politics and practice based on mindfulness

Monday, March 16, 2009

"Hello Health" (can this be serious?)

Imagine an electronic medical system that's physician-friendly and patient-friendly ... and it comes with neighborhood doctors who "care about the whole you."  

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.