Everyone involved in health care could be forgiven feeling a little downhearted to read Dr. Steven Charlap's recent piece in The Atlantic on his decision to shut down his preventative medicine clinic in Florida. Long story short: The quality of care and patient outcomes were very good (as they tend to be in this field) but the practice didn't make money and was unsustainable.
This story perfectly illustrates the big questions not just in preventative medicine, but medicine in general.
• What are effective clinical models for preventing, managing and reversing chronic disease?
• How do we make it work for doctors?
• How do we scale this type of care to every American?
The answer may vey well come from not that far away, in fact just a few hundred miles away on Florida's gulf coast. Dr. Shilpa Saxena is a family physician with a practice in Lutz, Fla., which is hardly a innovation hub or metropolis, but her new innovative group visit model seems to have the potential to answer those questions and more.
The group visit concept is not new, but Dr. Saxena's functional medicine slant on it is. I first heard Dr. Saxena speak about it at Heal Thy Practice, an annual conference for primary care and other physicians to learn both the clinical and practical tools for transition to preventative and functional medicine models. Dr. Saxena spoke with great authority and humility about her lessons learned from developing this new model over the last five years.
The core benefits of the model match the three questions above perfectly.
What are effective clinical models for preventing, managing and reversing chronic disease? Functional medicine
How do we make it work for doctors? Scaled visits
How do we provide this type of care to every American: Affordability and accountability
Let's look at each of these in turn.
Firstly, the clinical model. Functional medicine is an emerging model that is built on a systems approach to chronic disease and is trumpeted in the media through gurus like Dr. Mark Hyman and Dr. Andrew Weil. It builds on lifestyle and diet modification, adding in innovative testing, more time with the patient, patient education and therapeutic supplementation. This model is working currently for those with the resources to afford it, but is not accessible to the whole country yet, financially or geographically.
Second, how do make this work for doctors? The answer, like any other successful business, is scale. Dr. Saxena's "magic number" for a group visit is 16, as it gives the right balance of scale and positive group dynamics. By billing for 16 visits in a typical 90-minute period, this provides scaled income and great return on a physicians time, specially when the education portion can be provided by a less costly provider, like a nurse, physicians assistant or health coach.
For the patient, the value of the 90 minute group visit is much greater than the typical seven minutes, at no more cost. According to another group visit innovator Dr. Edward Shahady "patients may actually learn more from their other patients than the physician" and goes further to say that "patients really want to hear what other patients are experiencing."
Also, given that the majority of the group visit is non-clinical in nature, the potential for doctors to provide these group visits in the workplace seems like a logical strategy for any CEO facing a looming long term healthcare cost explosion.
Thirdly, how do we provide this type of care to every American? The answers are affordability and accountability. Group visits provide an opportunity for doctors to offer their services to people without insurance or high deductibles, which will surely be a massive proportion of the country after the March 31 Obamacare deadline. If you are effectively paying cash anyway, you might as well find a good deal. Some providers are offering a weekly group visit for issues like diabetes, stress hormone imbalance and digestive disorders for as little as $30.
Another added value in the group visit model is accountability. Every effective weight loss system has added accountability as a component. My mother in law recently lost over 100 pounds without drugs or surgery, but it was the daily accountability about food that made it "switch" for her, and we must learn from other successes to build a sustainable future model of medicine.
When you add technology into the mix, the potential is even higher. With social media and wearable technologies are making it easier to encourage and empower each other outside of the visit itself, exciting times are ahead for medical stakeholders who can integrate technology seamlessly.
Dr. Charlap's experiment in Florida may have failed, but if we can learn from his mistakes and adapt to and innovate within the medical system we have now, it seems like a sustainable model for preventative medicine might close at hand.