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Subscription-Based Practice

In healthcare, the fee-for-service (FFS) and value-based care (VBC) are the top payment competitors, according to XPC. The subscription-based practice model, like we see with DPC, falls under the VBC model.

I can charge $100 per patient per month and have a patient panel of 150 individuals. That’s $15,000 per month or $180k a year.

I gravitate towards this subscription model because I believe primary care for the right individual can provide 95% of the necessary clinical care.

A Primary Care Membership Model

The current healthcare system has most patients interacting with an urgent care doctor. Physicians like to poo-poo this fact, and many view the urgent care as a joke or a nuisance.

A real primary care system would have each patient paired up with a single physician, and they would get to know each other over several decades. Hopefully, there will be some care extension with the help of NPs, PAs, mental health experts, and dieticians.

In the membership model, instead of sending my patient to a consultant, I might use the services of platforms like RubiconMD to have my specialty questions answered. This allows me to continue the care of my patient with the guidance of your supernerds.

The Clinical Subscription Practice

In this subscription-based model, I am incentivized to keep you on my panel while improving your health outcomes.

You are incentivized to stay on my panel because I save you money and improve your health.

How much should we charge for this lovely service per month? That depends on how many patients you are comfortable managing, how much you want to work, how effective you are, what market space you work in, etc.

Redesigning Digital Nomad Health

The four of you who read this blog know that I have this Digital Nomad Physician brand for coaching, consulting, and bragging.

The other platforms I own and operate are Digital Nomad Health and Heart Health Coach.

At DNH, I see regular telemedicine patients. It was focused on primary care and prevention but was mostly standard telemedicine with medication refills and the occasional opioid request.

The HHC brand is about heart disease prevention with the tagline Improving your cardiovascular outcome. I charge an hourly rate of $250 and coach people to overcome their heart health struggles.

I set out to redesign DNH, my telemedicine brand, because I no longer enjoy meeting so many new patients. I wanted ongoing relationships and continuity of care. Something I was deadly allergic to in the past.

Ongoing Care with the Right Patients

I used to be allergic to standard continuity-care practices.

I recall a patient who would come in demanding antibiotics and would have a new heart attack, diverticulitis, or SBO every few months. It was daunting, exhausting, and a waste of both of our time.

Now, in my subscription-based practice, I am marketing to healthy individuals who are comfortable taking the driver’s seat. They may have many chronic conditions, but they are in the state of health.

The conversations with these individuals are bidirectional; I share tips and tricks, educate them, and they provide feedback on what worked and what didn’t.

In this role, I can see myself having a panel of 30 people over the next few years. Later, I’ll grow this to 100 and maybe up to 150.

Pricing out the Clinical Membership Model

To create a pricing model, I did the math working backwards from the income I wanted. $100k a year is more than enough for me from direct patient care.

In the first few years with a panel of only 30 I would need to charge $277 per month per patient to earn $100k. That’s silly.

Instead, with a panel of 30 I can still do some other telemedicine work, see patients in the urgent care, etc. I’ll have a cumulative clinical income of $100k.

When I grow my subscription-based clinical care practice, I’ll perhaps charge $150 per patient per month and drop this down to $125 and $100 as my patient panel grows.

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