Physicians

PHYSICIANS: Ed Goldman podcast transcript

This is the transcript from the interview/podcast I did with Ed Goldman from MDVIP a week or so back. (The transcript was done very well and very affordably by castingwords. I just gave it a light readability edit)
Matthew Holt: So this is Matthew Holt from the healthcare blog and I’m doing yet another podcast and this one is from Ed Goldman president and CEO of MDVIP. MDVIP is a concierge physician franchise company which is helping physicians setup in the concierge market. Ed is it correct to say you’re a retired physician or are you still practicing?

Ed Goldman: No I’m a full time administrator these days.

Matthew: Ed has crossed over to the dark side but is doing something that is very interesting. Those of you who have read the healthcare blog know I’m not a big fan of multi different tiers of medicine—I’m all for universal health insurance and all the rest of it. You may wonder why I’m featuring someone from the “other end”. The reason is I had a conversation with Ed a while back in doing some private consulting work. There were some really interesting outcomes and approaches that MDVIP is using. So Ed a) thank you very much for agreeing to coming on the podcast and b) why don’t you give me a touch about the background of MDVIP how you work with physicians where you are as an organization and a little bit about how you got into this just a little bit of introduction I don’t know much about the company. 

 

Ed: Absolutely. MDVIP currently is
approaching six years old. It really started with the question of how
do we change the focus of US health care. Right now practices in the US
are really oriented towards treatment and we have achieved remarkable
advances in terms of that. Both in the technological area with PET
scans and MRI scans all of the great stints and all of the bypasses and
even in the specialization we have become a specialty orientated
medical system. The real question came to how do we change the emphasis
from one that values treatment to one that values prevention and early
detection. It came out of a statement that ex secretary health and
human services Tommy Thompson made and Tommy said he believed by the
year 2013 we would be sitting a health care bill that was over 3.5
trillion dollars per year. It would constitute 20 percent of the gross
domestic product and we would no longer be competitive globally as a
nation that our health care costs would take us out of the ability to
compete with other countries that didn’t have those health care costs.
We’re already seeing some of that for instance General Motors spends
three times on health care the money they do on steel for each vehicle.
Starbucks spends more for health care than they do for coffee. Well the
Japanese auto makers don’t have that difficulty. In Japan they deal
with a health care system that is not orientated that way and is much
less expensive so General Motors has an uphill fight when they’re
competing with the Toyotas, Hondas, and Hyundais of the world. That’s
only going to get worse as our health care system increases its yearly
double digit inflation so the only to attack this was to change the
orientation from one of treatment to one of prevention and early
detection.

Intuitively to all of us that’s not only a better system but it
makes sense. It’s far easier and less expensive conceptually to stop a
disease before it happens or to identify it at it’s very earliest
stages when the chance of cure is greatest and the cost of cure is the
least than it is to wait for things to become more advance to cause
symptoms. Then patients go to the doctor and now you’re into a
treatment mode because the disease has progressed further along the
continuum. The real question and challenge we faced was, OK
conceptually all those things are wonderful but on a very practical
basis how do we do that? We started with the first question which was
how long do you think it would take for each patient to be truly
screened for early detection and to have their risk factors identified
by risk factors I mean all of the components that go into the
development of a disease and each of those components for each of the
major diseases that could affect all of us cancer, heart disease,
osteoporosis and the like. We sat down with a group of physicians and
determined the least amount of time we could conceive of would be an
hour and a half for each patient per year. That’s really a modest
amount. This would include physician time, examining the patient by
doing an annual evaluation or a comprehensive physical year.
Identifying the risk factors and then sitting down as the lifestyle
coach and going through education and risk factor modification with
each of those patients. Well the average internal medicine or family
practice today has about 2500 patients if you multiply that by an hour
and a half or even an hour per patient you end up with more hours than
we have in a year. That was a non-starter to begin with.

