When your clients share that they, or a loved one, is suddenly facing a critical or life-threatening medical diagnosis, what can you do?

Most likely you can reassure them that you have their financial, insurance or legal matters under control; but how much more helpful could you be, and how much deeper could you develop your client relationship, if you could provide them access to a professional advisor to advocate and quarterback their medical care?

Many people, perhaps naively, feel that as long as they have a long term care insurance policy and a solid health insurance plan then they have great “health care”. However, insurance is simply a currency. Health care comprises the services you receive from medical and health professionals for the prevention, treatment, and management of illness to preserve mental and physical well-being. To have truly great “health care”, you need both solid insurance coverage and the knowledge of and access to the most cutting edge treatment options, experts and medical resources.

In the suite of professional advisory services that are offered to clients, a holistic approach is emerging that integrates medical and healthcare planning into other professional planning services. Seeking the guidance of a professional health advisor is a vital next step to ensure that clients are prepared when a medical crisis strikes and nothing else seems to matter.

The Need for Professionals to Guide Medical and Health-Related Decisions

When it comes to complex matters like tax and estate planning, or high-risk financial and real estate investment decisions, most individuals seek the help of professional advisors.

No field has gotten more complex and few decisions are as critical as the health-related decisions associated with serious and complex medical issues. Health advisory professionals are gaining a seat at the table to help clients and their families navigate an increasingly complex healthcare environment for the best possible care and optimal health and well-being. By seeking the support of professionals for medical and health-related decisions, clients are more actively managing risk to stay healthy and ensure their access to the best possible care when needed.

While there are many business partners who provide expert advice and guidance for pivotal legal and financial decisions, there is rarely one objective, unbiased resource to guide individuals when facing a serious diagnosis, medical emergency, or other health care-related decisions. Many high net-worth clients are used to having financial advisors, attorneys, insurance brokers, CPAs, etc., but they have typically been on their own to navigate the healthcare system – looking often to personal connections, rather than independent health professionals, to guide their decisions.

Health advisory services have emerged to fill that gap and serve as a professional partner helping clients to navigate the healthcare system, providing objective information and research, coordinating all aspects of care, and facilitating access to the country’s top specialists and medical centers. It supports the primary care function to ensure both strong, local attention but also a national (and global) support system for critical diagnoses or medical emergencies that should arise while traveling anywhere in the world.

Health Advisory Group Benefits to Address the Middle-Market Gap

Just as 401K benefit plans emerged to fill the gap when the responsibility for retirement planning shifted from employers to consumers, health advisory group benefits are emerging to help manage the shifting burden for health decisions to the consumer.

It is a burden impacting all employees, regardless of age, as new consumer-directed health plans become the norm. More than 17.4 million Americans now rely on high-deductible health plans with HSA-based plans carrying median deductibles of $2500. The quality and cost of medical care is now more directly relating to decisions consumers are making – increasing the need for a professional advisor.

Growing Your Personal Connection and Enhancing Your Value

You may find it awkward or uncomfortable to ask your clients about their lives outside of your professional focus. But the fact is that healthcare is an exceedingly complex business today.

Medical decisions can be a heavy burden and without a support system in place, the responsibility of caring for loved ones can be overwhelming. By encouraging better and more informed decisions for maintaining good health and/or dealing with complex medical conditions and treatments, your clients can better focus on managing other aspects of their life trusting that their health is in good hands.

These simple questions could help open the door to a stronger relationship and give you the opportunity to help clients with one of the most important aspects of their lives – their health:

• Is there a medical condition that is taking a great deal of time to address for you or a member of your family? Would you like to have a professional “quarterback” who could help you manage that situation on a 24/7 basis?
• Would you like the same level of convenience, information and attention in all matters related to your family’s health that you receive for other concerns like your finances, investments and legal matters?
• Do you have in-depth information on and access to the best physicians, treatments and hospitals around the country?
• Would you like someone to take care of all the administrative details around doctors’ appointments – including scheduling, filling out forms, explanation of procedures, etc.?
• Do you have all your family members’ medical records collected and in one place for instant electronic access anywhere in the world?
• What would you do if you faced a medical emergency or illness while traveling away from home or internationally? Do you have a risk-management plan in place? Do you know where to go for qualified, expert care?
• Are you comfortable with the medical care and attention your parents are receiving? Is everything being coordinated and managed efficiently?

