Hello Health, the clinic that Jay Parkinson has been promoting for a while, is open for business. If all the patients are as happy as the first patient, success is assured!
The deal is that they’ve gone with mid-range concierge fee ($35 a month—around the cost of a low cost cell phone plan or high-end Netflix?) for patients to get access/membership and then have fixed charges thereafter. That amount is about three times what I pay for very basic low-end concierge services (basically email) at Tom Lee’s Metropolitan Medical Group in San Francisco, but way less than the typical $150–200 a month fee for high-end concierge practices.
What remains to me the tricky factor in their vision is how they’ll make this work with the bureaucracy & accounting behind high deductible plans (without taking on a ton of staff). But however that piece works out, someone needs to shake up primary care. Jay and his 2 colleagues are young entrepreneurial docs giving it a shake.
Health 2.0 had a film crew there with David Kibbe acting as roving reporter at the launch party. Much more on both these topics to come, but remember that Hello Health is also working with MyCa on a very interesting new interface to the EMR and much more.
Yes, you’ll see much more about the Health 2.0 Across America video starring David Kibbe and the MyCa interface at the Health 2.0 Conference.
I am new to the concierge concept, but how is the clinic not essential becoming an insurance carrier (and therefore subject to the rules, regulations and restrictions of such)? If I understand the article correctly, these clinics offer a monthly subscription / membership fee and then a flat fee per diam for all services? Just wondering if these set-ups have been challenged legally…
Jeff and others, if you want to look at another practice that is cash only – no insurance, check this local doc out: http://acchealth.com/
No $35 per month, no $150 visit fee, walk-ins welcome. At least this guy is tackling the high cost of healthcare not profiting from it, and still making a good living. He has his practice in Cary, NC – not quite the low rent district. Ask Jay why not this model?
While the Hello Health model is cheaper than other concierge practices, it is still rather expensive if you consider that fact that it is just delivering primary care with few very/limited add-ons in terms of ancillary services (imaging, labs, prescriptions). No branded prescription drug coverage or ER coverage.
Basically, a full-year of coverage will cost a user $420 in annual subscription fees and let say an average of 2-3 visits a year than we are talking about a minimum of $700-$800 a year for basic primary care coverage.
Plus, you still don’t have access to any kind of hospital coverage and frankly that is what I am covered about given my age/health status. If I get in a car accident with no health insurance, it could easy mean bankruptcy if I was unable to work during my recovery.
As Peter correctly states, this is a good business model but not necessarily one that will do anything to address the problems of access in the U.S. It will largely work be limited to cities with affluent younger individuals who choose not to purchase health insurance coverage or for affluent families that wish to have immediate access to a primary care physician outside of their normal health insurance coverage.
Frankly there is really nothing “empowering” about this to probably 90-95% of the U.S. population as a whole.
“And I suspect a lot of primary care docs in Canada are contemplating something similar,”
Why would PCPs in Canada leave the government system – if they could? It’s single pay, one set of rules, known and negotiated reimbursement and no collections. They’re not allowed to extra bill either. But I do know that docs hate government plans because their guild membership insulates their income potential and docs in Canada fought tooth and nail against medicare. Docs are not socially conscience business people. Jay may make a ton of money but he contributes nothing to solving healthcare problems here.
About one half of the patients Jay saw initially were uninsured, and a healthy fraction of the remainder never meet the deductible on their health insurance policies. I have a lot of friends who practice primary care medicine who are contemplating dropping health insurance altogether for similar reasons (benefits/costs?). And I suspect a lot of primary care docs in Canada are contemplating something similar, however politically incorrect it may be. It’s not an anti-social act for a physician not to accept health insurance, and it’s not merely a business decision, either.
Our health insurance system (public and private) is broken. And if Don Berwick, one of our most respected thinkers, thinks it’s time for us to us healthcare IT to free physicians and patient from what he calls “the tyranny of the visit”, I think a lot of experiments like HH are in order. A lot of medicine is not just about being touched; it’s also an exchange of knowledge (both ways). Let’s keep an open mind and see what happens.
Jeff this may be a good business model but it is not a good healthcare model. Jay is taking advantage of a PCP situation created by bad policy. He fractionalizes an already strained system by taking himself out of the access pool. I think Matthew’s “Hello’s $35 a month is not that much, but it’s not nothing. After all 1,000 patients x $35 x 12 = $420,000 a year.” is more to the point where young people want to work as little as possible for as much as possible. House calls for people too lazy to get off their ass to visit a doc – get serious. This is a symptom of bad policy not a cure for it. If we’re trying to increase access by having a doc travel around town when he could be seeing and interacting with patients then we need our heads read.
