Let’s face facts. COVID changed us all forever. For those with access to concierge health care, it quickly became not a nice-to-have but a must-have for many family offices. While it’s nothing new and although families have been turning to this type of care for decades, a new day is upon us. Providers have raised the bar, staying on top of cutting-edge technologies and new approaches that look for a more holistic medical experience.
In our second item for today’s newsletter, Erin Arvedlund asks the interesting question: Will the ultra-wealthy buy diamonds within a portfolio? She speaks with two U.S.-based family offices about this emerging asset class and how they choose to get exposure to diamonds, other than buying a piece of jewelry outright.
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HANDPICKED: Revolutionizing family health: How concierge providers elevate well-being
By ALEC FOEGE
A former U.S. Navy officer, Daniel Carlin spent his early years as a physician in a refugee camp in Pakistan and an American hospital emergency room before developing the idea of providing telemedicine to ships. Then in November 1998, Carlin gained global acclaim after emailing lifesaving instructions to a solo yacht racer, enabling the patient to self-operate on an infected elbow 1,000 miles offshore.
“It was a seminal moment,” he said. “I used the internet to save a man’s life.”
As the founder and CEO of WorldClinic, a concierge telemedicine provider to family offices and other ultra-high-net-worth individuals, Carlin centered his practice on understanding that today’s fast-paced, mobile executives need health care that goes everywhere with them. “What they’re looking for is speed, convenience and accountability,” Carlin said.
While concierge health care has been around for decades, a new generation of providers has raised the bar for what’s available for family offices and ultra-high-net-worth individuals, thanks to cutting-edge technologies and approaches that enable a more holistic approach than ever.
It’s no longer just about having a doctor on call; it’s about preventive health care and managing outcomes.
“The life sciences revolution is changing the way we understand bodies in high-resolution detail,” said Jordan Shlain, M.D., founder and managing partner at Private Medical, a concierge health care practice with offices in San Francisco, Miami and New York.
Private Medical’s model focuses on preventive medicine and relies on its relationships with academic centers of excellence in the United States and doctors in 203 cities worldwide. Shlain said his firm is less concerned with technology than access and convenience. “For our families, we’re on speed dial,” he said.
COVID CHANGED EVERYTHING
Having such a service at a family’s disposal certainly comes at a price. Concierge health advisers typically charge an annual fee of between $25,000 and $80,000 per family member. Others sell their services like law firms, in hourly blocks. But in most cases, those fees are all-inclusive and cover a wide range of tests and services.
Many family offices decide that the benefits outweigh the costs. “For this particular slice of the economic pie, money is no longer the currency of their lives,” said Carlin of WorldClinic. “Time is the most precious commodity. And thankfully, that’s our sweet spot. That’s often why we get hired, because they’re so time-sensitive. They are aggressively opposed to ever wasting time.”
When the pandemic first hit in early 2020, the traditional, insurance-based health care system was caught off-guard. Many health care professionals were worn out by the traditional model of medicine. According to a recent study conducted by Brigham and Women’s Hospital, nearly 50% of a group including doctors, nurses and clinical staff reported burnout, with 28.7% expressing an intent to leave the profession.
Rather than quitting medicine, some have migrated over to concierge health care to practice their craft the old-fashioned way. In today’s world of concierge care, house calls, prescription deliveries and coordinated appointment schedules are all part of the package.
And while concierge services are used by a relatively small group of ultra-high-net-worth individuals and only employ a sliver of the medical community, their innovations may offer glimpses of a solution to the overall crisis in health care.
Derrick Miles knew from his background as a health care executive what worked and didn’t work. He started CourMed as a prescription transport service in 2018. During COVID, he was able to get monoclonal antibodies to an executive with the virus traveling in Mexico. In another case, a hedge fund manager in Miami Beach woke up on Saturday morning and discovered he needed to close a deal in another country but needed a PCR exam to get on the plane.
“We sent a nurse to him in 15 minutes to do the test,” said Miles.
Now CourMed provides on-call medical care to family offices as well as to banking firms and branded residences. CourMed works primarily outside of the health care insurance networks.
“Our clients pay cash,” said Miles. “We work with our attorneys so they can write it off on their taxes.”
Better Health Advisors founder and CEO John Samuels, another former hospital administrator, built his concierge firm around the idea that insurers don’t have patients’ well-being as a priority.
“Our service is separate from health insurance,” he said. “Your insurance pays for doctors' visits and hospital care. The work we do is to help coordinate the care, so we arrange appointments, talk to doctors in between appointments. We help people find the right doctors and the right facilities. We help support second opinions. We create a plan for our clients.”
GOOD HEALTH — AND A GREAT VALUE
It’s not hard to imagine a future where looking at a family’s big-picture health needs becomes more commonplace. Taking a familywide approach to health care has significant long-term benefits.
Private Medical builds a detailed medical annual report for each person and creates an iterative strategy throughout the year. If its medical staff uncovers a genetic predisposition toward, say, cancer or dementia, it will notify younger family members and conduct the appropriate screenings and adjust the strategy accordingly.
