from Nick van Terheiden aka Dr. Nick, Director, ECG Management Consultations
Host of Healthcare upside down#HCupsidedown

For most of my early life, I grew up in a single-payer health care system that provided everything I needed throughout my childhood and early life as an adult. I was also training to be a doctor and working in a single payer system.

So it was jarring when I went to work in Australia and was expected to end all my consultations by asking, “How do you want to pay – cash, check or bank card?” This was something I struggled with; I have never dealt with the financial side of medicine, focusing on my patients and what they need.

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In the US, money plays a huge role in the delivery of care. This is especially true in primary care, where there has been a steady decline in payments to PCPs. To maintain their income, these groups had to take on a heavier workload, leaving less time for one-on-one consultations with patients. The average time a physician can spend with a patient in a primary care facility has dropped to less than 15 minutes, and in many cases as little as 5 to 7 minutes—an unsatisfactory experience for both patient and physician.

Zach Holdsworth, CEO of Hint Health, is trying to change that. Membership-based primary care models have provoked debate about affordability, equity, and sustainability. In this episode, Zach argues that not only is direct primary care economically feasible, but it can help restore the spirit of medicine. Here are some excerpts.

Rejuvenating the PCP-Patient Relationship.

“I think it’s possible. It is very difficult or perhaps impossible to do this within the construct of traditional health care payment models. Much of the innovation we’ve seen in healthcare is built on legacy infrastructure. And it’s really hard to restore the integrity of that patient-doctor relationship if you’re sitting on top of decades of legacy.

Direct primary care as a new foundation.

“There is no functioning health system in the world without a functioning primary care system. So our main thesis is to rebuild the system off the chassis of the insurance service, completely from scratch. We really need to restore the integrity of primary care, so we’ve built a company that supports the growth and success of innovative models, like direct primary care, that achieve the Quadruple Aim that everyone wants to achieve, but outside of the status quo infrastructure. The vision is long term – once you fix primary care, you can slowly but surely decouple more and more of the system from the legacy infrastructure and put in place a net new kind of ecosystem that thrives.”

Dispelling fears of overuse.

Physicians entering these patterns often fear, “What will happen to the over-utilizers and the hypochondriacs? We will be inundated with them. The short version – this usually doesn’t happen. What actually happens is that if there is excessive use, there is often an underlying mental health problem that will have serious consequences down the line if not addressed. So if you have people who are overusing, those are the people you probably want to spend a lot of time with so you can address those root cause issues. And what we’re finding is that once heavy users realize that they can access it at any time, that they have that connection with their doctor, it often goes away. Once these issues are resolved, people don’t want to spend all their time with their doctors.

The thing is, you have the opportunity to spend 45 minutes with your doctor, and most patients don’t want to spend that time, but if they do, it’s really amazing. You restore the spirit of medicine and allow that connection to form. And that’s deep for me. What healthcare is really missing today is this deep connection.

About the show
The US spends more on health care per capita than any other country on the planet. So why aren’t we doing better? Why have the principles of capitalism not prevailed? And why do American consumers have so much trouble accessing and paying for health care? Immerse yourself in these and other questions at Healthcare upside down with ECG Director Dr. Nick van Terheyden and guest panelists as they discuss the pros and cons of US healthcare and how to make the system work for everyone.

This article was originally published on ECG Management Consultations blog and is republished here with permission.

Restoring the Spirit of Medicine

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