For decades, primary care physicians have run their offices in a manner which was, let's say, "physician-centric." PCPs ran their offices during the hours that were most convenient for them, did little or nothing to reach out to patients when they weren't in the office and spent virtually no energy building their brand or their patient experience. And when retail clinics began popping up in pharmacy chains and megastores like Walmart, few PCPs saw them as a major threat to the business.
These days, however, the landscape of primary care is changing dramatically. Practices will need to embrace new models that make physicians more accessible, allow them to spend more time with patients and embrace new technologies, like mobile phones and tablets. And the primary care practices that want to survive can't dismiss alternate care models so lightly anymore.
For many physicians, in fact, it's not a matter of whether they adopt new practice models—such as direct primary care or concierge care—or not. It's more that PCPs will either change their business model or leave the practice of medicine, says Josh Umbehr, MD, of Wichita, Kansas-based direct primary care practice Atlas MD. "We feel pretty confident that 80% of primary care physicians will be a direct care model within 3 to 5 years," Umbehr says.
The millennials arrive
Why is it so important for primary care practices to consider new ways of doing business? Well, there's the obvious factors such as having to constantly wrangle with insurance companies and the need to see dozens of patients a day.
But there's more than that.
PCPs are now serving the new wave of consumers dubbed millennials. Millennials, the incoming wave of American teens and twenty-somethings, have much different expectations of the medical system than their parents, and medical practices need to prepare for that. For one thing, they've grown up in an era where consumer technology use—notably mobile—has grown at an astonishing pace, and they expect, not hope for, the convenience these devices bring. Recent Pew research described the generation as "digital natives." They also expect medical providers to meet their needs, especially for convenience, rather than the other way around.
So where is all of this heading? We're looking at the birth of the 24-hour, always on, social media-savvy, web-smart, patient-centric practice that makes it convenient to do business with them.
Revolution in progress
If you want to see an example of how all this might work, there's the revolution going on at the Cleveland Clinic, where most patients can get a same day appointment by making a brief phone call (or even an email or tweet). The clinic performs about 1 million same-day appointments each year, Chief Experience Officer James Merlino told Forbes. Seeing to offering same-day appointments was doubtless an extremely resource-intensive effort, but the Clinic sees this step as an essential way to capture the loyalty of millennials.
There's also a rapidly growing number of practices which are switching over to the concierge model, direct primary care or some hybrid of the two to address the demands of their shifting market.
For example, there's One Medical Group, a primary care practice that works like most others except that it charges an annual $200 fee to patients, and therefore can offer more time to patients that need it. Doctors at One Medical Group, which has locations around the country, can book a 45 minute session with a patient, something pretty much unheard of outside of concierge or direct primary care.
Another interesting example is Turntable Health, a Las Vegas "membership-based primary care and wellness ecosystem" (in essence a direct primary care practice). Among other advantages, Turntable offers access to its doctors via email and phone with video chat—and telephone access is 24/7. Patients pay a flat $80 a month for all of the medical attention they want. And to make the in-person visits more productive, Turntable has staffed the facility with health coaches who, as founder Dr. Zubin Damania told the Las Vegas Weekly, are much easier to communicate with than nerdy doctors.
And there's Dr. Umbehr's AtlasMD, a direct primary care practice whose three doctors see less than 1,500 patients all told. Patients pay a flat rate each month ranging from $10 per month to $100 per month, and in return get unlimited visits, plus doctor communication by phone, text and e-mail, including direct access via the doctor's cell phone number. AtlasMD also works with a health insurance specialist who finds ways to make a patient's participation in insurance cheaper by using AtlasMD's benefits.
A transformation underway
The bottom line is not that every practice is to do everything described here, but that PCPs need to be open and flexible to waves of change in their business. While it may take a lot of effort, PCPs need to take part in the transformation that's underway in how care is delivered. That transformation may seem heinous now, but for many doctors it has been a lifesaver that reignited their love of medicine.