The Doctor Is In

The Doctor Is In

Ear infections were du jour in my house when I was growing up. If one of us had ear pain, my mother would pack us into the car for a trip to the doctor. After a poke and prod by our friendly family physician, we picked up amoxicillin (the wonder drug of the ’80s) and headed home.

We had care. Everyone we knew did. Employers gave their employees health insurance, and moms took kids to the doctor when ear infections came along. This is what the 1980s looked like. Recently, I laughed when my mom told me what it used to cost to go to the doctor and what the health insurance premiums were for our family (read: nothing). Boy, how times have changed.

Somewhere along the line, care has become more institutionalized. Large corporations are running hospitals with eyes trained on the bottom line. Doctor appointments last 11 to 15 minutes. Insurance premiums, deductibles and drug costs seem to be rising by the minute. Millions are unable or unwilling to pay the high costs of health insurance and healthcare.

This is the customized and instant access generation. (Venti, soy, no-foam latte ordered on mobile app, anyone?) And healthcare is changing to adapt, offering on-demand or highly customized care for those who can afford it.

When You Need Care Now

Convenience rules much of what we humans do on a daily basis. We’ve increasingly become a society that hates going out of our way for almost anything.

In Chicago, immediate care clinics seem to be as prevalent as Starbucks. For many, neighborhood immediate care clinics—whether run by a drugstore or a physician group—sit first in line when one needs care.

“People are busy,” offers Paul Merrick, MD, a urologist with DuPage Medical Group. “It used to be that when you wanted to rent a movie, you got in the car, went to Blockbuster, chose a DVD and drove home. Now, you click a button at home. Immediate care centers give patients that same experience—it’s a faster way of getting medical service.”

DuPage Medical Group operates three immediate care clinics, supporting more than 600,000 patients, with another three centers scheduled to open in the next year. Appointments are offered on a same-day or walk-in basis and during extended hours including evenings and weekends. The clinics offer continuity of care, as many of their patients already receive care from a physician in the DuPage Medical system, and records are shared electronically.

“Our immediate care clinics offer patients an alternative to the emergency room,” Merrick says. “Even though a medical condition may be urgent, the ER might not be the best place for a patient to be accessing care. Immediate care can do much of what emergency rooms can do for conditions that are not life-threatening.”

Steve Sellars, president of the Urgent Care Association of America (UCAOA), agrees that urgent care clinics are good alternatives to crowded emergency rooms. “ERs are becoming fewer and more crowded due to closures. The more patients who know what an immediate care center can do, the better it is for hospital emergency rooms and patients all around.”

Immediate care bridges the gap between a routine doctor’s appointment and the emergency room. Many centers are equipped with X-ray machines, in-house labs, IV fluids and nebulizers.

And then there’s cost. The average cost of an urgent care visit is less than $150, compared to a nationwide average of $1,354 for a trip to the ER, according to the UCAOA.

“More patients are opting for high-deductible insurance plans, which makes them pay even more attention to the costs of care,” Sellars says. “Urgent care centers offer convenient, immediate access with out-of-pocket costs that are a fraction of what they’d pay for a nonemergency visit to the ER. [The cost factor] is essential for patients no matter their insurance status.”

Concierge Care

When you hear the phrase “concierge medicine,” you might immediately see dollar signs. You wouldn’t be wrong. Some 6,500 U.S. physicians provide this elite level of physician access, also called direct primary care. Each of those physicians charges between $1,000 to $2,000 per year, according to the American Academy of Private Physicians.

Alex Lickerman, MD, a direct primary care physician with Imagine MD in Chicago, is smack dab in the middle of that financial field. His practice charges patients $135 per month—which equals $1,620 per year. But what does a patient get in return?

First, patients receive all of their office visits for no additional charge. Next, there’s the direct line to Lickerman. During office hours, either he or a nurse answers a direct phone line. After hours, that line is forwarded to his cell phone, not a service. Then there’s the added bonus of services like joint aspirations and injections, EKGs and flu shots at no additional cost. Other immunizations are offered to patients at cost.

