telemedicine. Our highly personalized model is also designed to prioritize:

• Proactive, preventative care, which is particularly important as we age,
• Relationships between patients and providers that are founded in trust and tuned to patients’ unique values, goals and preferences, and 
• Convenient care, on YOUR terms, when and where you need it, whether at home or on-the-go. 
  
  

When you choose a practice like Patina for primary care, you’ll have a dedicated care team that takes the time to know you and creates a personalized care plan that supports your total health and well-being. Your physician-led team includes a primary care nurse practitioner, a registered nurse champion, and a health champion – your "go-to" resource for scheduling appointments, navigating care, securing needed resources, addressing questions, and more.

Mark Pinsky, a current Patina patient, experienced what I hear from many patients. He was increasingly frustrated with the impersonal nature of his prior provider — always waiting for appointments and then getting rushed out after short visits that didn’t allow for the time he needed to fully discuss his questions and concerns. 

“It felt like I started over every time I talked to a doctor or a nurse, continually rehashing everything and getting different advice for the same issues,” he said. ”I actually felt discouraged from calling to ask questions because I couldn’t get the answers.”

Mark leads a busy life and frequently travels, so he uses the Patina app to send photos to his care team, check in on his health status, or video chat with his nurse or PCP. When needed, a nurse will come directly to his home for care and loop in his PCP via video. “I never could afford concierge care. But now with Patina, I feel like I have it," he concluded. 

Having it all

Our continued health and well-being is important, and we all want to receive care that is timely, convenient and high quality. We want better service – less waiting, more meaningful visits, and better experiences and outcomes. A real relationship, rooted in trust, where you feel seen as a unique person by someone who is concerned about your total health and well-being. That’s what patients really want from their provider. 

The world of primary care is changing for the better, with new models and philosophies that meet patients where they are, whether they’re healthy or managing more complex conditions. A world where patients are treated with compassion, dignity, and respect, and can build strong, trusting relationships with providers and staff. 

When weighing your options for a new primary care provider, know that it’s possible to get the care you deserve without having to spend thousands of dollars on concierge medicine or compromising on accessibility and relationships. You CAN have it all: access, quality, affordability, convenience and personal attention with medical practices like Patina.