The Key To Premium Care

New health services pamper the wealthy, managing their medical needs even to the point of sending tips to their chefs.

August 14, 2005|By M. William Salganik | M. William Salganik,SUN STAFF

It's common for people who can afford it to hire a wealth manager. So why not a health manager?

That's the premise behind Pinnacle Care International, a Baltimore company that reports rapid growth in the newly developing business of patient advocacy.

Pinnacle advises families on doctors and hospitals that are likely to give them the best care, but also arranges appointments, fills out paperwork and sometimes even accompanies patients. From time to time, it coordinates with a member's chef on healthful menus and with his personal trainer on an exercise plan.

"You learn to anticipate their needs before they realize them," said Nuran Saydam, one of Pinnacle's senior advocates. "You learn to hold their hands every step of the way. You not only guide them through their medical needs, but you mother them."

This level of service doesn't come cheap. The lowest, or "silver" level of membership, carries a $10,000 initiation fee and a $5,000 annual price tag. The highest level, "platinum," calls for $30,000 up front and $25,000 a year. And that's just for the advocacy - the patient is still dependent on insurance or out-of-pocket payment for actual treatment, except for periodic "executive physicals" that come with membership.

Services like Pinnacle's are growing at a time when health care has become increasingly complicated and expensive.

With the entrenchment of managed care, many patients now spend time and energy finding health care providers who are part of their network, getting necessary referrals for specialists and navigating layers of automated phone systems to secure an appointment. More time is spent in a waiting room to get a visit with a doctor that typically lasts a few minutes. And then there's figuring out-of-pocket costs such as deductibles, co-payments and perhaps managing a health spending account.

But there are ways to smooth out the bumps, hassles and time spent - for those willing and able to pay top dollar for more attention and better service.

Uwe E. Reinhardt, a health economist at Princeton University, said that the American health system has a belief in access to care for all, but has historically paid less for services for the poor. Now that tiered system of care is creeping up the economic ladder.

As the distinction between care for the affluent and everyone else becomes more pronounced, "it will be jarring to the middle class" to see "some really rich people jumping the queue," he predicted.

"In the struggle between the egalitarian supply side and the income-based payment side, the payment side is winning," Reinhardt said.

Prestigious hospitals, including Johns Hopkins, offer "executive physicals" at about $2,000 each, with specialists lined up for back-to-back tune-ups of the busy patient. And there are "concierge" or "boutique" medical practices, in which patients pay a fee of $1,500 a year, in exchange for less-rushed exams, more preventive care and a pledge that appointments will start on time.

Darin Engelhardt, chief financial officer and general counsel for MDVIP, a Florida company that helps doctors set up such practices, said, "We joke that with MDVIP, you can leave your copy of War and Peace at home when you visit the doctor."

Clarifying confusing system

While convenience is nice, customers of Pinnacle say what they like most is a sense that they're able to work through a confusing system and get the care they need.

For example. Ernest DiPalo of Towson joined after having kidney surgery, which revealed that he had a liver tumor. The tumor was benign, but has potential for causing serious complications if it grows.

"I was living with this tumor, and everyone was telling me there was nothing that could be done," said DiPalo, 72, a retired Social Security Administration executive. Pinnacle put him in touch with a Hopkins surgeon who has removed such tumors.

Now, DiPalo gets regular liver scans - his advocate sent him an e-mail last week to remind him he has one scheduled soon - and would get surgery if the tumor is growing. Knowing that if it's needed, he can get the surgery from a top specialist, he commented, "I have a sense of well-being now."

There are also a few mass-market versions of patient advocacy companies. They may not hold personal meetings with a client's chef, but they're available by phone to provide information and straighten out billing hassles. They generally contract with employers, charging a few dollars per employee per month.

The lower-cost advocates and Pinnacle are "built from the same mold, from the idea that the health care system has become increasingly confusing and increasingly difficult, especially in a time of need," said Dr. Abbie Leibowitz, executive vice president and chief medical officer of Health Advocate Inc.

A few doctors have launched "advocacy practices," where they don't treat the patient, but advise the family and coordinate with other providers.

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