Direct Primary Care, Direct Care and Concierge Medicine Defined

What is does Direct Care Group do and how is it different from concierge medicine? Or, more generally, what is direct care/direct primary care and how is it different from concierge medicine?

We receive this question frequently. Since we are operating in a relatively new niche within a growing industry there are many terms used to reference our business. A century or so ago, the automotive industry was in a similar stage of development and their products carried many different names. Automobile. Wagon. Cab. Motorcar. Jalopy. It’s generally understood that each of these terms is synonymous with “private, personal, internal combustion transportation machine.”

In the medical industry, references to concierge medicine include: direct primary care, celebrity medicine, private doctors, personalized medicine, private medicine, elitist-sounding phrases, or direct care (as we prefer). Direct primary care (or simply direct care) is just another term for concierge medicine.

A broad definition of concierge medicine includes several key attributes. By any name, it is a format in which: doctors see fewer patients; patient access to a doctor in person, by phone or email is enhanced; an ‘executive physical’ is included; and patients are charged an annual or monthly fee. Benefits to patients consist of a better relationship with their doctor, more preventative medicine including wellness and nutrition, and overall enhanced wellbeing as demonstrated by fewer trips to the hospital. Physicians see an improved lifestyle, ability to focus on their craft, and stability of income.

Within the current discussion and nomenclature surrounding the product, there is little to no differentiation or coherent brand identity. There is no standard for a “premium” concierge offering nor is there a clear “entry level” version. In fact, there is little product development or marketing outside of broad, generic themes. As the industry grows, however, these types of distinctions will become more and more apparent and dichotomies will evolve.

At present, the most easily identifiable differentiator is price. Independent doctors charge from $1,000-$6,000 per year per patient, MDVIP doctors charge $1,500-$2,000, and at the high end, MD Squared charges about $50,000 per year per family. Features and benefits generally trend with the expenditure to some degree. But… these practices are indiscriminately referred to as concierge medicine, direct primary care, and etc. regardless of price or offering.

Upon close inspection two major distinctions emerge. Surprisingly (or not) they are rarely identified by how a practice is referenced and neither is clearly explained or promoted.

First: Hybrid vs. Pure (Patient Conversion)

In most cases, a doctor will complete a process whereby his patient base is solicited to join a new concierge arrangement. In a pure practice, patients’ options are to either continue on with their current doctor in the new program with 24/7 access, same or next day scheduling, longer appointments, wellness and nutrition, and more or to find a new doctor. In the hybrid model, the doctor retains those patients which do not wish to convert to the new format. While the ratio of hybrid to pure concierge practices is unclear, the differences are not.

Consider a long, transoceanic flight with a hybrid passenger cabin. Coach passengers are directed past roomy, premier lounge chairs on their way to tight, upright seats. Imagine the same flight attendants prioritizing between serving champagne flutes in first class and stale peanuts in steerage. Hybrid concierge practices are the healthcare embodiment of this system. In these practices, doctors are awkwardly juggling two classes and a large number of patients. While concierge patients get a special contact number, they cannot truly get the same quality of care as in a pure model since their doctor is still seeing upwards of 1,000 patients.

In pure practices, a clear distinction is made upon conversion that a doctor’s practice is at once a concierge practice. Each of her patients receives the same treatment and no uncomfortable jockeying takes place at the office. Each patient has 24/7 access and the doctor does not have to make the precarious – and ethically questionable – judgment call of the urgency of a patient’s condition versus their established payment arrangement.

Second: Insurance (Revenue Streams)

Not all concierge bills are built the same. Some concierge doctors rely on private insurance and Medicare for a portion of their revenue. By taking insurance, they may also be subjecting their patients to co-pays and co-insurance. When reviewing an annual $1,800 fee, it may be easy to overlook the additional per visit fees and find it a bargain compared to a $3,000 sticker price.

Health insurance (as it exists today) in concierge medicine complicates the relationship for patients and increases financial and regulatory risk for doctors. As Washington changes the face of healthcare delivery (including Medicare’s inclusion of executive physicals as a covered expense) the window for concierge doctors to find revenue outside of direct patient billing is closing. This means one of two things: doctors out of business or hefty rate hikes for those practices relying on insurance reimbursement.

