Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

An organic effort to reboot healthcare

Zubin Damania, MD
Physician
April 30, 2014
103 Shares
Share
Tweet
Share

For the better part of a decade, I practiced inpatient hospital medicine at a large academic center (the name isn’t important, but it rhymes with Afghanistan … ford).

I used to play a game with the med students and housestaff: Let’s estimate how many of our inpatients actually didn’t need hospitalization, had they simply received effective outpatient preventative care. Over the years, our totals were almost never less than 50%.

For my fellow math-challenged Americans: that’s ONE HALF! Clearly, if there were actually were any incentives to prevent disease, they sure as heck weren’t working.

In a country whose care pyramid is upside down — more specialists than primary care docs, really? — we’re squandering our physical, emotional, and economic health while spending more per capita than anyone else. Four percent of our healthcare dollars go towards primary care, with much of the remaining 95% paying for the failure of primary care. (The missing 1%? Doritos.)

Worse still, the oppressive weight of our non-system’s dysfunction falls disproportionately on the shoulders of our primary care providers — the very instruments of our potential salvation. To them, there’s little solace (and plenty of administrative intrusion) in the top-down reform efforts of accountable care organizations and “certified” patient-centered medical homes.

But what about a bottom-up, more organic effort to reboot healthcare? A focus on restoring the primacy of human relationships to medicine, empowering patients and providers alike to become potent, positive levers on a 2.8 trillion dollar economy? What if we could spend twice as much on effective, preventative primary care and still pull off a net savings in overall costs, improvements in quality, and increased patient satisfaction?

What if George Lucas had just quit after the original Star Wars series? Wouldn’t the world have been better without Jar Jar Binks?

While the latter question is truly speculative, the former ones aren’t. We’re trying to answer them in Las Vegas (hey now, I’m being serious) at Turntable Health, where we’ve partnered with Dr. Rushika Fernandopulle and Cambridge, MA based Iora Health.

We aim to get primary care right by doing the following:

1. Fix incentives. Fee-for-service reimbursement structures encourage providers to do things TO people, instead of purely FOR them. My father, a dedicated primary care doc, used to encourage me to specialize because “there’s $500 in everyone’s colon. Go in with a scope and retrieve it!” This ridiculous incentive system has no place in primary care where it rewards episodic rushed sick-care visits (with often unneeded referrals and testing).

By banishing fee-for-service insurance in favor of a flat-fee membership model, we incentivize strong relationship building and longitudinal population management. Ditching insurance billing means up to 20% less overhead and 2434.76% less aggravation. We eliminate copays and barriers to care, encourage use of convenient methods of patient engagement (phone, video, email, group visits, yoga classes), and free providers to focus on outcomes, cost, and patient satisfaction for their entire panel.

Unlike “concierge” models reserved for the wealthy, our services are offered with wrap-around insurance plans by the not-for-profit Nevada Health CO-OP and are eligible for federal subsidies on the state health exchange. That’s a model that puts the “care” in Obamacare, folks.

2. Shift the culture. There’s no “I” in “team” and but there’s a “we” in “well.” Apart from making the lamest bumper sticker ever, this sentiment is valid and should drive a new culture of care away from cowboy autocracy and towards non-hierarchical, collaborative teams where everyone practices at the top of their training. We have doctors working with nurses and licensed clinical social workers, but the unique twist comes with our health coaches.

Drawn from the very communities they serve, they’re hired for empathy and emotional intelligence and trained for the skills needed to motivate and support patients in setting and attaining goals. Each morning our full care team “huddles” to discuss all the patients who are to be seen that day, and all the patients who AREN’T but who merit outreach to keep them out of trouble.

There’s teaching, learning, and feedback. It’s goose-bump inducing stuff, folks, and should inspire our young physicians-in-training.

3. Make tech the glue. Most electronic health records are glorified insurance billing platforms with some patient care stuff thrown on top. So our partners Iora Health had to build one from scratch. Issue-based, with seamless assignment of tasks to a members of the collaborative team, it facilitates effective preventative population management while stripping away boilerplate nonsense designed to please no one but a bean counter at an insurance company.

Patients can read (and soon write in) their record because, well, it’s THEIRS, isn’t it? Tech should create connections, not barriers.

The results of all this? Significant improvements in hypertension, diabetes, and depression control. Evangelical patients whose satisfaction scores skirt the 90% range. Providers who love coming to work each day.

And an overall reduction in costs DESPITE the higher upfront spend on primary care. It’s the Wikipedia definition of “no brainer.”

Which is why academic medical centers should be exposing their trainees to what we and others, like ChenMed and Qliance, are doing to innovate in primary care. They should implement similar clinical models for their own institutions, models that encourage collaboration and break down hierarchical, autocratic structures.

Because what’s better for patients is also better for students, who know full well that they are entering a horribly dysfunctional system. We’ve seen how inspired they become when they see primary care at its best, when doctors are freed to simply do the right thing for patients. They recognize that this is what the future of healthcare needs to look like.

And it could look like this, if academic medical centers step up and become part of the solution.

Zubin Damania is CEO and founder, Turntable Health. He can be reached on ZDoggMD and on Twitter @ZDoggMD. This article originally appeared in AAMC Reporter.

Prev

Quality of life: We say it, but do we mean it?

April 30, 2014 Kevin 3
…
Next

Why doesn't everyone have a pocket ultrasound machine?

May 1, 2014 Kevin 26
…

Tagged as: Primary Care

Post navigation

< Previous Post
Quality of life: We say it, but do we mean it?
Next Post >
Why doesn't everyone have a pocket ultrasound machine?

