All too often, going to the doctor feels like a chore – something we’d prefer to avoid but know we have to do. We all have our reasons for putting off care, but the current state of the healthcare system certainly doesn’t help. Healthcare is costly and difficult to access, and in many cases it’s hard to know if we’re getting the right care.
It doesn’t have to be this way. A growing number of innovative doctor’s offices are bringing much-needed advances to healthcare in the United States, emphasizing personalized care, convenience, telehealth, and transparent pricing. It’s all in an effort to help people stay happy and healthy – and stay away from the emergency room unless they really, truly need it.
Many of these new providers tout their approach as the future of primary care. (Dentists are getting in on the action, too.) The goal is to give people a one-stop shop for all their basic healthcare services, and to give them a hand if they need to receive care elsewhere. If you want to give employees more healthcare options, these innovative doctor’s offices are worth a look.
Why the current healthcare system is outdated
Healthcare in the United States needs a fix. There are three major reasons why: The cost of care, the inability to access care, and the challenge in getting the right care.
High cost of care
Simply put, healthcare in the United States costs too much. The Centers for Medicare & Medicaid Services pegged the total cost of healthcare spending in 2019 at $3.8 trillion, or nearly $11,600 per person. And it’s only going to get higher: CMS projects an annual growth rate of 5.4% until 2028, which outpaces the average growth rate of 3.6% per year since 1980.
We may lead the world in healthcare spending – it’s nearly 17% of our gross domestic product, which is 42% higher than the No. 2 country (Switzerland) – but we don’t have the outcomes to show for it. Among the 37 countries in the Organization for Economic Co-operation and Development (OECD), the United States ranks 33rd in infant mortality and 28th in life expectancy. Among the OECD nations with the highest average income, the United States dead last in overall healthcare system performance.
What’s worse? Employers are overspending on healthcare by the millions, too:
Why does healthcare cost so much in the United States?
- Waste: Whether it’s due to poor care, high prices, fraud, or administrative complexity, about 25% of all US healthcare spending can be considered waste.
- Lack of preventative care: Roughly 80% of healthcare spending focuses on care and treatment that addresses conditions that patients already have. That means there’s not much left to spend on improving physical health and mental well-being or trying to prevent chronic conditions such as Type 2 diabetes or high blood pressure.
- Types of care: Where people go also matters. Receiving care in a hospital emergency department is 10 to 12 times more expensive that going to the physician’s office – but if office hours are limited and urgent care is scarce, then people have no choice but to go to the ED.
Who pays for this? The average family premium for employer-sponsored health insurance is more than $22,000, with workers contributing about $6,000 and employers paying the rest of the bill. Workers can also expect to spend $1,500 per family member on out-of-pocket healthcare expenses. What’s more, the rate of increase for both insurance coverage and out-of-pocket expenses has outpaced the rate of inflation and workers’ wages in the last decade.
What’s the impact of these rising costs? In a word: severe. Americans have to borrow about $88 billion each year to pay medical expenses, only 39% of Americans can afford an unexpected medical expense of $1,000, and Americans have more medical debt than all other types of debt combined.
America has resorted to crowdfunding their medical bills. How can employers help?
Lack of access to care
The cost of healthcare is a major barrier to accessing care services, but it is by far not the only barrier. Here are five common reasons that people can’t or don’t access care.
- If health clinics are only open during normal business hours, then workers can’t see a doctor when the office is open. This is especially a concern for non-salaried workers: Taking time off during the day means not getting paid.
- There are fewer physicians and general dentists in rural areas that in urban areas, which leads to longer wait times and delayed care for those living in rural areas.
- About 3.6 million Americans annually are unable to receive medical care due to transportation issues. This could be due to lack of a vehicle, long distance, lengthy travel time, or a combination of factors.
- For conditions such as substance abuse or mental health, there may be a stigma associated with seeking help, especially among men.