Like price point, hybrid/pure and insurance factors create divergent experiences, yet practices across the spectrum are collectively referred to as concierge medicine, private medicine, direct primary care, etc.


In practice, we at Direct Care Group define direct primary care (or direct care) as a concierge medicine experience where each patient has the potential for the same direct relationship with their health care providers. Patients have enhanced access, are given the time necessary for quality treatment, and receive whole-lifestyle care of a primary care physician and his team. Our doctors’ all-inclusive fees are moderately priced, their offices are pure concierge practices, and we do not require insurance for visits.

How long will hybrid operations in which a doctor provides some patients with a “Cadillac” product and others “Chevy” service last? How many offices depending on co-payments, co-insurance, and reimbursement from private or public health insurance will continue to operate successfully? Will these healthcare models go the way of the steam engine? We’re not sure, but we believe the solution is direct care – which is why we’ve based our business on it.

Five Super Ways to “Mobilize” Your Marketing

It is predicted the number of mobile phone subscriptions across the globe will hit 5 billion sometime in 2010, according to the International Telecommunication Union (ITU). In a world of 6.8 Billion people this means roughly seventy percent of the entire planet’s population will have mobile phones! More interestingly, the fastest growing segment of mobile phones are Smartphones, I.e. iPhone, Blackberry, Droid, and Palm Pre along with many others. Smartphones are basically little computers that also happen to make phone calls and they are finally at a stage where they make browsing the web on a small screen bearable. That said, already at least 80% of all mobile phones on the market right now can browse the web; some just do it better than others. Reaching prospects and customers through the mobile channel is now an important medium and the proliferation of mobile powered transactions (mCommerce) will add fuel to the fire. Pretty soon your mobile phone may also replace your wallet. But, lets not get ahead of ourselves since you would probably like to know what basic things you can do right now to take advantage of the mobile channel.

Optimize your website for mobile access. Most websites do not render well on a mobile device. Their layout and design is often compromised to display within a mobile browser and the user ends up looking at a jumbled version of the website you spent so much time trying to make pretty. It’s actually not expensive or overly difficult to optimize your website to display well on mobile devices. The simplest option is to have a custom style sheet implemented that activates when a mobile browser accesses your website. The stylesheet should be absent of most graphics and just focus on content. This approach works well if your website doesn’t rely too much on imagery. Another option is to create a separate mobile optimized version of your site with just the bare essential information a user would need when looking up your website on a mobile device. It should contain things like “about”, “contact”, “services”, “news”, “stock ticker” and/or some functionality relating to achieving a specific task (I.e. Accessing a boarding pass for a flight). A separate url may also be needed but you can install code on your site that can detect whether a mobile device is accessing your site and it will re-direct the user to the mobile version. It’s best to not have too much website duplication or multiple url’s, so if you have a separate mobile website make sure it offers value to the user by allowing them to perform a task contextually related to why they would be looking up your site on a mobile device (I.e. Store location and map).

Capture customer’s mobile phone numbers. Considering half of all phone connections in Canada are now wireless and almost 90% of metro residents have a mobile phone, collecting mobile phone numbers is a must. This is pretty simple to achieve and you can encourage customers/prospects to volunteer this information by offering exclusive coupons or promotions to mobile subscribers. Once you have a list you can implement campaigns using email generated notifications or SMS short codes. The simplest campaign is to send text messages and this can be accomplished with just your email program. As long as you have the number and know the carrier there are email formats for cell phone numbers you can use to send text messages directly from your computer. For more advanced campaigns using SMS short codes you will need to partner with a company that is linked with a gateway provider of the phone companies. Gateway providers have the platform and relationships with phone companies to execute a short code campaign (I.e. Text “win” to 5429 to enter a contest). There are two types of short code campaigns, non-premium and premium. The latter is much more expensive to set-up and is required for any campaign where you hope to generate revenues from the text messages (I.e. American Idol text voting). For non-premium campaigns you can get set-up relatively quickly and use the service for contests, coupons, text alerts, support, etc. There are guidelines around the use of mobile short codes for marketing purposes so be sure to review them before embarking on a campaign.

