Under the banner of What's Old is New Again, some employers and physician practices are reaching back in time and revitalizing two old — very old — primary care delivery models with modern missions and some new money.
MODEL ONE: Once upon a time, the on-site company doctor patched up injured workers and sent them back to the factory floor. Now some company work-site clinics offer a growing variety of primary care services.
A 2011 survey by human resources consultant Mercer found that 31 percent of employers with 500 or more employees had on-site clinics; 36 percent of companies with 20,000-plus workers did as well.
Gone are the days of the lone doctor or nurse dispensing Band-Aids and the occasional stitching job. Take Disney's Epcot theme park in Orlando. Its 15,000-square-foot clinic serves 40,000 full-time employees and 30,000 family members. Doctors see some 600 patients per week and the on-site Walgreens pharmacy fills about 3,000 prescriptions.
Not all are this extensive, but the list of services is way beyond wellness. Some also focus on their most at-risk employees who require regular monitoring for such conditions as diabetes and coronary disease, and coordination with a community-based medical home. Mercer cautions employers against working with health delivery systems because of a potential for "excessive referrals and costly services." (I'll let you think that over.)
Employers contract with private companies that staff and run the clinics. Reportedly, some 30 firms now offer package deals with options for various services. One of the largest, Take Care Health Systems, a subsidiary of Walgreens, employs 2,500 physicians, nurses, X-ray technicians and physical therapists and runs 360 on-site clinics across the country. These private companies are bullish on their future. And municipal governments also are interested.
MODEL TWO: This direct primary care movement is an inverted model of concierge medicine for the wealthy, but its taproot extends to the time before traditional health insurance. The most frequently cited practice is Qliance Medical Management based in Seattle. It typically charges a patient between $49 and $129 a month, depending on their age and service preferences, less for children. Doctor appointments last up to an hour; clinics are open evenings and weekends. Patients are not prescreened for health problems. Small businesses, unions and the uninsured are typical clients.
The monthly fee covers only primary care; no insurance is accepted. Qliance would like to link patients to a high-deductible plan for specialists and hospital care. The company says that it has significantly reduced ER, specialist and surgical visits while turning a profit by eliminating the insurance middleman. And it has attracted $17 million in venture capital.
Obviously, there are many legal and regulatory questions, and hospitals want to know that even if patients can afford a high-deductible plan, can they afford a $10,000 deductible if needed? But they could be listed on state health insurance exchanges where they will stand out not only as affordable but also as understandable. Some state Medicaid programs are interested and there's talk of a Medicare pilot program.
Two old ideas with new life. What's next, house calls? Oh wait, they're back, too.
— Let me know what you think. You can reach me at mgrayson@healthforum.com
