A Glass Half Full
My last several posts have been, shall we say, a bit on the frustrated side, so I’ve decided today to change my approach and embrace my inner optimist. Rather than lament the challenges surrounding us as we all swim our way through the muck and mire of healthcare reform, I have resolved to focus on the positive and share some of the new care models that are being tried by some very innovative folks. To be sure, these ideas are not what has been in the mainstream press and not one of them has the momentum of ACO’s, but I believe there are some real pearls in each of them. This list is not complete by any stretch and I would love to hear about others that I might have missed.
- The Prometheus Payment system – The theory of getting a group of physicians together to decide what it costs to care for a particular disease, paying them upfront, and then holding them accountable for the care is a very interesting physician-led twist on the ACO. Several large health systems are trialing this system as we speak. It has significant backing through the Robert Wood Johnson Foundation.
- FaircareMD – By striving for transparency in pricing, this model targets those with large out-of-pocket expenses and lets patients choose their doctors based on price. Wouldn’t this get interesting if it also included good solid quality measures and let patients choose on value? Maybe we could call it ValueCareMD….?
- Practice Fusion – Practice Fusion provides a completely functional EMR free of charge (yes, that’s right – free). The EMR is web-based and ad-supported with non-intrusive ads throughout the product, shifting the cost away from the provider to the vendors.
- Care Practice – By providing 24/7 urgent care and house call service this group has embraced the concept of “radical access” leading to “the practice of least resistance.”
- Qliance and One Medical Group – These models are bringing concierge care to the masses. For a fee similar to your monthly gym membership, you can get a greater level of service and attention than your traditional primary care practice as well as online records access and same day appointments. This may appeal to those with a high deductible HSA plan and who are becoming more and more cost conscious.
- Hello Health – By putting patients in charge of their own healthcare through creative use of the Internet and social media, this model is truly on the leading edge of the healthcare curve, and it may be just what the doctor ordered for the new iPad generation.
- ZocDoc – Think OpenTable.com but for medical appointments. The website says it all: Find a doctor. Choose a time. See a doctor. You are in control.
Even though CMS has created a Center for Innovation, true innovation is much more likely to occur on the fringes in models like the ones mentioned above. I, for one, will be watching these new and exciting innovations closely as they continue to evolve. PPACA is certainly not the only game in town and others are providing us with lots of great ideas and information along the way. Maybe the healthcare reform glass is half full after all.
Hi Dr. Browne,
Thanks for the positive thoughts Dr. Browne! It is hard not to be pessimistic about the future of healthcare these days. We are glad to offer a glimmer of hope for providers everywhere.
I agree that price is 3rd or 4th on the list of criteria when selecting doctors, or as we say, "Quality is King and Price is but a Prince." One of the reasons the best doctors are pessimistic is that the quality of care and the price paid are almost unrelated variables in what people get. The best doctors accept peanuts from for their services due to factors completely unrelated to quality and sometimes go out of business, become hospital employees, or quit medicine because of this.
By creating an efficient marketplace, FairCareMD seeks to get doctors paid fairly, not just get fair prices for patients. I hate to compare Physician Services to cars, but for a moment, consider the price of a Mercedes vs. a Volkswagon. If you could never tell the price of each and you outsourced the buying and selling process, a Benz might be purchased for less than a Passat. This is pretty much what happens every day in healthcare. Worse yet, great doctors have to see so many patients in one day that they can't possibly give the level of care that they think is acceptable. This is what happens when there non-transparent pricing and 3rd party purchasing and contracting.
The root of the problem lies in efficiency of contracting for care itself. Efficient markets reward the best providers and punish the worst. Without an efficient complex service contracting platform it is far too much work to negotiate and develop care plans for certain prices for every patient. Care is not generally a commodity, it is an offering of services provided by a highly variable group of providers. Insurance companies do this, but the cost is high and even they have trouble being profitable in the current environment. They too can benefit from a more efficient platform for care contracting.
As Dr. Brown notes, Qliance, Care Practice, Hello Health, and many other MD innovators have started packaging their services themselves and I applaud them. The efficiencies they bring cut so much cost out of the delivery of care that the care provided in these practices is always rated outstanding. This is because the doctors and their staff have the time to do it right. Most cash practices are like this too. In an efficient system the cream will rise to the top as patients shop, read, and review in an open marketplace. Drs. Bliss, Blackledge, and others are among the most sought after Doctors in their markets because of this (I know, we had a FairCareMD patient try to get an appointment with Dr. Bliss but the practice was full!)
With over 55,000 searches for care already, we know the patients are shopping for care, counting quality first and foremost (we can tell by the clicks!) This is why we incorporate all metrics we can find in our provider profiles. No one source is good enough and we wanted everyone to find whatever could be found out about a doctor in One Place. Now there is one place where the doctor can incorporate everything she or he wants patients to consider when selecting a provider. See example here of two great orthos on FairCareMD: http://www.faircaremd.com/findcare_searches/new?patient_seek=+orthopedic+surgeon&patient_zip=&patient_radius=&accept_tos=on&search_now_button.x=32&search_now_button.y=14 See how they included pictures, videos, links to ratings on other sites, links to their own site, services offered, personal statements, all their awards and credentials? Nowhere else other than on an expensive custom site can doctors do this - and here for about a dollar a day.
Why can FairCareMD bring this efficiency? Simply put, because a doctor can set themselves up in about an hour of effort and automate contracting with the public in a "set it and forget it" way that is unlike any other system you have seen. Any marketplace lives or dies on the participation not just of shoppers, but also of those with goods and services to sell. Most patients leave our site without finding the doctor they needed. To be truly efficient, we need more outstanding Physicians like Drs. Luks, Selby, Fishman, Blackledge, Eng, Bernstein, and many more to come to the table. Be the healthcare reform you want to create and help the 100 million or so Americans paying for most of their care themselves find you. We list no one without their active participation. We are not a directory, we are a highly efficient marketplace where doctors and patients can connect and agree on fair fees for services in seconds.
Once again, thank you Dr. Browne. Indeed, we are just getting going and haven't gotten all that much media attention. By helping us get the word out, you have done us a great service, perhaps helping this glimmer become the warm sunshine of tomorrow - when great doctors are paid fairly for their care by patients who pay less overall. Using our system insurance companies can also focus on what they do best, managing risk rather than trying to contain "medical loss".