Luke*, a healthy 64-year-old man, was feeling increasing chest discomfort one night after work and texted his SHIFT doctor. Luke is a successful entrepreneur and long-time leader of his company, and stress had always been part of his life. Knowing Luke’s background of high blood pressure, elevated cholesterol, and a high stress existence, his doctor urged him to go to the ER. As Luke’s wife made the short drive to take Luke to the hospital, Luke’s SHIFT doctor was simultaneously able to connect with the team in the Emergency Department to explain Luke’s health history. Knowing these details, after a quick assessment, the ER doctor was able to determine Luke was having a small heart attack and ushered him quickly to the cardiac catheterization lab for a stent placement.
Luke attributes this health success story to his relationship with his doctor and the comprehensive care he has experienced since becoming a SHIFT member. Luke is currently in recovery and implementing preventative health strategies in partnership with his SHIFT team to make sure his heart health continues to stay on track for a long time to come.
A growing number of Americans, like Luke, are participating in a powerful movement of consumerism in the US healthcare marketplace. Over the past 20 years, consumers and have been highly dissatisfied with unsustainably high costs and greater disparities in service quality in healthcare. At the same time, physicians have become frustrated by growing pressure from hospital systems and investors establishing higher expectations and placing greater emphasis on the need to increase daily patient volumes in order to generate more fees, making the experience transactional rather than relational. Some major effects include radically shorter appointments, lower patient and doctor engagement, and greater patient frustration as they are left on their own to navigate through the complexity of healthcare system bureaucracy, care siloing, and the often inscrutable methodology by which certain visits and procedures are deemed covered or not covered by insurance. In search of a better solution, providers gradually started to experiment with alternative methods for delivering care and consumers became more open to testing them. The convergence of need and opportunity in the healthcare sector between these groups has since led to a veritable explosion of new options.
To help you better understand the differences among these options and make the best choice for your own healthcare needs, the SHIFT team offers a general map of the still-forming landscape of primary care service models and a question set to guide you in your own personal decision-making process.
What are some of the new approaches to primary care?
Each care model in this new marketplace promises different benefits and features that you are unable to receive typically through your traditional doctor’s office. Some offer quicker direct access, some promise a deeper relationship with your physician, and some provide high-tech tools to track activity and provide data-driven insights based on statistical averages. Naturally, many of these features are promoted and used in different ways, which makes categorizing providers into easily segmented categories difficult. Nevertheless, here are a few that have been rising in popularity and what they entail broadly speaking:
Concierge Medicine – Involves more personalized comprehensive care, often including amenities such as 24/7 access, extended appointment times, wellness coaching, and advanced diagnostic testing. Typically accepts insurance in addition to a monthly or annual fee.
Direct Primary Care – Involves a monthly or annual fee paid directly to a clinic to address all primary care needs and which typically promotes that your physician has a smaller patient load. Does not accept insurance.
Advanced Primary Care – Similar to direct primary care, this approach usually includes additional screening compared to usual medical practices in the form of supplementary routine labs or imaging. The specific additions are highly variable from one practice to another.
Walk-in Retail Clinics – Often located in chain pharmacies, supermarkets, and retail stores, these clinics offer no-appointment-needed healthcare services for common ailments and are typically delivered by physician assistants and nurse practitioners. These groups work with most health insurance providers.
High-tech Hybrids – Companies that have both virtual and in-person care, with a traditional office visit, a video chat, or an app that offers an initial diagnosis and in-person or phone call follow up as necessary. Users frequently speak with different care providers who access existing patient records to address need. Some accept insurance, others charge membership-based fees.
While each model above has potential benefits and limitations; and, as these are still relatively new, there has not been much research published on the differences on long-term health outcomes associated with using a one approach or another.
I am considering a non-traditional primary care model – what questions should I be asking?
There are many factors to consider when selecting a traditional primary care doctor – including proximity to home, network status with one’s health insurance carrier, availability for new patients, and known reputation, just to name a few. However, when you are pursuing a different model of primary care, there are several other questions you may want to consider asking—the answers to which you can weight in terms of relative importance for yourself and your family—to make an informed decision.
- What is important to you? Is it more important for you to build a real relationship with your doctor or are you just looking for easier access when you’re sick? How much are you willing to spend?
- Will I have the same doctor to communicate with? If not, does the doctor work closely with the other physicians within the practice or am I “starting over” each time?
- Does the doctor spend a significant amount of time with each patient? Does he/she dig in at the initial visit to learn more deeply about your life and the lifestyle factors that might be contributing to the state of your health?
- Does the doctor offer a longer executive physical-style yearly assessment?
- Is the doctor connected with various specialists and hospital systems throughout the country? Can they expedite appointments or help “get me in” if necessary?
- Is the doctor’s practice collaborative and are there other specialists/ healthcare experts on staff?
- Do I have a preexisting condition or a family history that requires additional attention?
- How quickly can I be seen for acute issues? Does the doctor offer same-day and telemedicine appointments?
- Do I receive the doctor’s direct information, or do I need to communicate through administrative staff or a portal system?
- What is the doctor to patient ratio?
- How much are you willing to spend?
- What are the out-of-pocket costs associated with seeing this doctor? If it’s a membership model, does that cover unlimited visits and access? What is not covered in the membership?
Seeking primary care outside of the traditional model can be a big decision, so it is important to do your research and understand what you value most in your primary care experience to choose a practice model that aligns best with your needs.
What is the SHIFT model and what makes us unique?
In building our practice at SHIFT, we considered these questions (among many others from the healthcare consumers perspective) and analyzed the existing models before finalizing our initial blueprint for primary care delivery. We believe that everyone should have access to high-quality care. Our approach to primary care is one that incorporates low doctor to patient ratios, a simple, straightforward financial arrangement (membership-based), access to an array of specialists (not tied to an institution or hospital system), with a focus on establishing deep and meaningful relationships between patients and their physicians.
What makes SHIFT innovative and different from other models of care, is that our practice is designed to put building health at the foundation of everything that we do. Many of the other alternative methods of primary care are predicated on a sick care approach to medicine – sort of a “diagnose and prescribe” reactive mindset, so that while they may improve some aspects of one’s healthcare experience, the approach is still reactive and no different than traditional care. At SHIFT, we understand the importance of providing high-quality, swift care to patients when they become sick—but for us, care doesn’t start or end there. Our physicians work side by side with in-house dietitians, physical therapists, and fitness coaches to provide a comprehensive and proactive approach to enhancing each person’s quality of life, working together to not only increase lifespan, but also healthspan, or the part of a person’s life spent it good health. We spend a great deal of time learning about the context of your life in order to help you develop and maintain positive health habits, knowing that better health isn’t built in our doctor’s offices, but in the everyday choices you make.
What our model at SHIFT hopes to achieve is not simply the promise of a “good” or “fast” experience at the doctor’s office. For us, it is about delivering excellent care regardless of need, and providing you with the information, tools, and support to build health and a longer, happier, more fulfilling, and more enriching life.
In Real Health,
The SHIFT Team