Interesting comment John. I lived in Florida 10 years until 2010. In Florida many Internal Medicine doctors were starting to go "Concierge" - which meant you had to pay to be in their "network". So, Concierge doctors would be outside any Advantage Plans. I have traditional Medicare with good Medigap policy so I can self-refer to any doctor who takes Medicare, and I never see a bill. Adding Concierge doctor fee increases everybody's cost, not everyone can afford it.
I am back in Minnesota now and am patient of Mayo Rochester for lung cancer, cardiac stent, and now need other health issues addressed at Mayo. It is important for me to now stay with specialists at Mayo because they need to consider my whole clinical picture when making treatment decisions, and Mayo lab already has lab work on me which could be improtant.
I cannot have a Primary care physician at Mayo Rochester because one needs to be in a certain geographical area. Otherwise, the people living close to Rochester would not be able to get in to see their closest PCPs. So, for the same reason I suspect a Medallion program would interfere with the care of people living in the rural areas around Rochester.
I am less than 2 hours' drive from Rochester, and we do have snow so driving to Mayo for Urgent/Emergency Care or normal PCP stuff is not really practical. I work with my local PCP for standard stuff, and to review tests done at Mayo and discuss anything popping up that is outside my specialist's area of expertise, but that might be a concern. I want to be able myself to go directly to the Specialist for questions on the relevant issues and not through a PCP.