Retainer-based doctors

There are approximately 500 retainer-based practices in the U.S. associated with organizations such as Society for Innovative Practices Design (SIMPD) and MDVIP, a company that develops and supports retainer-based medical practices, plus another 1,000 or so practices that have established themselves independently.

What you’ll pay: $1,000 to $25,000 a year, depending on location, local market conditions, patient age and the physician’s patient load as well as the frequency, and breadth of any included physical exams. Expect scaled pricing for couples and families. Physicians who see a smaller number of patients will likely charge a higher annual retainer. Practices in the $1,500 to $3,000 range will typically charge additional fees for office visits.

What you’ll get: Extended time with your doctor, since the fee system allows them to carry a lighter patient load. Office visits range from 30 to 60 minutes, or longer. You get to discuss your health in the thorough manner you would a legal issue with your attorney. More costly programs include house calls and your personal physician’s direct assistance when you visit a specialist, go to the emergency room, or have an extended hospital stay. Count on same- or next-day appointments that start on time and 24/7 access to your doctor by phone and email.

Extra services: Many practices compile your medical records in an electronic format—CD, DVD, flash drive, or online—so that you have ready access to your health history.

Additional costs: The annual fee may include a comprehensive annual physical but other consultations can be charged separately. Some practices accept insurance or Medicare for covered treatments, while others do not (but they will help you with claims paperwork). Also, annual fees are typically not covered by health insurance. Flexible spending accounts may help you defray the cost, but in most cases, you’ll pay for these services out-of-pocket.

Executive health programs

Leading hospitals across the country including the Cleveland Clinic, Johns Hopkins, Mayo Clinic, UCSF, and Stanford offer health programs for busy executives that coordinate medical consultations and lab tests into one to three very full days.

What you’ll pay: $2,500 to $3,500

What you’ll get: A focus on assessing your current health and your risk for future problems, such as heart disease or cancer. At the Mayo Clinic your schedule would include an extensive questionnaire about your past and current health issues; a one to two hour initial physical exam; a range of tests including blood count, blood chemistry, coronary risk/lipid panel, and urinalysis; prostate cancer (PSA) test for men; mammogram and pelvic exam for women; chest x-ray; resting electrocardiogram and cardiovascular evaluation; and, perhaps most importantly, very thorough individual health counseling. Dr. Donald Hensrud, the clinic’s former director for more than a decade, said that what sets the program apart from the typical exam is the “time for discussion and exploration of your health that leaves no stone or pebble unturned.” At the end of your stay, you’ll receive a full report that you can (and should) discuss with your regular doctor.

Additional costs: The cost can rise substantially if you select optional tests such as a full body scan, carotid artery ultrasound, or an angiogram.

Private health advisor

Companies such as PinnacleCare, Healthcare Advocates and Health Advocate work with clients who want dedicated assistance finding the right specialists, scheduling laboratory tests or dealing with an insurance paperwork.

What you’ll pay: Healthcare Advocates has plans that start at $300 a year with a la carte charges depending on your needs, while PinnacleCare runs $7,000 to more than $25,000 a year, depending on if you are in good health, or confronting chronic illness. A family of four pays $10,000 annually at PinnacleCare.

What you’ll get: Help navigating the insurance quagmire, and more. Health Advocate can correct insurance billing mistakes as well as explain an illness in-depth to better prep you for a visit with a specialist. Many PinnacleCare Advocates have clinical medical training. They’ll compile your medical records (the company launched online health records in the spring of 2008), interface with physicians, hospitals, and insurance companies on your behalf, and be your personal “first responder” if you need medical assistance when traveling. The company has relationships with hospitals nationwide in order to expedite appointments and lab tests. Chairman and co-founder Bruce Spector says that PinnacleCare sets itself apart by providing more independent, objective referrals than some local physicians are able to make. The company also helps clients evaluate multiple medical opinions and the complexities of managing a serious illness.

Extra services: Plans are available for management teams and family offices.

Additional costs: One-time administrative set-up fees. The family of four with a $10,000 plan will pay an extra $5,000.

Five things to know when shopping for personalized healthcare