The goal here is learning how to engage with clients in a meaningful way and providing reassurance that there are other options available to help support their medical decisions and steer them to the top medical experts and centers of excellence.

With clients having less time or limited expertise to commit to researching important health care decisions, you can extend a helping hand that will coordinate their access to appropriate health care providers, open doors to top medical specialists; and shed new light on evidence-based treatment options, wherever and whenever your clients should need it.

Many of you are looking for innovative new solutions to serve your clients and build broader family connections for intergenerational planning. By bringing a trusted health advisor to the table, you can grow your value and strengthen these relationships, engaging other family members in the process.

The health-insurance landscape has changed drastically. There has been a huge influx of newly insured people, and the population of older people in need of more healthcare is growing exponentially. In short, there are not enough doctors, which may cause challenges in terms of finding primary-care providers and cause long waits for appointments.

While your family can likely access a robust health-insurance plan, it’s important to recognize that health insurance is only one small part of the healthcare puzzle. As our healthcare system grows increasingly complex, there are a number of challenges you may face.

Challenge #1: access to physicians:
Recent estimates project a growing shortage of physicians as the population ages and millions of the newly insured enter the healthcare system. At the same time, more physicians are opting out of Medicare and other forms of insurance, moving from a private practice to a salaried model and preparing for retirement. This impacts your access to primary care physicians for your day-to-day health needs and preventive care, as well as access to specialists when complex needs arise. While concierge physicians may help to ensure your access to primary care, you may still have difficulty getting an appointment with top experts in specialties like cardiology, orthopedics and oncology. And specialist referrals are typically influenced by geography and the medical centers your doctor is associated with.

Challenge #2: risk of misdiagnosis and overdiagnosis:
The growth in medical specialties, technology and treatment options also makes it difficult to digest the broad spectrum of providers and appropriate treatment options. This can impact your ability to make decisions that protect your family’s best interests. According to PinnacleCare, a leading health advisory firm, research has shown that anwhere from 20 to 30 percent of cases are misdiagnosed, resulting in unnecessary testing or inappropriate surgery and treatment.

Challenge #3: continuity of care when travelling:
If you become ill or injured while travelling for business or vacation, you could face serious health and financial risks. PinnacleCare also reports that evacuation to a facility providing high-quality medical care can cost more than $40,000 within the U.S. and $100,000 in foreign locations. Additionally, physicians treating you may lack access to your current medical records, which is essential in a medical emergency or crisis.

Health advisors: an approach to managing your health-associated risk:
How do you navigate these challenges and ensure that your family is adequately protected? One approach is to work with a private health-advisory firm to manage health-associated risk the way you work with a private wealth advisor to manage your financial risk. Personal health advisory firms address a broad spectrum of health needs, from helping members navigate the healthcare system to managing complex and serious diagnoses.

Health advisory services can bring a more personalized approach to help you tailor a plan of action to promote health and longevity. Services may include the collection, organization and review of medical records; objective data on physicians and treatment options; access to expert medical opinions and appointments with specialists; 24/7 travel support for international medical referrals and resources; and support to care for aging parents.

How you deal with the complexities of the financial system may come down to whether you are a passive investor or prefer an active role. The same is true of healthcare. Your most valuable assets are your wealth and your health. Consider addressing them both with a team of experts to ensure you get the best advice and personalized support.

MARCH 11, 2014 – The field of concierge medicine, also known as retainer medicine and boutique practice, is coming up on its tenth anniversary. Begun in 1996 in Seattle, the creation of MD2 kicked off the provision of the type of high-touch medical service that had previously only been enjoyed by athletes, dignitaries and entertainers. The hallmarks of concierge medicine since then have been limited numbers of patients per doctor combined with house visits, longer appointments and the type of care that had been banished from the field of medicine by drastic cost control measures. Many doctors who have chosen the route of concierge medicine have done so for the quality of their lives as well as that of their patients. By limiting the number of patients they serve through the concierge medicine structure, they are able to provide the time and attention they always expected they would when they chose medicine as their profession. Today, most states have a variety of forms of this type of practice, from single doctor offices to groups of doctors who have banded together to provide concierge medicine style services to their patients. Any doctor who moves to a concierge medicine structure for his business however, has to go through some difficult procedures and has to be mindful of significant legislation bounding the provision of medical services. Since concierge medicine is predicated on serving a smaller client base, a doctor must first notify all his or her patients of plans to pare down and move to an annual fee-based service. Not all patients can afford or believe in this type of medical service. Next, the doctor must be very careful that they are not “double billing” for those services judged to be covered by Medicare. This can include care for optimum health or health assessment procedures. Some concierge practices have received unwelcome attention from Congress, as their annual fees were seen as illegal overcharges to the patient.

