Solutions have frequently been cited as a major part of the healthcare cost crisis. Their wide variation in how aggressively and expensively they treat sick patients is one example often cited. Their modest adherence to best practices in such treatment, barely over 50%, is another. Physicians have been criticized for not providing enough prevention, wellness, and risk reduction, as well as not managing chronic disease cost-effectively, though since they are rarely paid for such services, this can hardly be surprising.

But there are exceptions, and there have been significant recent moves toward creating practice models that balance sick care with true health care, protecting and improving patients’ health, managing their chronic conditions, and as a result, actually saving money for patients and payors. One example is the “concierge medicine” development, where physicians collect an annual retainer from patients, to cover the added costs of delivering health as well as sickness care.

The MDVIP organization of primary retainer practices has about 175 physicians practicing in 16 states the last time I checked. For an annual retainer of $1500-1800, they offer a comprehensive program of health protection and improvement to each patient, and with no more than 600 patients per physician, they have the time as well as money to do so. As a result, they have reported dramatic reductions in the average hospital and ER costs per patient, compared to patients in traditional practices in the same states. (www.mdvip.com)

An even more radical and recent example is the practice of Dr. Jay Parkinson, in New York City. He opened this practice on Sep 24, so it could hardly be more recent. It combines a “prepaid” visit program, where patients get up to two visits a year, the first to obtain basic information on each patients’ health history, current medications, etc., as a foundation for subsequent care. These visits are made at patients’ homes or work sites, since Dr. Parkinson does not operate an office practice, thereby keeping overhead minimal. In addition to these prepaid visits, patients get e-mail or phone consultations, referrals to specialized care when needed, prescriptions and advice for routine problems, and ongoing health or disease management support.

Dr. Parkinson intends this practice for adults aged 18-40, without traditional health insurance. It fits well with CDHP insurance, since the deductible may be satisfied, or at least largely satisfied by the prepaid payment, while the practices services will tend to keep patients from incurring the total deductible unless they are really sick. And the “catastrophic” insurance of CDHP, or any major medical insurance plan, would fill in for specialist physician, hospital, and other costs that exceed the deductible.

He also intends to help patients save money by having information about the prices charged by specialists, lab tests and diagnostic scans, prescription vs. generic drugs, etc. so that patients may choose the “best deal” available as they see it. And by promoting healthier lifestyles, risk behavior and condition reversal, and disease management, he will save them money on sickness care, if they cooperate in such efforts.

Unlike the MDVIP retainers of $1500-1800 per year, Dr. Parkinson charges $500, with additional house calls when needed at $200 each.

With unlimited access to phone, online ,video chats, instant messaging or wireless communication, patients may aim to lose weight, quit smoking, manage diabetes, reduce cholesterol, handle chronic migraines, improve fitness, diet, or any similar proactive health goal.

This practice is specifically designed to serve employers well, in addition to patients. The age group of 18-40 is most likely to be employed, compared to seniors, for example. By making worksite “house calls”, he saves employees the need to seek care elsewhere and lose travel and waiting time away from work. By making lower-cost CDHP insurance work better for employees, it helps employers save money on health insurance, while still offering it in order to recruit and retain employees.

Moreover, since protecting and improving employees’ health saves employers, the practice is one both could love for that reason alone. With proven savings from employee health management in terms of health, disability and workers compensation costs – absenteeism, presenteeism and turnover costs – and even improved quality, customer satisfaction and new business and their related revenue increases – employers could gain far more than just saved physician visit time.

Physicians who are aware of the potential savings from practices that focus on both sickness care and proactive health management may find an interested audience among employers. After all, a large number of employers, mainly larger ones, pay for onsite medical clinics to provide precisely this mix of services for their employees. Physicians in practices such as the MDVIP organization, and Dr. Parkinson’s “placeless” care, should represent a significant source of support for this model, to say nothing of their employees.