"Concierge wellness" becomes a new primary care

• But experts say there's little evidence many of the services have clinical benefits and warn the demand for care could provide a potential harbor for unqualified or under-qualified clinicians peddling dangerous or untested treatments.

The big picture: The trend is further evidence that patients with resources can pay for better access in a glutted medical system.

• Fitness club giant Equinox, which made splashy headlines earlier this year with its $40,000 health concierge program, is a key example of concierge wellness, said Kate Festle, director of health care and life sciences for consulting firm West Monroe.
• Equinox recognized that a subset of its high-income clientele would be willing to invest in optimizing their health.
• "It's that whole-body health: physical fitness, but also nutritional supplements, wellness, hormone and blood panel monitoring, all of those things are what the upper crust of Americans are starting to have as a status symbol," Festle said.
• While still largely fragmented, the concierge wellness segment is drawing more private equity interest. "We're working with a couple small regionals right now who are on track to grow 50% year over year," Festle said.

Between the lines: Much of the growth in aesthetic and wellness services is driven by the proliferation of anti-obesity drugs, and by independent physicians looking for options that don't involve battling insurers and wrestling with crushing caseloads, said Sam Patel, founder of Astra Culture, which helps doctors transition to aesthetic and wellness care.

• "I just worked with a bariatric surgeon who's been working for years of doing surgeries ... when he removes a gallbladder, as an example, he only makes $168," Patel said.
• "He's like, 'Why am I doing this? I'd rather do provide services like medical weight loss, hormone replacement therapy, body contouring. It will still help my patients, and I don't have to worry about ... minuscule reimbursements.'"
• Primary care docs, as well as OB-GYNs and even dentists are looking to diversify their income streams and get more time back, he said. And it's attractive for patients who get access to services from a trusted provider.

Zoom in: Private equity-backed Formula Wellness has grown to 15 locations around the country in upscale neighborhoods and features pay-as-you-go medical aesthetics and longevity services.

• Rather than turning to drugs to treat chronic illness, they search for holistic methods to address the underlying concerns, said CEO Michael Bennett.
• The client base is high-powered executives craving peak performance and wellness faddists who expect easy access to a doctor when they're unwell.
• They don't promote themselves as a primary care but say many of their clients use them in that way because of the array of services and the convenience offered.
• "I want to text my provider through a HIPAA-compliant secure link that goes directly to their phone," Bennett said, describing the patient experience. "Say, 'I need to be on the phone with you in 15 minutes. Can you or one of your colleagues be available?' We can make that happen."

Go deeper: Such customized services are attracting backing from bold-faced names.

• Function Health, co-founded by prominent doctor and author Mark Hyman, raised $53 million earlier this year from celebrities such as Kevin Hart and Matt Damon and boasts a 300,000-patient waitlist. It's also partnered with Equinox.
• Its providers do not diagnose but say their goal is to "empower" members to "live 100 healthy years" through the information from their annual lab tests and comprehensive personalized results delivered online. It costs $499 a year.

• "People are just dying to get their own information and not have to go through their doctor and insurance and get caught up in the health care system that's mostly focused on diagnosing and treating disease," Hyman said.

The intrigue: The timing may be right as more people gravitate toward DIY medicine.

• "People are exploring the realms of peptides and supplements, plasmapheresis and all kinds of stuff at the margins because people are looking for not just 'How do I treat disease,' but 'How do I actually become healthy?'" Hyman said.

Reality check: When conventional doctors prescribe obesity drugs or hormone therapy, they're generally following evidence-based guidelines for treating an identifiable disease, as opposed to providing therapies without a clear illness.

• Experts say while many of the recommendations — healthy diets, exercise, adequate sleep — are generally beneficial, there may be little direct evidence of improved outcomes.
• It may also come with risks, Alexa Mieses Malchuk, a Durham, N.C.-based family medicine doctor, told Axios. Some providers may automatically look to hormones or nutrient deficiencies as the drivers of symptoms and overlook more obvious diagnoses.
• The "more and more you deviate from [evidence-based guidance], it just becomes riskier because the risk-benefit analysis is now not so clear," she said.
• That means its up to patients to exercise due diligence, including asking about a provider's level of experience or even reading online reviews.
• "Just because someone has a certain degree doesn't mean that they're competent at a skill, especially when it comes to aesthetic procedures," Mieses Malchuk said.

What to watch: The trend could widen health disparities as doctors flee to cash-pay businesses and cherry-pick patients.

• There's also the perennial concern of whether consumer-driven care is directing scarce medical resources to the "worried well."
• "It is going to impact the health care system," Patel said. "I can't really blame the health care providers."

Editor's note: This story has been corrected to reflect that West Monroe is a consulting firm (not an investment firm).