Tweaking the Model for Healthcare Delivery

PHOTO: WELLCOME TRUST

Urgent care was a major disruptor to the U.S. healthcare delivery system. Telemedicine is arguably positioned to be the next major disruptor to healthcare delivery. But there is clearly space in the landscape for other models. WBUR reports that Jeff Gold is breaking ground as the first Massachusetts physician to practice under the direct primary care model. Gold doesn’t take insurance, but rather charges a flat monthly fee for one-hour, same day appointments. He also makes himself available via text message, Skype, and email. Moreover, he makes house calls.

The Dallas Morning News reports that Jonathan Clarke offers his own version of house calls, where he meets patients at their place of employment. Clarke, who is an emergency physician, launched a house call app called Mend, and currently has six physician assistants and nurse practitioners who go on the house calls.

Like Jeff Gold, Mend doesn’t accept insurance. Unlike Gold, who uses a monthly fee model, Mend uses a fee-per-appointment model. Both appear to appeal to patients who have insurance, but who have high deductibles – as well as those who value convenience over cost.

From a regulatory standpoint, the question is whether or not paying a doctor (such as Gold) a monthly fee constitutes a new form of insurance. Massachusetts is in the process of deciding whether Gold should be regulated as an insurer. WBUR reports that 13 states have determined that direct primary care isn’t insurance, but the jury is still out in other states.

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