The way the practices were constituted if we truly wanted to do that
we had an immediate time limitation that precluded our being able to do
that. That actually complies with some of the studies that have been
done in 2003 Duke University published a study in the Journal of Public
Health where they said if we did nothing more than 25 procedures
preventative procedures—not lifestyle modification or coaching that
were named by the US preventative services task force—it would take,
given the size of the practices we have, seven hours and thirty minutes
out of an eight hour just to do the prevention. Which would leave only
30 minutes to treat all the rest of needed illness both acute and
chronic. Their conclusion was that prevention is not really compatible
with the current US healthcare system and we agree with that.

We made the radical leap to say well if we’re really going to do
this then what we need to do is not increase the throughput of patients
to get the treadmill to run that much faster. What we really need to do
is to decrease the size of practice. We sat with charts and graphs
looking at how many times 30 year olds go to the doctor how many times
50 year olds or 70 year olds go to the doctor so we could treat
illness, and then factor on this hour and a half we were talking about.
We came to the conclusion the maximum that a practice could be was 600
patients which meant we were decreasing the size of practice by 70 and
in some cases 80 percent.

Matthew: You’re talking a practice of
all age ranges? We’ll get into this in a second, but what types of
patients that are likely to sign up for a MDVIP practice?

Ed: In our experience you’re exactly
right. The patients who sign up typically are slightly older and
actually slightly more informed. They know that they have illnesses
and they want the ability to have the individualized attention. When
we’re younger we want prevention and when we’re older and have already
developed several of these diseases or at least one then we want
protection. We want the doctor to tell us how to protect ourselves from
the ravages of the disease. Younger people want to learn how not to
develop the disease at all to begin with.

Matthew: So the 600 number takes into
account that you’ll have a self-selecting population that will be a
little older and sicker than a typical family practice?

Ed: Exactly, and what we did
actually is we looked around, and said OK,  if you’re going to reduce
the size of the practice to that extent how do you make the economics
work? Doctors are seeing the 2500 patients because given the
reimbursement today that’s really what you need to keep the doors open
and pay the ever increasing medical malpractice, staff salaries, etc.
When we queried some insurers they were reluctant to embrace the model.
They said you want me to pay the doctor more for treating less
patients? That doesn’t work in our model. When we talk to the
government they were (and rightfully so) concerned with how to expand
the benefits of Medicare to cover prescription drugs, to cover other
aspects of the Medicare program that were in need, but were big dollar
commitments. Looking to change fundamentally practices worked was more
than they contemplate at this time. So we held a series of focus groups
with patients. We said, listen if we could have a practice that
functioned this way would you find enough value in it to want to
supplement out of pocket, over and above insurance, this type of
practice because without that we couldn’t make the economics work.

Resoundingly almost overwhelmingly the response was positive so at
that point and with that mandate we tried our first practice. What we
basically did was invited all of the patients in an existing practice
in Boca Raton, Florida—practice of Dr. Rob Colding—invited them to a
town hall meeting in a hotel. We said here’s what we’re going to do.
We’re going to have everyone in this practice get a risk factor
assessment once a year to identify all of your risks. We are going then
to educate you on those risks and coach and modify those risk factors
so you never develop the disease. Concurrently we’re going to do a head
to toe comprehensive annual exam similar to what you would get at an
academic center like Scrips, or Cleveland clinic or Mayo and we’re
going to do that on every single patient every single year.

Due to the smaller size of the practice instead of the eight to ten
minute office visit we’re going to schedule these at a minimum of a
half hour which will give our physician plenty of time to do the
coaching, follow up, to do the reinforcement that only the doctor &
patient working in concert can achieve. Also due to the fact we have a
smaller sized practice there will be no waiting. These appointments
will start exactly on time and after hours instead of going through the
answering services we’re going to make a major leap and give you the
doctors cell phone number, home number, beeper number so that it’s very
easy for you to get in touch with the doctor to ask your questions so
you don’t have to anxiety of not knowing your physician is there in
times of need or emergency. We held that over a several day period and
quite literally talked to almost all patients in that practice and
within a week that practice was full with 600 patients.