Use geolocation services to turn mobile users into viral marketers. A hot new trend amongst mobile phone users with web access and support for third party applications is providing updates as to their whereabouts and knowing the whereabouts of others. Services such as FourSquare and Gowalla allow people to send updates about where they are at and can turn it into a game by being recognized for claiming certain destinations. So what? Well, companies can leverage this desire of mobile phone users to update others on their whereabouts by offering promotions or discounts for those people that provide updates about the store’s location and related promotion which is then broadcast to everybody in their network. Now customers are advertising for you. Yelp is another service that is geolocation based but it’s basically a user generated review site for things like restaurants, bars, banks, coffee shops, hotels, etc. There are reviews provided for thousands of businesses in hundreds of cities and the application can automatically bring up reviews for establishments in your direct vicinity using geolocation technology. If you don’t have a listing for your business, especially if it’s consumer oriented, then getting set-up on Yelp is a must. Yelp has taken off in the states and is gaining popularity in many Canadian cities.

Develop a mobile application (that adds value). The popularity of the iPhone and Blackberry app stores has caused a frenzy of demand for companies to produce mobile applications to promote their brand. It may be a good idea for your company but before joining the fray and spending money on development you should consider what value you can provide that will convince people your app is worthy of download. For instance, an application for a jewelry franchise that simply lists store locations is not really valuable and not worthy of download. Jewelry purchases are typically infrequent and store visits are usually done by people with an agenda. The iPhone TimmyMe application for Tim Hortons, on the other hand, was a great success because it targeted a very brand loyal customer that makes frequent purchases and seeks out Tim’s coffee wherever they may be. In this case providing store locations based on the immediate vicinity of the user provided value. It is also a simple application that does one thing very well without need for much configuration.

Integrate QR Codes into communications. QR is short for Quick Response (they can be read quickly by a cell phone) and their use is already famous in Japan. They are used to take a piece of information from a transitory media and put it in to your cell phone. Instead of requiring a chunky hand-held scanner to scan them, many modern cell phones can scan them using a third party application. QR Codes look like a psychedelic version of a bar code and can be generated rather easily using services like or you can use the Open Source code to generate codes for you if you have a smart developer on hand. You may soon see QR Codes in a magazine advertisement, on a billboard, or even a web page. Once it is in your cell phone, it may give you details about that business (allowing users to search for nearby locations), show you a URL which you can click to enter a contest, or it may give you a coupon which you can use in a local store. The reason why they are more useful than a standard barcode is that they can store (and digitally present) much more data, including url links, geo coordinates, and text.

Going Back to Conventional Door to Door Marketing

At present, there are companies that have resulted to telemarketing as one way to getting potential clients. On the contrary, there are certain kinds of business that have more chances of succeeding via door-to-door marketing as compared to telemarketing. This is particularly true for telecommunications industry.

The strategy of using house-to-house client capturing has stemmed from the objective to assess and ask clients to change their service provider. There was further more positive response in this strategy as more people are getting annoyed with receiving cold calls. It is also extremely inconvenient to be receiving a number of spammed e-mails in one day. And with the existence of anti-spam software, it has become an effective tool to combat these unwanted messages.

Direct selling is another effective door-to-door marketing that has been overlooked by many institutions and is often considered as too conventional and ineffective. This is one way of expressing the ‘approachability’, thus offering a friendlier way to persuade clients. Although direct sales people may likewise experience rejection just like any telemarketers at present, the risks are much lower.

Although marketing via the web and the phone may seen effective in particular businesses (such as for non-profit organization, church donations and other campaigns), knocking on the door can definitely create easy rapport as compared with phone ringing once in a while which is by far more annoying than answering the doorbell. Many people are starting to rediscover the efficiency of door-to-door marketing. Restaurant owners are going back to the conventional distribution of leaflets from one house to another. New products are also being launched via this system. The advantage of this marketing strategy is the fact that the business owners can get direct feedback from potential owners. This is also very crucial as future projects can be construed from this feedback.

