While numerous and varied healthcare reform gurus have suggested numerous and varied solutions to the healthcare crisis, physicians, employers, and other stakeholders in the “system” have already initiated their own.   There are four specific medical care innovations, for example, that have created a mixed “sickness and health” model for delivering real healthcare, with increasing focus on health, as well as sickness.

Concierge Medicine

This innovation is not the oldest, but is certainly one of the more successful, both in growth and in health results.  I have a list of over 200 organizations engaged in “patient-paid medicine”, and know of over 700 physicians involved in either these organizations or private practice examples thereof.  The vast majority of these mix health management with sickness care, often in a close to 50/50 mix overall, though the mix for individual patients can vary widely.

While the MDVIP organization of over 150 physicians is the only one that I know of that has reported results of its model of health and sickness care, it has described dramatic reductions in the use of expensive sickness care, such as hospital inpatient care, among both commercially and Medicare insured patients served by its practices.  These reductions range from 30% to 90% across the states where comparisons have been done with patients served by traditional primary care. (www.mdvip.com)

Worksite Medical Clinics

Employer-sponsored medical clinics have been offered by large businesses for decades, though most used to be limited to occupational medicine and work-related injuries.  Many of those limited to sickness care closed as employers found them an insufficient and expensive solution to rising healthcare costs.  But there has been a resurgence in this innovation, mainly including health along with sickness care, and promoting risk reduction along with general wellness, to reduce the incidence and prevalence of sickness, along with eliminating the need for employees to go elsewhere for sickness care.

Employers have frequently developed their own clinics, though firms specializing in operating such programs, such as Concentra (www.concentra.com) which operates in over 200 locations across the US, can bring in “outsourced” programs.  Quad/Med is the medical care division of Quad/Graphics, a major printing firm in Wisconsin, and uses its experience as an employer to help other employers set up and operate onsite medical clinics of their own.  Whole Health Management in Cleveland is another example of outsource clinic managers.

It is the emphasis on health and wellness, along with risk reduction that makes these onsite clinics different from former occupational health programs aimed mainly at reducing employee time away from work getting sickness care.  These new clinics enable employers to reduce healthcare, workers compensation and disability costs, but also worker absences and impaired productivity/performance at work, greatly multiplying the benefits of a healthy workforce, to the employees as well as the employer.

Retail Clinics

These rapidly increasing innovations fill a niche as convenient, low-cost alternatives to physician practices and hospital ERs.  While most are staffed by nurse practitioners, whose limitations rather than advantages seem to get most of the attention from physicians, there are many “urgent care” clinics staffed by physicians as well.  Their location and hours-of-availability convenience are widely popular among consumers, though controversial among physicians.

While the major emphasis of these clinics is on routine sickness care, along with immunizations and school physicals, their potential value as sources of inexpensive and convenient health management services has also been recognized.  A reader’s comment to a bog story (“Some Health Systems Out to Beat Retailers at the Clinic Game” Wall Street Journal Health Blog May 16, 2007] suggested that Wal-Mart-based clinics would be great places for checking blood pressure, blood sugar, weight, etc. in conjunction with primary-physician-based health management.  But most physicians do not really manage health, and most insurers have no codes for billing such services.

At least one retail clinic chain, RediClinics, has a “Stay Well” as well as a “Get Well” program, with health management services at affordable prices, just like its sickness care services (www.rediclinics,com).  It offers preventive services such as risk condition and chronic disease screening, smoking cessation, etc. for as little as $19, more complex screening men’s, women’s and heart health packages for $59+, and cholesterol challenge packages starting at $5.  The full potential for retail clinics to become major sources of ongoing health management support for consumers is only beginning to be recognized.

As primary physicians continue to be in short supply, and this form of sickness care practice loses even more of its luster for medical school graduates, the health management side of healthcare may offer new reasons for physicians to choose one of these innovative options.  Physicians may be the sole or major health manager for patients, the leader of a more cost-effective team approach, or merely stay informed about services provided by nurse practitioners through close communications therewith.  All three at least have the advantage of working toward what virtually all healthcare stakeholders are hoping for – reduced incidence, prevalence, and financial as well as life quality costs of sickness.