Matthew: So what you’re saying is that
we’re was clearly demand at least that the patients in that practice
went to go to that model. Just to be clear this is a $1500 a year
commitment from the patient?

Ed: That’s correct the patient is
committing 125 dollars per month for all of the services that I have
just innumerate. There is no extra charge for x-rays in the physical
exam for laboratories for cardiograms for lung function tests for any
of the testing that we do and we don’t bill that to insurance either.
That’s part of the 125 dollars per month.

Matthew: Just to be technical here Medicare doesn’t regard this as balanced billing, it’s a separate payment?

Ed: For Medicare these are considered
non covered services and for most insurers the extent of the
preventative services are much more than their usual benefit plan.
About 80 percent of the insurers consider this substantially non
coverage services as well.

Matthew: You mentioned about 80 physicians are involved, is that right?

Ed: No we’re at 130 physicians and over 40 thousand patients.

Matthew: I don’t know if you want to
discuss how the relationship between MDVIP and the physicians work
financially. And the other thing that should be interesting for my
audience to know is what other services are you providing the physician
especially in regards to information technology.
Ed: The relationship between MDVIP and
the physicians is that they are essentially independent contractors to
us. Their practices are exclusively MDVIP patients—you can’t have
regular patients and patients who sign up for this membership because
you violate several federal statutes if you do that. They run their
practice and do their hiring and firing. We don’t own them or control
them. They’re independent contractors who agree to provide the
preventative services our patients sign up for in their membership. All
illness is still covered by their regular insurance with the same
deductibles and co-payments as always happened. So what patients are
actually paying for is the prevention program which is a non-covered
service for insurance and for Medicare. Of the $1500 per year fee, the
physician receives a thousand dollars per patient for providing these
services and MDVIP receives $500.

Matthew:
Then you also provide practice management EMR and also
patient portal online service? Talk to me a bit about the way that you
and the physicians involved are coordinating care especially with
specialists and hospitals.

Ed: Certainly what we provide at
MDVIP firstly is a turnkey operation for the doctor. Costs the doctor
nothing to start practice as long as we and the doctor agree to go
forward. We do extensive due diligence to make sure that the doctor and
the practice can be successful in this type of model. But assuming the
doctor passes the due diligence—I must tell you we probably turn down
eight out of every ten doctors, either because we don’t believe the
practice economically sustains it, there’s not enough patient interest
or affordability or the physician doesn’t qualify in terms of
credentials as one of the top physicians. Assuming that does go forward
there is a four month transition time where we tell the patients
basically that four months from now Dr. Smith Jones will be in a new
practice. Come to a meeting much as we did the first time and hear what
the difference in this practice is going to be.

We then do everything from mailings to call center follow-up to
educate the patients as to what the new practice what the new benefits
will be and four months from now or from the imitation the new practice
opens. We make certain that for all the patients that either cannot or
choose not to join there is a continuity of care plan. We identify
either other physicians in the group or in the community who have
openings and will match disease expertise, personalities to insure
every patient who chooses not to proceed has a smooth transition to a
physician with the expertise and personality to take care of them. Once
a practice becomes a MDVIP practice the first thing we do is put in an
electronic platform that allows them to be on the cutting edge. What do
I mean by that?

Most of the discussion today in the press or the government turns to
instituting an electronic medical record. We certainly think that’s an
essential but we think it’s just the foundation and to really do
meaningful intervention you need a far more sophisticated electronic
platform than just an EMR. So in our world we need an electronic
medical record, we need a patient wellness portal that’s individualized
to each patient, we need a physician portal so that they can
communicate in a secure environment complete with compliance with
regulations with those patients. Then we need a data warehouse where we
can download the results of treatment, download the use of medications
so if we’re ever going to get to the point where evidence based
medicine and outcomes are really measured, we can do that with
physicians across the nation.