Is it Possible to Get Started With Affiliate Marketing Without a Website?

This question has been asked many times by newbie Internet Marketers – “Is it possible to get started with affiliate marketing without a website?”

My answer to this question is – Yes, you definitely can. What I mean here is that you can get started with affiliate marketing without purchasing your own domain name, as well as hosting.

And in this article, I’m going to share with you 5 different methods on how you can get started with affiliate marketing without a website (some methods that I’ll be sharing here are free methods, while some are paid methods).

1. Web 2.0 Sites

You can create your online web presence (and promote affiliate products) using Web 2.0 sites such as Squidoo, HubPages, Blogger, etc. – All of which allow you to sign up for free and create your own websites in a matter of minutes (by following their step-by-step instructions).

Days are gone when you need create your own website from scratch using hard coding (using web design software). Now, you can create your own websites in a few simple mouse clicks. However, take note that when using these Web 2.0 sites, you do not want to slap all your links onto these sites (as it may get yourself banned).

What you may want to do here is to create useful contents (related to the products and services you are promoting) and you can put your affiliate link (for the products and services that you are promoting) at the end of these contents. By doing so, people will look upon you as someone whom they can learn and benefit from, instead of being a spammer.

But, if you prefer to use the microphone to convey your message or share information, you can create videos and submit them to video sharing sites such as YouTube – They can help you get sales for the products and services you are promoting as well.

2. Write Articles & Submit To Article Directories

You can write short articles (ranging from 200 to 350 words) relating to the products and services you are promoting (with your affiliate link in the author’s bio) and submit them to the various article directories such as EzineArticles, GoArticles, Articles Base, etc.

However, one thing you may want to take note is that in some article directories, you may not be allowed to paste your affiliate link directly into the author’s bio as it is – You will need to get yourself a domain name and do a domain forwarding to forward it to the affiliate link of the product and service you’re promoting (by doing so, when someone clicks on your domain name, he/she will be directed to the product/service you are promoting with your affiliate link).

3. Write EBook & Distribute To Free EBook Directories

Here’s another method you can use if you find creating websites a hassle – And that is to create your own eBook (with contents circling around the products and services you are promoting) and submit them to free eBook directories.

What you can do here is to create a simple 15 to 20 page eBook around the products and services you are promoting, and within the ebook, you sprinkle affiliate links to the products and services you are promoting.

4. Pay Per Click Search Engine Marketing

You can make use of Pay Per Click Search Engine Marketing to advertise the products and services you are promoting as an affiliate – And whenever someone clicks on your advertisement, it will direct them to the merchant’s product page via your affiliate link.

There are advantages and disadvantages to using this method though – The main advantage to using this method is that you can get traffic quickly (if you are targeting the right keywords, you can see traffic going into the merchant’s product pages via your affiliate link within 10 minutes).

However, the main disadvantage is that you must equip yourself with good keyword research skills or else you’ll stand to lose out a lot of advertising fees and yet not get any sale.

5. Classified Ads (Both Online & Offline)

Finally, you can advertise the products and services you are promoting using classified ads (both online and offline).

In some of these online classified ad sites, there are free, as well as paid membership that you can sign up for. I would recommend you to sign up for paid membership as you can have more flexibility in placing your ads.

As far as using online classified ads are concerned, some of the online classified ad sites that you can post your ads on are USFreeAds, AdLandPro, etc. When it comes to offline classified ads, you can post a classified ad about the products and services you are promoting as an affiliate in your area’s local newspapers (and it might cost a fair bit to do so).

I’ve just shared with you 5 different methods that you can get started with affiliate marketing without a website.

What you need to do now is to take action – First to locate products and services that you’ll like to promote (you can conduct a search on Google for the keywords “your niche area affiliate program”, where you need to replace “your niche area” with the niche area that you are interested in promoting products and services for).

After you’ve selected a particular product and/or service you like to promote, select one of the five methods I’ve shared with you above to get started in promoting the product and/or service.

When you’re getting success with that particular method, pick and choose another method and work on it again to promote the same product and/or service – This will allow you to multiply your sales for that particular product and/or service that you are promoting, earning you more affiliate commissions.

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