What is the difference between healthcare advocacy firms like PinnacleCare and concierge medical practices? It’s important to understand that patient healthcare advocacy firms differ from concierge medicine practices in a number of ways. First and foremost, concierge medical practices practice medicine. They are primary-care practices that provide care to a limited number of patients for an annual fee. Referrals, when needed, typically are limited to the doctors’ personal referral network. Also, concierge medicine services, by necessity, tend to be confined to a specific geographical location.

Patient advocacy and healthcare advocacy firms such as PinnacleCare International not provide medical care but do provide healthcare management. PinnacleCare is staffed by former health-care administrators, nurses, social workers, etc., who manage all aspects of the health affairs of its Member families. This includes researching medical centers, doctors and treatment options; arranging for timely access to top physicians; handling all details related to appointment scheduling; organizing the Members’ medical records and history; providing global resources on a 24/7 basis; and, in general, advocating what’s best for each and every Member. Some of PinnacleCare’s Members are clients of concierge medicine practices. Here, the doctor works in conjunction with PinnacleCare to make sure their mutual clients receive the very best care possible.

About the author

To learn more about PinnacleCare services, its PinnacleCare Advocates and read more Member testimonials, please visit; http://www.PinnacleCare.com

NEW YORK–When adviser Thomas West first visited his clients’ home, he immediately saw that its many rugs and pieces of furniture could cause the wife to trip and fall.

But the woman wasn’t ready to acknowledge that her multiple sclerosis was starting to affect her mobility, and her husband didn’t want to upset her by addressing it.

Mr. West,…

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Morgan Stanley Wealth Management has launched a referral arrangement with PinnacleCare, a health advisory firm, to provide medical referrals and health advice for the clients of its financial advisors, Morgan Stanley announced Tuesday.

The agreement is designed to provide a more holistic approach for its clients to manage health-care costs and services, Morgan Stanley says.

Benefits with the PinnacleCare arrangement include the ability to coordinate access to medical institutions and resources, referrals to vetted doctors and consultations on private health insurance and Medicare enrollments.

Through its alliance with PinnacleCare, Morgan Stanley will offer an eldercare option for geriatric assessments and coordination of associated medical needs and insurance claims.

“Health related decisions are becoming more complex and we are seeing a convergence in health and wealth planning, as concerns over costs escalate,” says Bruce Spector, chairman and founder of PinnacleCare. “We leverage our experience with leading research PhDs, medical specialists and centers of excellence to engage the right physicians and guide people through the medical choices and treatment options available to them.”

About a year ago, Ann Principe saw worrisome symptoms in her 75-year-old mother. “Her short-term memory was gone. She was forgetting her own granddaughter’s name,” the 47-year-old Kensington, (Md.) woman recalls. Principe sought help. Instead of calling one of her mother’s half-dozen doctors, she phoned the family’s health advocate — a new breed of adviser who guide patients through the medical maze.

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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.

Nurses and social workers also have “hung out a shingle” as advocates, said Dr. Gail Gazelle, an assistant clinical professor at Harvard Medical School who is starting an advocacy practice in the Boston area. “I don’t think it’s really defined as a field yet.”

Pinnacle grew out of one of the hospital-based high-end services. John Hutchins, who had run a deluxe program for wealthy foreign patients at Hopkins (and before that at Cleveland Clinic) was looking to offer similar care more broadly. He didn’t want to be tied to a single institution so he could be free to refer patients as needed to a top oncologist at M.D. Anderson Cancer Center in Houston or a skilled surgeon at Mayo Clinic in Minnesota.

Local entrepreneur

A local entrepreneur, Bruce Spector, brought Hutchins together with Bart Herbert, then an executive at Aegon USA, the Dutch insurer whose U.S. operations are based in Baltimore.