That’s really what we have created. Our patient portal has general
information in it much as you’d find on better sites on the web. Our
purpose in that is we would like our patients to have only reliable
information and the web has very reliable information but it also has
very spurious information. So first you can encyclopedia lookups on
every disease and medication, on all sorts of procedures and techniques
down to looking at the body layer by layer. The real purpose of it is
this is really where your prevention technology starts. So the patient
can take their health risk assessmentonline or on paper to be put
online . The health risk assessment then will result in a missive to
their physician who now understands all of the possible risks that go
into the major diseases and for many patients this is the first time
they’ve thought of their health in that way.

It generates what we call a red box chart which are all the risk
factors that can be modified and we show patients much like their
health age and real age, what their risk factors would be if they
modified these risks for these diseases. Then we hired a company called
Wellness by Choice which worked with Duke University. They developed
150 video tutorials for us. Multimedia, fun to play with, each lasting
about ten minutes and these are video tutorials on risk factors. So if
you have a risk for coronary artery disease you might review the
tutorials, what is cholesterol good and bad? What’s transfat? What’s a
high fiber diet? How does exercise interplay with this and if I were
going to exercise what do I do and how much is enough and how do I get
started? All of those are part of the videos.

We then have applications to track exactly what you’re doing to make
sure that you are in fact modifying these risks. If cholesterol is a
risk we track it LDL/HDL/VLDL. If exercise is something that is
important, put in what you do at work every day, put in what you do in
terms of your exercise; we’ll tell you in terms of metabolic
equivalents whether you’re fit. We will tell you whether you’re
achieving your target goals the government recommends. But more than
that from the doctor’s standpoint the physician standpoint can allow
the physician even without the patient being in the office to look and
see what the patient is doing.

Matthew: Are you getting much take-up from patients in using the self input?

Ed:
I would say that probably 30 percent of our patients are utilizing the self input.

Matthew:
That sounds pretty high to me. That’s really good. I
think the other thing that would be of interest is there’s obviously a
huge problem in coordination between different specialists. You’re now
putting the primary care physician in care of that. How is it actually
working in practice? Say I’m the patient I need to go see one of the
specialists. Do I get referred by the primary care doc? How is the
primary care doc handling that process?

Ed: In our world the primary care
doc performs three functions: treater of illness, lifestyle coach, and
coordinator of specialty care. There are two things that we do with
regard to specialists. Not only do we give to each of our practices at
no cost an electronic medical record which we have single handedly
developed or modified, we also have on the patient’s wellness site a
synchronized personal health record so that the patient gets to see
their own chart and own medical records and anytime the doctor changes
anything or prescribes a new medication or lists a new problem, it
instantaneously updates that patient’s record on the web.

So when you go to the specialist you can give the cardiologist or
dermatologist a onetime guest user pass and they can access all of the
records. They can see the cardiograms, lab tests, x-rays, and
medications prescribed. They don’t have to duplicate tests and now they
will not prescribe things or do things that are contra indicated based
on other conditions. That’s the first thing we do.

For patients who don’t want their records on the web we will burn a
wallet sized CD that looks like a business card with a hole in it and
that contains all your records. You can give that to the specialist and
he can pop it into any computer and again he gets to see exactly what
you’re doing and will update whenever anything significantly changes.
We also have a software program that, when you are supposed to see the
specialist, about an hour after your appointment should have taken
place, it auto dials the specialist and one of our medical assistants
follows a protocol. First question is, did the patient get there? If we
thought it was important to refer you, shouldn’t we think it’s
important enough to find out if you kept the appointment?

Matthew: That’s a massive innovation in American medicine.

Ed:
So the that’s the first thing we do. Obviously if the
patient didn’t show up we want to know a whole bunch of reasons of why
and what happened et cetera.

Matthew:
At that point in the medical system the clerk or
whomever in the office will chase the patient down and try to find out
what’s going on.