But beyond the itemized list, Lickerman says that his patients are looking for a partner who understands them as a person, not just a patient. “As a physician who spent 20 years in the traditional primary care model, where more patients meant more money, I know why people lose trust in our healthcare system. People are looking for a doctor they trust, and it’s hard to trust someone who’s been beaten down by the system. People want to be cared for by their doctor, and it’s easy to feel as if someone doesn’t care when they rush in and out.”

Concierge physicians often eschew the insurance system and instead use a monthly or annual fee to offer fully personal access. Patients pay the fee themselves, and that fee covers all office visits. Patients may have traditional insurance to cover additional services like labs and X-rays. The lab or service provider then bills the patient’s insurance company directly; the concierge doctor is not involved.

For the concierge doctor, this means less time spent on billing and administration and more time spent on personalized patient care. For the patient, it means personal access and control; when they want to talk to their doctor, they can call him or her, no matter the time of day.

The patients who choose concierge medicine or direct primary care aren’t looking for just a doctor. They’re looking for a 24/7 partnership in illness and wellness. It’s a higher level of access to a different kind of physician who’s not interested in insurance billing or stacking more patients in a practice to raise revenues. “By running this kind of practice, I have time to take care of the whole person,” Lickerman says.

Membership Models

To customize their care in a different way, many people are turning to membership-based healthcare models, like One Medical Group, that work in tandem with their traditional health insurance.

One Medical Group asks a single question: When is the last time you felt good leaving the doctor’s office? The practice has basically combined the best of what an immediate care center has to offer with the personalization of concierge-level medicine, charging an annual membership fee of less than $200.

“We’re bringing concierge-style medicine to the masses,” says Ron Englert, DO, of One Medical Group. Members of One Medical Group can call anytime—day or night—to reach the Virtual Medical Team to address timely medical concerns. “We’re available 24/7/365 by phone. So if a patient has a question in the middle of the night or needs to follow up on their appointment, they can call us and potentially save a trip to the office. This level of access also helps cut down on unnecessary visits to the ER or urgent care.”

One Medical has also tapped into technology to enhance the patient experience. Members can email their physician, and One Medical’s mobile app allows members to book appointments, renew prescriptions and request treatment for common issues like rashes, UTIs, yeast infections and allergies.

Beyond the ease of accessing care, the bigger win is the experience while receiving care, Englert says. “We’ve completely transformed the in-office experience for patients. Providers see one-third fewer patients per day than the average primary care practice, and 95 percent of appointments start on time or early. When you come into the office, you spend the entire appointment length with your provider—allowing for more quality time and effective treatment.”

Membership models are like an upgrade for insurance. Patients still pay their insurance premiums and copays. But the additional $199 annual membership fee gives them more personalized care, same-day appointments and an app for after-hours use. It’s not as personal as concierge medicine—you can’t call the doctor on his or her cell phone—but it does offer increased convenience and an alternative to urgent care.

With full disclosure, I’m a member patient with One Medical Group and can tell you that Englert isn’t just whistling “Dixie.” I now have a trusted relationship with a primary care physician for the first time in my adult life. Making an appointment is a breeze, and I never have a problem getting a response, even if it’s merely a billing question. Conversations about cost are part of my patient-physician relationship, which helps me manage my high-deductible insurance plan.

It’s different. For me, it’s better. It fits my life.

Transforming Now into Always

So, here we are—a nation of people ruled by convenience and quality. Immediate care is no longer the patch-you-up “doc in a box.” The primary physician who you’re assigned to through your health insurance is no longer the only option. And patients who demand the utmost from their patient/physician relationship are not afraid to pay for the privilege of membership medicine. Money—from the cost of an immediate care clinic to monthly fees for concierge medicine—rules access.

Yet there are those, regardless of the increasing popularity of these options, who don’t have many choices when it comes to accessing care. While we enjoy the wider options that are accessible to us, we need to remind ourselves that there are many who still struggle for access and remain bound by limited choices.

That’s what will truly improve access to care—the ever-improving access to choices for all.

Originally published in the Fall 2016 print edition