“I said, `That’s a service people will pay for,’ ” Herbert recalled. “It’s not only something VIPs and princes and kings deserved, but that everybody deserved, at least if you can afford it.”

Three years ago, Pinnacle was formed, with Herbert as CEO, Spector as chairman and Hutchins as managing director.

It now enrolls about 800 people in 300 families (membership covers spouse and children), including “32 families who are part of a billionaire family group,” according to Herbert.

That’s more than double the membership a year ago, he said, and Pinnacle expects to double again over the next year. Within four years, Pinnacle projects, it will have 7,500 families.

The company is hiring to keep up, and is looking to add 12 new advocates by next month to join the 20 already on board in Baltimore. (There are currently eight advocates based elsewhere.) Most advocates are nurses or clinical social workers.

With expectations that it will have 250 advocates in four years, the company moved its 50 employees last month to more spacious quarters in an Inner Harbor office tower.

Two mass-market advocacy companies that launched about the same time as Pinnacle, Health Advocate Inc. and Patient Care, also report doubling each year.

“The kind of advocacy we do, the employer community has begun to be very interested in,” said Jane Cooper, CEO of Patient Care, which is based in New Orleans.

Pennsylvania-based Health Advocate, the largest, contracts with employers, including Home Depot, Westinghouse and Viacom. Health Advocate now covers 3.5 million people in 800,000 families, although it says only 10 percent to 20 percent of families use the service.

No corporate accounts yet

Pinnacle, so far, has marketed mostly to individuals and families, often making contacts through financial advisers. However, it’s now beginning to gear up to pitch corporations on the idea of covering top executives, offering what amounts to volume discounts on the membership fees.

About a third of the members are in the Baltimore-Washington area, with other concentrated pockets in Chicago, New York and South Florida.

Pinnacle’s founders said they don’t believe that by getting extra care for some, they are reducing care for others. Pinnacle is producing “white papers” with health information that will be available to anyone, Herbert said, adding that pushing for better care “brings the game up for the entire system.”

When a member signs up, Pinnacle assigns an advocate to introduce the company and collect information about the new member’s health history. Pinnacle doctors review health records for unresolved issues, and the member is booked for an executive physical.

The health history “is the only form our member ever fills out,” said Deniz Ozkok, a senior advocate. “We fill out everything else.”

Pinnacle collects all the health records of its members, and keeps them in electronic form to zap out to physicians as needed. Gold and platinum members are also given a “Pinnacle Care Key,” a thumb-sized key-chain storage device with their medical data that can be popped into a computer port anywhere in the world.

Advocates consult the staff doctors, or a national advisory panel of doctors at prestigious medical centers, when they’re looking for guidance on treatment.

Takes days, not weeks

When it comes time to book appointments, Herbert said, typically it takes days “rather than weeks to months.”

Doctors are happy to work with Pinnacle members because “they can spend more time with the patients, and can charge accordingly,” said Hutchins. In most cases, the doctor can bill the Pinnacle patient for extra fees (a practice known as “balance billing”) beyond the discounted amount paid by insurers.

And hospitals, Hutchins continued, see Pinnacle’s members as “a group that tends to give a higher number of donations.”

However, Hutchins added, there’s no exchange of money – in either direction – between Pinnacle and the doctors and hospitals to which it refers patients.

There is no regulator that oversees those relationships, since Pinnacle is neither practicing medicine nor selling insurance.

As the medical advice and advocacy industry grows, it’s likely that rules and oversight will develop, Hutchins said. But for now, the quality control on Pinnacle is whether clients write a check for another year of membership.

“We’re dealing with a demanding clientele who are used to service, and you get pounded if you don’t provide it,” Hutchins said.

The majority of members are healthy when they sign up, and are joining “for convenience or from frustration,” Herbert said, but perhaps 40 percent join when they have chronic or acute health problems.

For example, Patrice Brinkman, of Potomac, said her parents joined when her mother was diagnosed with cancer.

Her mother had already chosen a surgeon at George Washington University Hospital, but Pinnacle arranged for confirming exams at Hopkins and at Memorial Sloan-Kettering Cancer Center in New York. Pinnacle also helped set up follow-up care at Hopkins.

“While you may have the resources” to research treatment options, at a time of crisis “you don’t have the emotional resources. You’re almost paralyzed, and they handle things,” she said.