Ed:
Precisely. The second thing we do is we want to know answers
to this series of questions: Did the doctor prescribe any medication?
Did the doctor or the specialist order any tests outside of the
practice? What did he do in the practice? Can they fax us or email us
the office notes? Can your doctor talk to our doctor because at half an
hour a visit, our doctor has the time to actually get on the phone and
find out what exactly has transpired? All of that gets logged into our
electronic medical record.

Matthew:
You’re really back filling the lack of interchangeable
data between physicians by sort of getting the information from any
source you can.

Ed:
Exactly. I hope at some point it will be seamless and
everyone will have interchangeable information. Right now we have to
work around the system that doesn’t afford us that.

Matthew:
Let’s not hold our breath for that. That’s really very
interesting. Let’s shift gears to perhaps the most interesting part of
all.  This is America so people with money are going to trade up to
better service and that sounds to me like a relatively modest amount of
money for fantastically better service. For someone who is very health
conscious who has to pay that amount of money, it’s not a huge amount
but it is some money. One of the things that perhaps I found most
interesting from hearing  about some of the your data is the result of
spending this amount of money upfront and this amount of time, a lot of
other money spent in the healthcare system in terms of hospitalization,
missions, surgery, etc. has gone down by substantially more. So could
you run me through that data a little bit because I think the
implications are very interesting.

Ed:
I think I would agree with you. The implications for that probably have far wider application than we first even conceived.

Matthew: Could you just give us a bit of information on some of the data that you’ve put out?

Ed: Sure and we’ve been following this
data now for probably three years with the sample size being large
enough in the past two years that it really starts to get difficult to
refute. Might I point out in much of the cases the data really comes
from states that are reporting. So this not MDVIP manipulated data.
This is data that the states use and they also do a severity index to
see how sick the patients are. This time we have averaged 60 percent
fewer hospital admissions than Medicare across all our states which is
15 states right now. So the data holds not only across all the states
but through the years and this includes Florida which is the highest
utilization Medicare state in the union. For commercial patients,
non-Medicare patients we have 50 percent fewer hospitalizations than
the best managed HMOs in the state and in some cases it’s 60 or 70
percent fewer than the worst managed. We’re talking about drastic
reductions in hospitalizations. We average at least 40 percent fewer
emergency room visits and in some cases much less than that. We’re
stopping people from being admitted and once they do get admitted our
costs per case and our length of stay in the hospital are shorter and
less expensive than the average comparables.

Matthew: Do you have an average
breakdown of cost per patient or sort of an average yearly breakdown of
average expenditure on patients for all of this we talked about?

Ed: I do not have it totaled across the
board but we presented data to some insurers showing the number of
patients they have. We can save them tens and in some cases hundreds of
millions of dollars.

Matthew: You would imagine that. And
just to give an example, there’s a similar study I just saw from
MedDecision, a company that just announced its IPO. They’ve been
providing payer-based data to physicians in emergency rooms—quite
extensive data just around what tests people have had and what drugs
they’re on and what doctors they’ve seen. Just them having that data
has done things like reducing second tests being done, increased
certainty of diagnosis, fewer admissions. Through observation there has
been a saving of a substantial amount of dollars, 400 or 500 dollars
per admission per emergency room visit. If you take a population of 500
patients and spend quite a bit more on the front end through this
preventative work, you can target the right type of people within a
bigger population. You can imagine an insurance company targeting the
right people and saving 60 percent of the hospital admission. You don’t
have to reduce too many hospital admissions before you start saving
substantial dollars over the population.

Ed:
I will tell you that my fondest hope will be for us to prove
over time that the 125 dollars a month that we’re charging in fact
could be either supplemented or totally wiped out by the savings that
we’re able to save from this type of approach. We can demonstrate that.
I’m not sure why this isn’t the approach that all of healthcare users
and all of the insurers and governments. Certainly secretary Thompson,
who has always emphasized prevention, believes that we have the right
approach and may be on the right path and has heralded our community of
cost effectiveness through prevention. The company at this point is
looking to put together a think tank and a panel that can evaluate this
as having validity and wider application than we currently have.