More by Zubin Damania, MD

  • The truth behind that Baltimore patient dumping video

    Zubin Damania, MD
  • A love letter to those on the primary care journey

    Zubin Damania, MD
  • We need to demand technology that lets doctors be doctors

    Zubin Damania, MD

More in Physician

  • Lively communication in the service industry

    Deepak Gupta, MD
  • Reigniting after burnout: 3 physician stories

    Kim Downey, PT
  • Inside the grueling life of a surgery intern

    Randall S. Fong, MD
  • The shifting landscape of gastroenterology manpower and compensation

    Brian Hudes, MD
  • Surgical procedures for inpatients: Addressing socioeconomic urgencies

    Deepak Gupta, MD
  • I’m a doctor, and I almost died during childbirth

    Bayo Curry-Winchell, MD
  • Most Popular

  • Past Week

    • Reigniting after burnout: 3 physician stories

      Kim Downey, PT | Physician
    • I’m a doctor, and I almost died during childbirth

      Bayo Curry-Winchell, MD | Physician
    • I’m tired of being a distracted doctor

      Shiv Rao, MD | Tech
    • Inside the grueling life of a surgery intern

      Randall S. Fong, MD | Physician
    • Ketamine for mental health conditions: What every primary care physician needs to know

      Carlene MacMillan, MD & L. Alison McInnes, MD | Meds
    • Physician autonomy and patient interactions in corporate health care

      Michele Luckenbaugh | Conditions
  • Past 6 Months

    • Medical gaslighting: a growing challenge in today’s medical landscape

      Tami Burdick | Conditions
    • Balancing opioid medication in chronic pain

      L. Joseph Parker, MD | Conditions
    • I want to be a doctor who can provide care for women: What states must I rule out for my medical education?

      Nandini Erodula | Education
    • Mourning the silent epidemic: the physician suicide crisis and suggestions for change

      Amna Shabbir, MD | Physician
    • Reigniting after burnout: 3 physician stories

      Kim Downey, PT | Physician
    • 1 in 4 attempt suicide: the persecution of autistic physicians

      Patricia Celan, MD | Physician
  • Recent Posts

    • Physician autonomy and patient interactions in corporate health care

      Michele Luckenbaugh | Conditions
    • PSA screening: What you need to know [PODCAST]

      The Podcast by KevinMD | Podcast
    • Vague criteria can lead to misdiagnosis and prison

      L. Joseph Parker, MD | Conditions
    • U.S. maternal mortality crisis: a deep dive

      Alan Lindemann, MD | Conditions
    • Lively communication in the service industry

      Deepak Gupta, MD | Physician
    • Contemporary weight loss: Unveiling the quest for elusive elixir

      Osmund Agbo, MD | Conditions

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 17 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

CME Spotlights

From MedPage Today

Latest News

  • 'Not Clear If the Juice Is Worth the Squeeze': What We Heard This Week
  • Avoiding Male Doctors Is Not Discrimination. It May Be Risk Aversion.
  • What Is the 'Carrot Tan' Trending on Social Media? A Dermatologist Weighs In
  • Did Gabapentin Improve Post-COVID Olfaction?
  • Fentanyl Death Trends; Food Additives and Heart Disease

Meeting Coverage

  • Loneliness Needs to Be Treated Like Any Other Health Condition, Researcher Suggests
  • Stopping Medical Misinformation Requires Early Detection
  • AI Has an Image Problem in Healthcare, Expert Says
  • Want Better Health Outcomes? Check Out What Other Countries Do
  • ERS Roundup: Cell Transplant Boosts Lung Function in COPD Patients
  • Most Popular

  • Past Week

    • Reigniting after burnout: 3 physician stories

      Kim Downey, PT | Physician
    • I’m a doctor, and I almost died during childbirth

      Bayo Curry-Winchell, MD | Physician
    • I’m tired of being a distracted doctor

      Shiv Rao, MD | Tech
    • Inside the grueling life of a surgery intern

      Randall S. Fong, MD | Physician
    • Ketamine for mental health conditions: What every primary care physician needs to know

      Carlene MacMillan, MD & L. Alison McInnes, MD | Meds
    • Physician autonomy and patient interactions in corporate health care

      Michele Luckenbaugh | Conditions
  • Past 6 Months

    • Medical gaslighting: a growing challenge in today’s medical landscape

      Tami Burdick | Conditions
    • Balancing opioid medication in chronic pain

      L. Joseph Parker, MD | Conditions
    • I want to be a doctor who can provide care for women: What states must I rule out for my medical education?

      Nandini Erodula | Education
    • Mourning the silent epidemic: the physician suicide crisis and suggestions for change

      Amna Shabbir, MD | Physician
    • Reigniting after burnout: 3 physician stories

      Kim Downey, PT | Physician
    • 1 in 4 attempt suicide: the persecution of autistic physicians

      Patricia Celan, MD | Physician
  • Recent Posts

    • Physician autonomy and patient interactions in corporate health care

      Michele Luckenbaugh | Conditions
    • PSA screening: What you need to know [PODCAST]

      The Podcast by KevinMD | Podcast
    • Vague criteria can lead to misdiagnosis and prison

      L. Joseph Parker, MD | Conditions
    • U.S. maternal mortality crisis: a deep dive

      Alan Lindemann, MD | Conditions
    • Lively communication in the service industry

      Deepak Gupta, MD | Physician
    • Contemporary weight loss: Unveiling the quest for elusive elixir

      Osmund Agbo, MD | Conditions

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

An organic effort to reboot healthcare
17 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...