We are a society of people who like to feel part of something. We fill our wallets with membership cards for stores or hotel chains and sign up to be part of an ever-proliferating number of online communities, to connect with friends and join circles. So, when a flier dropped in my mailbox offering me “membership” to a new primary care practice on State Street in Boston, I thought they might be on to something.
Concierge medicine is nothing new. But One Medical’s $199 annual fee is about one-tenth what many established concierge practices charge. The office takes most major insurance carriers, but no Medicaid patients. For those who are uninsured, there’s a flat-fee schedule for doctor visits. The company has offices in San Francisco, where it started, New York, Chicago, and Washington, D.C.
It will be interesting to see how the Boston office does compared with offices in cities where there are bigger populations of young professionals who are uninsured and looking for low-cost, high-value health care. Will people want to pay the membership fee, on top of other health care costs, for internet access to lab results, e-mail communication with their doctors, and convenient appointment times?
Shouldn’t those things be available today at most good doctor’s offices? One Medical’s growth to date strikes me as a commentary on just how far behind primary care may be in keeping up with modern expectations.
I talked with Jeffrey Levin-Scherz , the company’s chief medical officer, who has a long history with major Boston health care institutions, including Partners HealthCare and Tufts Health Plan and began working for One Medical this year. Some excerpts from our conversation:
What’s your best pitch for this practice? Why become a One Medical member?
The first thing we offer is really, really good access. We have physicians who are taking new patients. We generally offer same-day office visits. We give people access to our entire appointment schedule, so you don’t have to choose between three bad appointment times but you can see your options and optimize it for yourself. We have an iPhone app, where young women with urinary tract infections [for example] can answer questions about their symptoms. . . We have a group of nurse practitioners and physician assistants who call people back and confirm and can actually treat them or if there’s anything that sounds more worrisome, can expedite them and get people an appointment more quickly. We also offer full e-mail access to our physicians. . . Also, the offices look somewhat spa-like. We see people on time so people don’t spend much time in the waiting rooms, even though they are quite beautiful.
We don’t think of ourselves as a concierge practice. The fee is very modest compared to actual concierge practices. If you think about many concierge practices, they’re actually taking leave of the broken model, eliminating a large portion of patients, and then using that model, which works a lot better when there are fewer patients to be seen. We’ve really thought a lot more about what a model should look like, starting with a blank sheet of paper.
How many patients do you expect to serve at the Boston office?
We’ll have to see exactly what our patients need. We don’t know yet. I guess the answer will probably depend over time, but I think that we will really measure ourselves based on whether we’re meeting the needs of our patients rather than an exact panel of patients. . . There are two full time physicians there now and a third joining early next year. Basically we’re committed to having the right staff to meet the needs of our patient population.
Why open an office in Boston?
There is a pretty large amount of commerce that goes between Boston and San Francisco and amongst our San Francisco and New York and Washington base of patients. It seemed very clear that people felt there would be a demand in Boston, too. . . Word of mouth is the best way for us to attract new patients.
You’ve worked for some of the major, traditional health care institutions in Boston. Why did you move to One Medical?
I practiced primary care before medical executive roles. I continued to do some urgent care since then. I’ve been watching primary care for a long time and honestly the signs haven’t been that good. . . It’s been hard to recruit medical students into primary care, although things have been getting better in the last two or three years. Primary care physicians have been really unhappy and people I know have been somewhat unhappy [as patients] in primary care, too. . . So when I saw this model—easy to get into, nice offices, using technology well, looking to decrease waste in terms of not having people wait, not putting people on antibiotics when they shouldn’t be on antibiotics—I was very excited.
I’ve seen a lot of models that have been very physician-centric, and I’ve seen models that look like they would work but require everybody to be on capitation. . . This is a model that is sustainable. A lot of people said that this couldn’t be done.