Matthew: That’s very interesting. Let’s
talk a little bit about both sides of this. Let’s assume for a moment
that it’s not going to become mainstream but there will be people
paying with their own money. What is your guess as to the number of, if
you’ve done business planning around this, to the number of people who
will be prepared to pay that amount of money in certain groups? One or
two percent or more like five or ten percent? The other question is,
you said you reject 80 percent of the doctors who come to you about
this. We still have only about 25 to 30 percent of physicians in the
country being primary care physicians. If only two in ten is good
enough to get in this model can we expand it? Can this whole model be
expanded to meet the demand for people who will pay? Let alone before
we talk about what happens if this becomes mainstream for primary care
across all health plans.

Ed: Surely. Let me take some of
those one at a time. Firstly with each practice we have about ten
percent of our patients on what we call scholarships. These are
patients that receive the same care and the same wellness programs but
are not charged. We leave it to the discretion of the physician because
they know that we’re with all the patients in terms of economics. They
know whether the patient has a disease that they have particular
expertise in. We try and leave no patient behind and we give the doctor
the discretion to include those who he thinks have need in the practice
even though the economics may be compromised. We try to cast as wide a
net as we can.

Having said that, we think that there are probably five or ten
percent of the population that is capable of doing this and interested
in doing this. We have health clubs almost on every corner these days.
We all know that exercise is beneficial. How come we’re not all members
of health clubs and in them exercising? Because it really is a matter
of choice and a perception of value for some people even though the
affordability is there they don’t have the perception of value or the
interest. We think that between five and ten percent, especially with
the baby boomers who are about to become the new health care consumers,
we think that there is that kind of population that would be interested
in this.

We turn away eight out of ten physicians now because we want to make
certain that they will be successful. The last thing in the world I
want to do is take a physician who has been in practice fifteen or
twenty years who is making mortgage payments, sending kids to college,
and find them reducing the size of their practice and giving a party no
one comes to. I think that as the idea and the experience becomes more
widespread and more acceptable and we’ll be seeing this quite literally
every day. That 80 percent rejection will decrease substantially as
more patients are prone to seek this product and become more aware of
it and there will be more physicians capable of participating in it.

One of things we have today that for some reason doesn’t get a lot
of press is we’re sitting in a middle of a potential health care
crisis. The American College of Physicians just sent a communication to
Congress very recently stating that specialty of medicine is dying.
We’re in the situation now where we have the result of a Mercer study.
Mercer is a benefits group that showed that over the next three years
for physicians over the age of 55, over half of them are considering
early retirement or changing from a practice into another facet of
medicine. Administrative medical directorships are getting out of the
practice of medicine. So our best and our brightest are choosing to
leave the profession earlier and yet on the other end where we used to
get about 55 percent of graduating students going into primary care now
we’re down to about 23 percent.

Matthew: Well they can do the numbers, right? They can see the money diagnostic radiologists, and surgeons are making!

Ed: There’s no question if you’re coming
out of medical school with 100 to 140 thousand dollars worth of debt,
you do the numbers. It’s much easier to pay that back as a radiologist
or dermatologist than it is as a primary care physician. That leaves us
with at one end we’re decreasing numbers and on the other end we’re not
supplying at a time where 30 to 35 million baby boomers are about to
start accessing the system. Our approach at least keeps the good
doctors in practice longer and starts to stimulate the students coming
out to think that maybe there is a way for them to be respectable and
to have a family life, to be able to have the economics of paying back
loans, and to make the primary care profession once again attractive.

Matthew: I think you’re right but
obviously that’s going to be a slow transition because people are
already choosing what they’re doing coming out of medical school one
year at a time. Obviously there is some leverage to keep all the
physicians in the game and keep them in practice but if we’re talking
about putting a substantial chunk of the primary care docs in the
country—I’m making this up but I think we have a couple hundred
thousand primary care doctors—but if they’re dealing with 500 patients
each there is a capacity constraint somewhere along the line. Obviously
you’re nowhere near that since you’re dealing with such small numbers
at the moment but if this is going to become mainstream, I’m just
speculating here, but would you think that there is the ability to use
technology or other professionals to surround the physician to enable
them to cover more people with the same level of intensity?

