Club Troppo

This is an interesting article on things at the cutting edge of healthcare (if you’re a free market type).  If you’re not such a free market type, there may be some things at the other cutting edge of community medicine and other things - feel free to let us know in comments.

I don’t know what promise such things have to deal with mass health problems, but they are promising at least at the top of the tree. And the first extract below cites a real life example of what I’ve floated on this site a while back - medical advocates.

Best Doctors uses peer evaluations of physicians—polling 50,000 doctors worldwide in 400 medical specialties—to identify leading medical experts and then makes them available to 10 million patients in 30 countries. Normally, insurance companies limit patients’ access to specialists by requiring prior authorization for referrals, limiting access to preferred networks, or asking patients to pay more out of pocket. Patients whose employers offer Best Doctors, on the other hand, can go directly to the firm without prior authorization whenever they have serious medical problems and need help making decisions.

One such patient is John de Beck, a California teacher diagnosed with prostate cancer. De Beck faced a dizzying array of options, from cutting-edge robotic surgery to more traditional surgical, hormone, and radiation treatments. Since his employer had contracted with Best Doctors, John immediately had access to a “handler” who got John’s permission to send his medical records—including original biopsy slides and CT scans—to a Best Doctors clinical team. The team wrote a synopsis of John’s case and sent it to a leading Harvard expert on prostate cancer. Within a few weeks, John and his doctor got a binder from the expert that examined and explained his treatment options and made a personal recommendation for him.

Over the next year, John consulted with Best Doctors every time he needed to make a key decision about his treatment—for example, getting another opinion from a University of Chicago expert about a new type of radiation treatment, proton therapy. The depth of the reviews—and the fact that they came from leading experts who had no stake in his case—proved invaluable. “I can’t imagine, with the income that I’ve got, to be able to even find . . . somebody to personally review my case and write a personal diagnosis,” de Beck says.

“We trust patients to self-select,” Best Doctors president Evan Falchuk explains. “When they feel uncertain about something, they have the most interest in making sure things go right.” Falchuk hopes that Best Doctors is part of a growing trend toward more consumerism in health care—even in single-payer systems like Canada’s. “Even government-run systems are suffering from the same cost trends we are,” he says. Consequently, they are searching for ways to share costs with people, “and as the financial burdens fall more on individuals, those individuals want control.”

On reading this, I thought that it would be fine and dandy if Best Doctors - or someone similar - set up some internet service where you can get help by phone and internet for a reduced fee. Wonder if it exists somewhere and if it’s any good.

Also there’s this:

Instead of waiting for the system to change, some physicians are changing the system. In 2004, in Reston, Virginia, Kelleher and Mark Vasiliadis founded Executive Healthcare Services, where clients receive a full range of preventive, primary-care, and acute treatments for a flat monthly fee of $150 to $450, depending on the size of their families. There are no contracts; if EHS clients don’t feel that they’re getting value for their money, they can leave. Kelleher says that EHS’s patient-retention rate is about 98 percent.

This out-of-pocket payment model counters some of the system’s perverse incentives. “We can very frequently just discuss problems on the phone with patients, since 90 percent of the diagnosis traditionally comes from their history,” Kelleher points out. “If someone calls with elbow pain, I can spend 15 minutes on the phone with them. I don’t have a financial impetus to get them into my office.”

Comparatively high prices allow EHS to operate with just 300 patients or so, a stark contrast with the 2,500 patients whom the average primary-care doctor must serve in order to turn a profit after low insurance reimbursements. EHS’s enviable scale won’t work nationwide, Kelleher admits, but he thinks that components of his program could be modified to accommodate larger practices and lower prices. For instance, patients could bolster their current insurance reimbursements with a flat monthly fee—maybe as little as $20—and in exchange receive enhanced primary-care access (longer appointments, say) from doctors with somewhat smaller practices.