In 2008 Eisenhower Medical Center made a frontal attack on a failing system. In its crosshairs was our system of primary care in the U.S., notorious for crowded waiting rooms, impersonal office staff, long delays for appointments, and blink-of-an-eye face-time with over-scheduled doctors. Eisenhower wanted to do better by its patients. They hired family physician and medical office reformer Dr. Joseph Scherger to overhaul the system.
“My goal was to create a system where more time and attention are given to meeting the needs of each patient,” says Scherger. “This would reduce the need for emergency department visits and hospital stays, thus lowering overall costs. It would restore the deep relationships with patients most physicians go into medicine for.”
Nine years later, 8,500 lucky patients and 55 happy doctors are engaged in a program called Eisenhower Primary Care 365. It’s characterized by:
• Longer office visits (30 to 60 minutes)
• 24/7 email access to doctors
• Access to a team of physician assistants, nurse practitioners, and health coaches who help manage chronic conditions and keep track of patients’ daily needs
• More comprehensive health care
Sounds Like Magic
Known as direct primary care, the system is being implemented by hospitals and insurance companies across the country. How does it work?
It starts by taking a page from the concierge model of the 1990s. Back then doctors fed up with insurance companies accepted only cash payments from well-to-do patients. For a $1,500 annual retainer a patient could get the doctor’s complete attention whenever they needed it.
The result: great health outcomes. For those who could afford it, that is.
Which was understandably only a small percentage of Americans.
Direct primary care improves on that model. It asks patients to pay a small monthly out-of-pocket fee (about $50) but keeps insurance companies in the picture. Insurance is billed for office visits only.
Dr. Joseph Scherger
The retainer allows doctors to set up their practices with a streamlined team of nurses, coordinators, assistants, and coaches who handle online communication, telephone consultations, lab work coordination, prescriptions, etc. It guarantees doctors enough income to limit their patient loads to 800 or 900 patients. (In the general fee-for-service world, doctors often take on 2,000-plus patients to make up for insurance shortfalls.)
With fewer patients, doctors can spend time with each person instead of rushing off to the next exam room, providing them the opportunity to familiarize themselves with patients’ individual health needs and provide truly personalized care.
Go with a Winner
With advanced information system tools, secure online communication, team practice, and happy patients, direct primary care may become the traditional primary care model of the 21st century.
— Illustration by Stuart Funk