Top Docs '14: The Doctor is In, Sort Of
Among the most critical agents of change spawned by the Affordable Care Act are the millions of newly insured people catapulted into the system, creating new demands and pressures for already jam-packed emergency rooms and medical practices. In Washington state, since October 2013, more than 164,000 residents have signed up for private health insurance through the state’s health care exchange, with the bulk of people enrolling in the final three months leading up to the March deadline, state officials announced in April. Hundreds of thousands more signed up for Medicaid.
In an attempt to meet those needs and numbers, clinics—walk-in, urgent care and retail —are multiplying around here like coffee kiosks. Overlake offers six primary care clinics on the Eastside and urgent care clinics in Redmond and Issaquah. Virginia Mason Medical Center opened a clinic in University Village last December that provides same-day access for primary care and specialties such as pediatrics and dermatology. “We are meeting a demand,” says Jim Cote, Virginia Mason clinic administrator.
“Patients don’t want to wait for two or three weeks to see a doctor when they have an issue they want to be seen for today.”
Bartell Drugs, in partnership with Group Health Cooperative, opened in-store CareClinics this year in Ballard, University Village and Crossroads. Staffed by nurse practitioners, the clinics are meant to treat common illnesses such as colds, flu, sprains, ear infections and minor injuries, with a maximum out-of-pocket cost of $75. “We are trying to deliver care that’s more affordable and more convenient,” says Wellesley Chapman, M.D., a primary care physician at Group Health. Swedish Medical Center made headlines this spring when it announced a surprising partnership with Country Doctor Community Health Centers to provide evenings and weekend care. The move helps patients with non-emergency conditions avoid emergency-room costs and expands access to primary care for low-income patients.
In addition, clinics not connected to larger hospitals are popping up around town. Seattle-based Qliance (available through the Coordinated Care health plan in the Washington Healthcare Exchange) offers “direct primary care.” For a monthly fee, ranging from $60 to $99, Qliance patients have easy access to providers and plenty of one-on-one time. “In medicine, you want to slow it down, talk and formulate a good plan,” says Qliance CEO Erika Bliss, M.D.
Portland-based ZoomCare embraces a tech-driven model. You can go online—OpenTable style or via Skype—to book an appointment in one of its five Seattle neighborhood clinics. ZoomCare accepts most insurance plans (but not Medicare or Medicaid) or a flat fee of $140 (for most visits). Immediate Clinic, a Seattle-area urgent care chain, offers lab testing, physicals and treatment for a variety of maladies in each of its 12 (and growing) Puget Sound–area locations—accepting insurance or a flat fee.
Sprig Health, headquartered in Portland, allows patients to connect online and select from more than 130 services, use a credit card to pay ($200 for two doctor’s visits) and schedule an appointment, no insurance necessary. Sprig claims patients save as much as 50 percent on every visit.
Clinics are also coming to the workplace. Vera Whole Health is a Seattle-based service that offers employer-funded primary, acute care and wellness clinics onsite or near businesses. Ideally, these clinics reduce chronic illness, which saves overall on the cost of care.
Last January, Vera partnered with Virginia Mason to utilize Virginia Mason’s evidence-based criteria. “The idea is to deliver primary care to the patient where they spend their time,” says Ryan Schmid, Vera president and CEO. “People were having a challenging time accessing care, and that leads to reduced productivity.” Schmid says we need to try “hundreds of new things” as we revamp the health care system. “One of the great payoffs of the ACA is that it has disrupted things and blown open the doors for innovation.”
So far, Vera has rolled out two clinics in the Seattle area—for Seattle University and Seattle Children’s—and expects to have four to six clinics by year’s end. Employers pay a monthly rate that’s based on the number of employees using the services. Vera creates custom programs for employers, and staffs every clinic with doctors, nurse practitioners and wellness coaches, depending on the employer’s needs, Schmid says. “Our real goal is prevention. We help people make healthier decisions.”
While clinics are one key in getting care to those who need it, here in Amazonland, telemedicine is catching on. Seattle techies who click for clothes and books online relish the idea of ordering medical care the same way. The Internet has long been a source of medical information, teeming with experts offering advice by email (justanswer.com) or avatar doctors assessing symptoms (freemd.com).
Thirty-year-old Vanessa Cohen, who lives in Auburn, visits walk-in clinics staffed with health care providers when she needs medical attention. Occasionally, though, she opts for consultations by phone or webcam, connecting with providers through the Tacoma-based Franciscan Health System. Franciscan partnered with Carena, a Seattle-based service that promises “virtual house calls at a moment’s notice” for children and adults in Washington, California and Illinois.
Patients can log on 24/7 to chat with doctors or nurse practitioners—within 30 minutes—via phone or webcam. With subscriptions, which range from $25 per month to $385 a year for families, visits cost $5. For nonmembers, visits cost $85, although it’s $35 for patients who access the service through Franciscan. The service is not covered by insurance, but it can be applied to a deductible plan and paid for out of a health savings account.
The list of ailments that providers can treat through a screen is stunning. Shingles. Sinus infections. Bladder infections. All conditions many of us thought called for personal attention—the kind of attention that requires the health care professional to actually look at your throat or your sinuses or, heck, take a urine sample.
Clearly, that was then and this is now. “We’re starting to question the way we used to do certain things, such as the annual physical or the ‘laying on of hands,’” says Ben Green, M.D., medical director of CareSimple. “Maybe we were doing it because we’ve always done it. Now we’re asking, what’s best for the patients?”