That's the promise offered by Hello Health, a new, concierge-model, primary care service in Brooklyn, with a new branch in the West Village. It uses email communication between MDs and patients to break the artificial standard of a 15-25 minute office visit, a stricture commonly imposed by private insurers. The goal, according to the site, is to renew the personal attention and old-fashioned relationship we patients once enjoyed with our family doctors.
Emails could reduce unneeded office visits in this new model. By using graduated units of care (beginning with a simple patient query by email as the minimum unit), their approach can increase office visit length when required, and without long waits. It would permit the docs to appropriately price and offer many levels of service, even house calls. The cost to the patient rises with the time and the level of individual attention involved in a single consult. The EMS software that allows for emails and access to patient records will also link MDs to colleagues and their own community of providers. (Maybe a few yoga teachers too?)
Oh, by the way, other physicians can purchase the Hello Health system. That makes me wonder -- is the software the real news here or is it actually a workable clinical model? And why do they have a name that reminds me of the ubiquitous Hello Kitty? How serious are they?
Hello Health also means goodbye to security because it's strictly pay as you go: there's no insurance billing. But when you consider that almost 20% of Americans under age 65 lack insurance at the moment, that's not a bad market share. Here's the article about it on Health Affairs.
What's missing? Maybe some realism about how to maintain clear boundaries with patients. What happens when the patient's credit card runs out? Will the "personal attention" and the doctor-patient relationship they touted on the site terminate (like shutting off the tap when you haven't paid your water bill)? That's the troubling scenario that insurance often helps us to avoid with our PCPs. Imagine having the "relationship" ... and then when funds run out, your emails bounce back. That's ugly.
Hello Health is a new model worth exploring, but it may be another way to sell clinical software. I'm not sure that they've solved the underlying problem: how to determine the amount and type of services offered to a patient according to need AND capacity to pay. In an ethical system there has to be a good way to balance out this equation, and I'm not sure the heuristics are there yet!
Still if emails can help doctors avoid unnecessary visits and patient backlogs .... it's not a bad start after all.
You raise some great points:
ReplyDeleteHaving a relationship with a healthcare provider (really, a provider of almost any service) makes a difference to the consumer. But will the provider who answers my emails or twitters be the person I have the nurturing provider relationship with? Or will that person be busy seeing someone else in the office? Maybe I'll get a "ghost writer/doctor?"
Email and twitter users likely want their questions answered now. How will your provider balance seeing people in person with virtual visits?
We have way more technology available to us now than the old-fashioned doc did. So why aren't providers calling or emailing families the next AM after a sick child was seen? Or emailing to find out how they are doing?
If the provider initiates the email/call, does the patient pay for it?
What if I think the remote access MD ought to have been able to deal with my problem by internet when he/she tells me otherwise? Will there be lists of items that can and cannot be addressed by email or twitter?
You have identified the core of the problem . . . determining the amount/type of service according to need and ability to pay. Otherwise it is Hello Health, Cheerio Checkbook!
Carolyn
I agree with both of you.
ReplyDeleteIn theory this is a wonderful idea. There are many issues regarding boundaries to work out.
The patient should know that each email will be added to their record.
I cannot imagine how each provider would respond to the amount of email that could be generated in a "timely" manner. The point made by Carolyn is well taken!
Large office practices have nurses who have the knowledge or script of how to respond to questions- will they now be given this task as well? How will this added burden be paid for?
I would like to communicate with my provider via email- but knowing the boundaries would be very helpful first!
Pat