Healthcare for the Rest

In my last post, I discussed some of the new startups and models of care targeting the top 1 percent. I’m not faulting any of those services or saying they aren’t valuable, but they are for now targeting customers who can pay.

Companies like Fitbit have a similar model and will ideally see more widespread use as they scale and conduct pilots with payers and hospitals. They get a disproportionate amount of funding because investors are cautious about betting on companies that rely on payment and practice reform.

That last post made me think about who is targeting the rest of the spectrum — people who can’t pay for them. As a reader’s comment indicated, “The universal in healthcare, for all people, is access to a good doctor when somebody needs one.”

Creativity and new approaches will be needed to "access" care. Patients will find it harder to see good doctors, but easier to see care managers and nurses in call centers and back offices. We’ll also see more automated messaging and data collection such as Healthloop. The goal is to be proactive in reaching out to patients and to overcome the lack of trust and motivation to access health resources. 

Here’s a good post about population health that discusses who is going to manage populations. It  concludes, "One thing is for certain: in the vast majority of cases, it will not be the physicians."

I can think of several organizations and services that are targeting underserved populations (i.e., those who can’t pay.) None of them are funded startups.

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ChenMed. ChenMed has been getting good press lately and is apparently growing rapidly. I spoke to ChenMed CTO Oliver Degnan a couple of weeks ago and was impressed with how many practices it is creating and by the technology platform it developed to power its model of care.

ChenMed started as a medical clinic in South Florida that served low- to moderate-income seniors. It embraces Medicare with a care model and technology platform that has demonstrated outcomes that include reduced admissions, reduced readmissions, and improved A1C and LDL results. It provides transport for patients, dispenses most medications at the clinic before patients leave, offers same-day appointments, and schedules regular monthly appointments. ChenMed takes on all of the risk in caring for Medicare patients.

This is like concierge medicine, with lots of touch points and patient panels under 400 patients per doctor. It’s an effective way to care for patients that are high risk and need higher levels of care. This seems like a good approach if systems can intelligently segment populations and manage high-risk groups with emerging evidence.

I’ve had recent conversations with direct primary care and concierge groups that are offering their care models as high-touch services to payers, using concierge models to manage risk for high-risk populations and using risk as a profit center.

ClearlyDerm.  This is a new model for a dermatology practice that wants to shift the paradigm from doing more. It offers derm services in PCP offices at hourly or risk-based rates. The goal is to improve access to dermatology care and make it affordable, although the company still offers cosmetic services for self-pay patients.

Text4Baby and other Voxiva messaging offerings for diabetes and smoking cessation. Text4baby is a messaging service for pregnant women and new moms. It has had great success in targeting underserved, largely Latino populations with educational messaging and information about medical and social services.

Academic Centers like UIllinois. I was on a panel with Ben Gerber, MD at the mHealth Summit and was impressed with the work he has done, mostly in pilots, with text messaging and underserved populations. Academic centers are doing a lot of interesting pilot work through grant funding and Dr. Gerber’s is just one example.

Integrated Delivery Networks like Denver Health (DH). Similarly to Ben Gerber at UIllinois, DH has successfully shown the potential of text messaging to improve patient activation and adherence to glucose testing. It also does lots of other very cool stuff around technology and patient care with great outcomes. It’s a system that I’ve always thought deserves more credit. DH serves a predominantly underserved, mostly Latino population.

Population Health Tools. To a certain extent, population health tools empower systems to care for patients by helping to segment and identify at-risk groups. What is needed, as the Triple Tree post above stated, are the processes and organization to then care for those at-risk populations.

Other great examples probably exist, especially considering academic medicine and integrated delivery networks. Startups may exist that target populations that can’t pay, although the two I can think of went through health accelerators and either pivoted or shut down. Please let me know of other examples if you have them.

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Travis Good is an MD/MBA and co-founder of Catalyze. More about me.

  • Hi Travis, obviously I have to say something here 🙂 There are a couple of nice sounding efforts in your list, that I didn’t know about, so thank you for that. However, I cannot and will not accept that improving health care means that “[p]atients will find it harder to see good doctors”. It makes no sense, and those technology enhanced non-physician services, should be in addition to, not instead of, a “good doctor” for the entire 100% without exception. I know I am largely tilting at windmills, and the decision-making 1% has this all figured out, or so they think…. We shall see.

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