Pinnacle members say the service can be a relief even when they are basically healthy. Sims Hagan, of Lutherville, said she e- mailed her advocate to find a dermatologist for a daughter in Vermont and an oral surgeon for a daughter in North Carolina. She got back reports on the training and credentials of each.

“I’m overwhelmed with how complicated today’s medicine is,” she said. “Fifty years ago, your country doctor was probably all you needed.”

Up-market medicine

Here are some of the health services available for a premium:

EXECUTIVE PHYSICALS

Intensive exams, usually one to three days, by a primary-care doctor and a tightly scheduled group of specialists. Offered by top medical centers such as Johns Hopkins, Cleveland Clinic and Stanford University Medical Center. Also offered at some resorts, such as the Greenbrier in West Virginia. Cost: $2,000 plus.

`CONCIERGE’ OR `BOUTIQUE’ MEDICAL PRACTICES

Primary-care doctors who charge an additional annual fee, which covers a comprehensive exam and preventive care plan. They accept no more than 600 patients, compared with the typical 2,000 to 2,500. For the extra fee, the doctor promises more preventive care and service amenities. Cost: $1,500 a year.

HEALTH ADVOCATE

Pinnacle Care International, a Baltimore company, offers health advice and logistical help. Members get an executive physical on joining. Pinnacle also collects all health records from a patient and transmits them to new doctors as needed. It will help find doctors and arrange appointments. Cost: The cheapest memberships require a $10,000 initiation fee and $5,000 a year.

Suzanne Rice was on a private jet, flying from a golf tournament back to her home in Palm Beach County, when the husband of a friend started talking about how Pinnacle Care International had helped him negotiate the complexities of the healthcare system for a painful back.

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‘Personal Advocates’ Research Treatments, Book Appointments; A Limo to the Doctor’s Office.

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The folks at e.magination Network LLC — if all goes as planned — have found a new home and provided a local development with another trophy technology tenant.

Executives at the Baltimore-based Web development and marketing firm signed a letter of intent this week to lease 30,000 square feet at the Tide Point complex, which is being developed by Struever Bros. Eccles & Rouse Inc.

A lease is expected to be finalized in a few months. Financial details of the agreement were not released.

The $53 million development has been considered by most observers as the future center of Baltimore’s growing technology community. With e.magination (http://www.emagination.com) moving in, the predictions appear to being coming true. Local economic developers and technology leaders are applauding the company’s decision to move to the six-building complex in Locust Point.

“We are very excited about this move,” said Syd Rubin, president of e.magination. “We think Tide Point is really going to put Baltimore on the national map.”

Carl W. “Bill” Struever, president of Struever Bros. (http://www.sber.com), said he shares in e.magination’s excitement. “They are a super group,” Struever said. “We are looking forward to having them here.”

The tech company will join one of the city’s fastest-growing companies — Advertising.com Inc. (formerly TeknoSurf .com) at the 400,000-square-foot complex that once housed Procter & Gamble’s local manufacturing operations.

The presence of Advertising.com and e.magination — combined with developer Struever’s reputation for creating office space designed with technology firms in mind — are just the foundation needed for Tide Point to become what its backers plan.

Chris Parente, spokesman for Advertising.com, said the people at the Internet advertising firm are pleased with e.magination’s decision.

“This proves that we are turning Locust Point into a new `digital harbor,'” he said.

Officials with the Greater Baltimore Technology Council said the e.magination’s move is another sign that the technology community is still growing.

Rubin said his company went through an extensive search process. “I don’t think there is a building in Baltimore I haven’t been in,” Rubin said.

What sold e.magination on Tide Point was the developer’s vision. One of Rubin’s goals was to have a basketball court at the next place his company moved. Fortunately for him, a basketball court is one of several amenities Struever has planned for Tide Point.

Other plans for the project include a restaurant or bar, a large waterfront patio complete with kayaks and rooftop decks.

According to e.magination’s proposed deal with Struever Bros., the company’s 60 or so employees will not move into Tide Point until October. In the interim, the company is expected to be housed in the former Kirk-Stieff Co. silver plant, which also is being redeveloped by Struever Bros.

Currently, e.magination leases approximately 7,000 square feet in The Can Company — also a Struever Bros. project.