Really if you go back to your point at the start of this
conversation the question is how do you get the level of focus on
prevention and wellness and care that really a primary care physician
can provide. How do you extend that out? I guess there is some doubt as
to whether a simply a physician focused model can expand out to cover
the whole population? Although what we’re talking about in the long
term if we change the motivation from being treatment to prevention
it’ll wash out, but we have to prepare for that transition.

Ed: I would tell you that we’re
looking at two things right now. The first thing we’re looking at is to
expand our electronic platform into home diagnostics and home
monitoring. The first step we’ve made is allowing the physician without
the patient being in the office without them taking office space and
waiting room chairs or examining room chairs the physician is able to
communicate electronically with the patient through email and through
seeing what preventive efforts the patient is making. But we want to
extend that we’re looking to do home monitoring, home diagnostics and
remote telemedicine. We have an effort now that will involve the
Cleveland clinic that will use some of their specialty expertise and
some of the technology that they have developed that will allow our
physicians to obtain second opinions from the clinic but to monitor
patients in remote sites. They have wonderful technology they can
actually hear a heart better from Cleveland to Saudi Arabia than I can
from the bedside. We’re trying to work with that technology so that we
can monitor patients at home saving them the trip to the office. We can
do diagnostics at home but when you do all of that you need a platform
that to transfer the information and the data you are receiving so that
a physician can review it.

We think we have created that platform so we’re looking to see if we
do some of this can in fact we extend the membership above our set
target. Remember that we did that by how frequently patients utilize
physicians if we can reach patients without them coming into the
office. If we can communicate them through tele medicine through remote
video coaching then perhaps we can in fact extend beyond the numbers
we’re talking about. At the same time we’re looking to see how would we
transition? One of things that we’ve talked about is next year setting
up a similar practice to the ones that we have but in needy areas and
in Harlem and in Liberty City, Miami—in economically disadvantaged
areas to see if we get the same utilization savings and if we in fact
do get that, how do we design a transition on a demonstration project
basis. So that we can setup practices that would be able to treat a
wider group of patients that would be able to incorporate students just
out of school to give them the motivation and the incentive to swell
the ranks of internists. You’re right now about 30 percent of our
physicians are primary care and 70 percent are specialists—we think
that’s topsy turvy and doesn’t make sense. We think that 70 percent of
the physicians should be primary care physicians. It’s certainly like
that in many of the European countries and what we think is that there
needs to be a transition perhaps based on the model that we’re
currently using but certainly in any event based on a model that
focuses on prevention and early detection that we can transition
practices and the whole health care system into that focus.

Matthew: I think that’s a great ending
point to end with because we’re really talking about it seems that you
started with one very interesting idea and it’s raising a lot of
possibilities. I think the answer is no matter who you talk to in
health care the model in which we currently give care is broken and we
have to figure out some way to fix it. Here’s one that’s is using some
of the best that has been developed in medicine over the years—the
physician as the captain of the team and the advocate for the patient’s
care—but wrapping around it technology and services and information,
that looks like it has some real possibilities to do good. Also making
physicians love this model. In the end I guess you’ll have more
hospitals thinking about losing half of their admissions in the future.
That’s part of the process.

Ed: The shifting sands of health care.

Matthew: Thank you very much for your
time it’s been really interesting talking to you it’ll be a very
provocative interview for the podcast for the blog and I look forward
to checking in with you in the future years to see how things are
developing.

Transcription by CastingWords

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Wow, a real mind-blower, Matthew. One problem: the part that was of most interest to me — the response from the insurers — is where the transcription got the most muddled, and I’m not exactly sure I have the details right. Any chance you could clean it up and re-post, so I could share with colleagues?