Modern Primary Care Takes Center Stage

We have many health system clients who ask: “If we were to start from scratch, what should our urgent care model look like?”

The answer is to look not at the current state of urgent care, no matter how slick, consumer-friendly, or retail-oriented it may appear.  Unfortunately, many health systems are caught up in the look and feel of urgent care, many of them hiring executives from places like Neiman Marcus or Amazon.  There is also the “rear guard” focus on justifying purchased medical group assets, referring patients downstream to areas that may not necessarily be expeditious or economical, and spending large sums on outdated, system-level patient experience programs.

If I were starting a new urgent care platform, I would focus on what urgent care might look like 10 years from now.  This is not an exercise in predicting the future.  It is an exercise in taking a look at some of the models that are breaking the mold today.  As the author Dan Millman says, “The secret of change is to focus all your energy not on fighting the old, but on building the new.”

I mentioned in last month’s blog that we are fortunate to have some outstanding healthcare leaders as keynote speakers at our January strategy symposium.   David Sanders, M.D., co-founder and CEO of Zoom+Care, is one of those.  Since our theme for the conference is the intersection of on-demand and value-based healthcare, his talk will be one of the highlights of the conference.  Here’s why:

Dr. Sanders is not only a great speaker, but his Zoom model is what any provider group starting from scratch should look at.  We believe urgent care 10 years from now will be a hybridized model of primary and urgent care.  And that model will be aimed first and foremost at self-insured employers who are paying their primary care/urgent care providers to better align the interest of care and cost.

It is what Richard Park, M.D., co-founder and CEO of CityMD, calls, “payer-centric” care delivery.

“Most traditional medical groups and health systems are locked in a model I would call ‘provider-centric’ care,” he says.  “We are going to see urgent care go vertical, entering the primary care space.  And we are going to see more and more of those urgent care-primary care models become payer-centric.”

But you won’t have to wait 10 years to see this manifest in the healthcare marketplace.  Zoom is doing it today.

THE ZOOM+CARE MODEL

The Zoom model has several characteristics and we think have long-term value.  First, it originated as an on-demand platform, so walk-in or immediate access is part of the culture.  Says Dr. Sanders, “Zoom set out 12 years ago to build an on-demand complete system of care, such that people could get at the highest-access, lowest-cost point of care with ease and simplicity.”

Go to the Zoom website and you will see there is on-demand access to virtually any of their providers, including specialists.

“Our population thinks about urgent care and primary care as the same thing,” he says. “That includes illness, injury, and prevention.”

That last statement captures the second thing to like about the model: simplicity for the patient.  Sanders and his team guide patients to the most accessible/least costly frontline point of access. There is very little overlap as care moves to the most appropriate and cost-effective provider.  It turns out this is also the most effective way to move patients without a medical home into a primary care relationship when that patient is ready for a provider connection with more continuity.

This leads to the third characteristic of this model that we like: integration across multiple specialties, and a broad spectrum of acuity levels.  That starts with virtual care and escalates as necessary across increasing specialization and acuity levels up to and including a Zoom-operated emergency department.

“Customers are encouraged to start with the virtual access point at the lowest cost, and then we can migrate them to modern primary care,” says Dr. Sanders.  “But we do have an alternative 24/7 emergency department (ED) for higher levels of severity and acuity.  And that ED has transparent pricing.”

Modern Primary Care.  Direct Primary Care.  Primary Care On Demand.  Primary Care 2.0.  Call it what you want, but we know one thing: primary care and urgent care will merge into a radically different model.  And you probably think the basic premise of that model is to make care available anytime, anywhere.  That’s only part of it.  The more important premise will be that the owners of these new “modern primary care” platforms are in business to align the most convenient access points with the most cost-effective provider.  In other words, the core of their business model is not delivering RVU volume downstream, which is arguably the centerpiece of most large medical groups.

If this catches momentum among large employers, it will be a huge shift for most provider organizations.  The concept of “primary care” and having a “panel of patients” was a construct created decades ago with the Medicare (1965) and HMO (1973) legislation, which resulted in a government-mandated structure around how to pay for services.  This continues today with Medicare Part A and Part B rules and institutional mindset, such as place-of-service (POS) codes.

The result is that the U.S. healthcare system spends twice as much per capita on healthcare compared to other developed countries.  Since we spend around $3.2 trillion in this country on healthcare, that means there is a roughly $1.6 trillion savings opportunity.  If you think you can’t make money by focusing on reducing costs, you might want to change how you view the world.

Dr. Sanders is looking to change the construct.  And payers are taking notice. One reason we have asked Dr. Sanders to speak this year is because Zoom has just partnered with Aetna to offer the first on-demand-based accountable care organization (ACO) to employers in the Portland and Seattle markets.  We have always believed that large, self-insured employers are the ones who push change onto payers, not the other way around. If this takes off in the Pacific Northwest, you can bet it will spread rapidly across the country.

Very few of you reading this have the luxury of starting from scratch.  But you do have a choice.  You could put more money into the brick-and-mortar that supports your highly profitable multi-specialty practice or you could put some money into a completely different primary care incubator.  That incubator should have the characteristics of what primary care will look like 10 years from now.  We look forward to the lively, insightful discussion at our symposium about what component parts will constitute this primary care/urgent care platform.

The symposium will take place January 21-23, 2019, at the Westin Fort Lauderdale Beach Resort.  For more information go to the symposium page on our website or email us at info@merchantmedicine.com.