Every Saturday morning, dozens of cyclists and walkers gather in Redlands outside a restored Victorian to exercise with Dr. Steven Wilson.
With its huge bike rack and organic vegetable garden out back, it's not what you'd expect from your primary care doctor's office.
But this isn't your typical practice.
At a time when in-and-out appointments are a financial necessity for most physicians, Wilson and a growing number of direct care or "concierge doctors" are using their practices to focus on wellness, not illness. They work on health and fitness goals with their patients, and are available to speak with them regularly by cellphone to help them make better lifestyle choices.
Some physicians who operate under the concierge model don't take insurance at all but may offer better rates on lab work, drugs and common procedures. Others take insurance but charge an additional annual fee for more comprehensive annual physicals and testing that might not be readily covered by insurance or offered at other practices.
Physicians say the concierge model allows them to have fewer patients and more conversations focused on wellness and preventive care.
"Doctors want more time with their patients, but with all of the paperwork and regulation they're dealing with, they get less time and less eye contact. It's hard to talk about wellness under those circumstances," says Tim Norbeck, chief executive of the nonprofit research and policy group the Physicians Foundation.
Of the doctors surveyed in 2016 by the Physicians Foundation, 23% already offer concierge care or plan to transition to this direct pay model either fully or in part.
And though it used to be for the very wealthy, with fees that ran more than $10,000 a year, many annual fees now are $1,800 or even less, according to statistics from the American Academy of Private Physicians, making it available to a much larger range of upper middle class patients.
Physicians say many see this cost as an investment in their health, one that is even easier to swallow if doctor visits feel more relaxed and pleasant — more like a trip to the health club or spa than a sterile medical office.
"We focus on the fun and fellowship," Wilson says, of his yoga classes, walks and healthful eating lectures held in the garden. "That's what keeps people coming back."
Here's a look at a few Southern California concierge medical practices that think differently about patient health:
The fitness doc
Dr. Steven Wilson, a doctor in the MDVIP network made up of concierge physicians, creates an annual "business plan" for improving each patient's overall health. It includes services such as the use of a portable ultrasound to look for signs of heart disease or an enlarged liver, lipids testing as well as screening for inflammatory markers and dermoscopy to look for skin cancer. Patients set health and fitness goals each year, and Wilson develops lifestyle strategies for each patient around diet, fitness, sleep and stress reduction, checking in periodically to hold them accountable, or looking at data from their Fitbit or other wearable fitness devices.
He says 90% of his patients meet their annual goals, perhaps, because "they pay to be in [the practice].… I have the time to spend with them," he said, and can ask about what issues they've been "blowing off" or things that their spouse has been complaining about. He also helps athletes with competitive training plans and VO2 max metabolic testing.
As with most other concierge doctors, he takes same or next-day appointments, and can be reached by cellphone.
Cost: $1,800 annual fee through the MDVIP network covers an annual two-hour annual exam and all related testing, as well as access to same-day visits throughout the year, which are covered by a patient's insurance.
The spa doc
At Dr. Lisa Benya's offices for Cure in Malibu and West Hollywood, the scene is as much a spa or health club as it is medical office, with aromatherapy candles and patients walking around in fluffy robes.
The internal medicine doctor's concierge service includes 24-hour access to the internal medicine doc, as-needed house calls and coordination with specialists, complimentary massages or facials at her in-house spa, free health lectures, and discounts on medspa and salon services, such as nontoxic hair coloring.
"It's all about creating a healthy lifestyle," she says. But it's also about pampering. "It can feel completely awesome and luxurious," she says of the experience.
She said many of her clients are CEOs or entertainment industry professionals who travel frequently, work long hours and want a one-stop shop for health and beauty.
Cost: $500 a month or $6,000 annually, which includes 24/7 access, same-day appointments, house calls, administrative work and coordination of care among specialists, as well as a monthly massage or facial in its spa. Insurance is accepted for testing and other medical care.
The good listener
Dr. Michael R. Lewis in Woodland Hills knows that many client health problems don't come up until the end of an appointment when a patient says, "Oh, by the way...." That's why he spends up to an hour with each patient, trying to get to the root of their issues. "You have to let people have time to say what they need."
A visit to Willow Healing Center usually starts out over a snack and beverage around his desk, rather than in a sterile exam room, where they can discuss what they're feeling and "how they're living," so he can make recommendations for medication, treatment and changes to a patient's lifestyle such as meditation, which he might practice with a high blood pressure patient in the office's quiet room.
Mental health is also a big focus, with his wife, psychologist Jennifer Lewis, seeing patients out of the same office, and a reiki practitioner coming in weekly to help stressed patients unwind. A unique aspect to his practice is his on-site pharmacy, which dispenses about 120 common medications, most, he says, at prices cheaper than an insurance co-payment.
Cost: Three tiers of service, ranging from $179 to $365 a month, that provide for all visits, many standard procedures such as suturing wounds, some in-office testing such as EKG stress testing and urinalysis, as well as reduced rates on outside lab work (that can be billed through PPO insurance).