And how are those prices good for the uninsured, unless they are for the, “I’m never going to get sick and have lots of money” attitude uninsured. Price is the problem with U.S. healthcare and this will only add to those costs.
This is a mixed model, Peter, incorporating FTF home and clinic visits with e-care.
The working hypothesis: there will be fewer but longer and more detailed FTF visits because of easy, multi-platform access to clinical expertise. It’s a very promising and intriguing experiment. A lot of the disease management will be web-enabled, but a lot of the heavy lifting (and specialty referrals) will probably be generated by in person interactions. We’ll see. . .
Jeff, where’s the office visit to actually touch, feel, and observe symptoms and take basic temperature, BP and heart rate? Where is the, “does this hurt” interaction? I’m missing something here. I see e-care for script re-fills and making appointments but when does the real diagnosis and disease management occur?
I know Jeff, and we agree!
Remember that we are talking primary care here, Matthew, not surgery. And though your 99% pay no fee for using their conventional fee-for-service doctor, they have to queue up to get appointments, take time off of work (which never ends up in the health accounts) and spend countless wasted hours hassling with their health insurer and physicians’ billing offices. The access you talk about ain’t free at all, dude. It is a broken business model that no longer works either for patients or doctors.
Concierge medicine has a connotation similar to private medicine in Britain- wealthy people paying lots of extra money to jump the NHS queue. That’s not what Hello Health is about. It is targeted at the forgotten 100 million millennials who already conduct much of their lives online, at least one third of whom are uninsured, and are ignored by a care system which focuses on older and more lucrative patients. The existing office visit based primary care model needs to be replaced by a continuous, low intensity relationship paid for by subscription and assisted by 2.0 technologies. Jay Parkinson does a way better job of explaining all this, and he’ll be at your October meeting to do so in person.
Jeff. Just a teeny quibble on terminology. 99% of Americans don’t expect to pay any kind of fee beyond a co-pay to their doc, or cash for a service not covered by insurance. Anything else can be called Concierge. Obviously the MDVIP docs charge some $150 a month for higher end stuff (probably not much higher than Hello Health, but this is Target to their Nordstroms). On the other hand some (like the one I go to) Metropolitan in SF charge about $10 a month for something similar on the record setup side but no IM, no video, no remote. They do though take regular HMO.
Hello’s $35 a month is not that much, but it’s not nothing. After all 1,000 patients x $35 x 12 = $420,000 a year.
Which of these is “concierge”? Who knows, and who cares.
On the money side, having personally visited a cash only surgeon once (long story) I can assure you that their staff spent plenty of time dealing with my insurance company–mostly because I withheld payment (I actually canceled a credit card transaction) until both sides sorted out the problem. So the concept of “pay cash and take this receipt = no office staff” may not be as generalizable as you might think!
Matthew, what “bureaucracy & administration” are you talking about with respect to HSAs? Actually, I think I know and likely agree with you. Health plans have not figured these out and are failing to reduce administrative costs.
Mr. Goldsmith’s statement that most people with consumer-directed health plans never meet their deductibles accords with what I think is going on. I was concerned about the fact that there is still close to zero price transparency when I go to an in-network doctor, but that I thought it was necessary because I wanted my payments credited to my deductible, even though the claim still had to be adjudicated.
The concierge doctor told me: “Don’t worry about it. Nine years out of ten, you will not hit your deductible. So don’t even bother to send the claims to the health plan. One year out of ten, you’ll hit your deductible. Then you can send the health plan a shoebox full of receipts with a reckoning and wrangle over it.”
I suspect many people with CDHPs are doing this. If this is true, then health plans have little idea of the real claims experience of their CDHP beneficiaries.
As someone else who is working with Myca and Hello Health on this , just a tiny quibble. Most concierge practices charge a hefty entrance fee; Hello Health has none. Moreover, the subscription amount includes the initial assessment, H+P and set-up of the personal health record. It’s actually a really good deal. HH is not a concierge practice; most of the members will not be able to afford concierge medicine.
There is no billing bureaucracy as HH is all self-pay. Most of the young people who will sign up either do not have insurance at all, or never meet their deductibles. Hello Health will print them a receipt for visits (home visits or home visits) to claim on their insurance, but otherwise does not become entangled in the billing process otherwise; visits (including online video consultation) and other services are charged to members’ credit cards.