“A lot of people take comfort that we are managing ‘the medical spreadsheet of their life,’ ” said Private Medical’s Shlain.
Some concierge health care providers rely on technology for that high-touch experience.
“Yes, we have technology, and similar to Uber and Lyft, we have health care providers who use that app,” said Miles of CourMed. If a patient needs a blood sample analyzed before taking a certain medication, the need will be addressed in real time by a professional who can help immediately.
Other providers are more advisory and focused on on-call human interaction. Samuels of Better Health Advisors said his firm does everything from mapping out the costs of long-term assisted-living care for a senior family member to determining whether a family office has the right insurance plan.
“It’s not a family office’s job to solve the health care dilemmas of their family members,” he said.
Regardless of the solution, most concierge health care providers argue that their services are becoming more of a necessity than a desire.
“A lot of people don’t think of their health as an asset, they just take it for granted,” Shlain said. “But if you thought of your body as a portfolio risk, how do you invest in decreasing the risk? So that’s what we do. We use data-driven evidence and try to get you to understand what your state of health is and how do we improve it. How do you become healthier 10 years from now than you are today?”
High-net-worth investors may love to wear diamonds — but will they buy them for a portfolio?
By ERIN ARVEDLUND
As he does every year, last summer Les Kravitz was hiking the Colorado mountains with his brother, a wealth manager with UBS. Along the way, his brother told him about the May 2022 launch of a new asset class — an investable diamond via Diamond Standard. Kravitz was intrigued.
Diamonds “to me represent class, love, beauty, purity,” says Kravitz. “It’s a precious possession.” But he recalls asking himself, “How could I fit this into my alternative-asset portfolio?” He’d come across private equity, venture capital, real estate, commodities and collectibles — including art, antiques, wines and, of course, cryptocurrency.
Today, Kravitz and his family office are investors in diamonds as a counterweight, through Diamond Standard’s coins and bars.
“They’ve created a new asset class and a way to invest," he said. "They’ve solved a number of problems. No. 1 is price discovery, plus liquidity and transparency."
Diamond Standard coins and bars “finally unlock diamonds as an asset, and because most investors simply can’t hold physical commodities, we remove that hurdle,” said Cormac Kinney, founder and CEO of New York-based Diamond Standard.
Each coin is worth roughly $5,000, while each bar is worth $50,000 — although prices update weekly.
There’s a blockchain use case as well: Each coin and bar have a unique identifier on the blockchain, creating an electronic title.
“There’s no confusion about it being a security or a derivative or a commodity," Kravitz said. "It’s actually an electronic receipt of a piece of an actual diamond."
INFLATION HEDGE
Anthony Baranello, who runs his own Florida-based family office, traded oil and gas for 30 years. Two years ago, “I saw inflation percolating with the printing of all this money inflation, and I hunted around for inflation hedges” such as gold and crypto. Gold prices have climbed steadily to $2,000 an ounce currently, in part due to rising global central bank buying, according to the World Gold Council.
Other than its coins and bars, Diamond Standard launched a fund as well, with plenty of risks in the fine print. The fund is unlisted and has 2% management fees annually and a costly 0.45% expense ratio, according to the tearsheet.
Baranello found Diamond Standard coins and bars “easier to understand, with lower carrying costs” than gold. As for owning crypto, “I got the math behind it, but I like having the bar or the coin in my hand.”
Given his experience with volatility in petroleum markets, “I’m battle-hardened by that," Baranello said. "I’m not afraid to try some of this stuff. The more I read, this is a unique product."
Diamond Standard has created its own spot market for the gems, although its business is hampered by the lack of a diamond futures contract and almost zero institutional ownership in the asset class, other than family offices and hedge funds.
Trades average within 1% of the spot price on Bloomberg, according to the company. A Diamond Standard Coin is "marked to market" daily and trades with tighter spreads than loose diamonds, which can be 20% to 40%, through an auction house, pawn shop or jeweler, said company founder Kinney.
“We buy certified diamonds every day,” he said, and every bar’s contents never change.
“When you buy diamonds as jewelry, you are price takers. You never know if you’re getting a good price or not,” Baranello explained. Diamond’s founder has created a formula that standardizes diamond prices, which Baranello called “a game-changer. Yes, I could buy shares in diamond mining companies, but this really stands alone.”
LOOSE CHANGE
Billionaire Barry Sternlicht sees ‘Category 5 hurricane’ spurred by Fed rate increases: The Starwood Capital Group chairman scooped up distressed assets during the Great Recession. He’s eyeing opportunities again, as the sharp increase in interest rates deflates commercial real estate values.
Harrods to open first private China club catering to ultra-rich: The new club, called The Residence, will open at the end of this year on the second floor of Cha House, a central Shanghai heritage building where a Harrods tea room and bar, which are open to public, are already located.
Meet the billionaire who convinced Messi to pick MLS over Saudi Arabia: Construction executive Jorge Mas persuaded the world’s biggest soccer star to join a bottom-of-the-barrel team that’s languishing in last place in its league. Now he needs to make it pay off.
Help us with a story: We are working on a feature piece on DEI within wealth management. If you have any comments on the topic, reach out to [email protected].