- People may avoid going to a doctor if they don’t think it will help, especially if physicians haven’t listened to their concerns or they otherwise had a less-than-stellar experience.
Not getting the right care
Along with the high cost of care and the difficulty of accessing care, there’s a third problem with the current way we receive care: It’s not always the right care.
Some care is unnecessary. Physicians report that roughly 25% of medical tests and 22% of prescriptions are unnecessary; this overtreatment contributes about $100 billion in wasted spending. Physicians said three factors driver overtreatment: Fear of malpractice, patient pressure, and payment models that reward physicians on the volume of services they provide.
Some care is based on an old way of doing things. Many studies have shown that it takes an average of 17 years for research evidence to reach clinical practice. If physicians don’t know about new therapies or treatments, then patients miss out on the latest advances in healthcare.
And some care is so-called “textbook” medicine. Physicians have to balance the desire to provide personalized care with the drive to provide care based on standard best practices that are tied to care quality metrics, which in turn are tied to reimbursement bonuses or penalties. This could mean that physicians conduct assessments or order tests not because they’re in a patients’ best interest but because they have to hit the numbers.
The future of healthcare: A look at 10 innovative doctor’s offices
The current healthcare system clearly leaves a lot to be desired. It costs too much, it’s hard to access, and people don’t always get what they need. The good news? Many of you are already encouraging your employees to get more innovative about their healthcare:
So, what should the system look like? A quick look at 10 innovative doctor’s offices may shed some light on why accessible primary care is the future of healthcare.
Carbon Health brings primary care, urgent care, and virtual care together in a single experience. Offices include lab test and X-ray facilities, so patients don’t have to schedule another appointment elsewhere for services like blood work or flu screenings. Out-of-pocket costs are on full display, so bills won’t be a surprise.
CareMore Health emphasizes personalized and preventive care provided by a clinical team, which includes a role called an “extensivist” that helps patients coordinate appointments across multiple care settings. CareMore also is willing to partner with care providers outside its network who like how the care model works.
Coast Dental has more than 100 locations in three states. Along with in-person services that range from routine cleanings to oral surgeries to orthodontics and periodontics, Coast Dental offers virtual emergency exams – saving patients a trip to the office when they are in obvious pain.
Crossover Health brings together primary care, physical therapy, mental health, and fitness services. The organization offers tiered membership plans to individuals as well as employers. Crossover Health members can visit physical sites in three states or use a range of virtual care services.
Forward focuses on proactive care – but it’s more than just the annual wellness visit. Members have access to in-person and virtual services such as genetic testing, heart health monitoring, and personalized nutrition plans, all of which are designed to provide a complete view of health.
Heal emphasizes home-based care. That’s right, house calls are back. Heal specializes in primary care, preventive care, and urgent care. Pricing is transparent, physicians can refer patients for prescriptions or lab work, and Heal uses Apple Health to help patients and physicians share records and support care coordination.
One Medical offers same-day in-person and video appointments for primary care and urgent care. Membership also covers pediatric care – peace of mind for any parent who has contemplated a 3 a.m. trip to the emergency room. One Medical’s locations also offer onsite lab services.
Tend refers to its dentist offices as “studios,” and they’re meant to take the pain out of going to the dentist. Tend offers exams, cosmetic services, and major oral procedures – but dentists don’t make a commission, so patients won’t be pitched anything they don’t need. Offices are open 12 hours during the week and on Saturdays, so patients can get care without juggling schedules.
VillageMD emphasizes community-based and preventive primary care, coupled with easy pharmacy access
Zoomcare offers same-day urgent care, specialty care such as dermatology, orthopedics, and medical massage, and onsite imaging and ultrasound. Zoomcare makes it easy to schedule appointments online and to see how much a service will cost before heading to the doctor.
What do these innovative doctor’s offices have in common?
Personalized care. Preventive care. Virtual care. Onsite lab services. Convenient access. Transparent pricing. Help navigating the healthcare system. Now that’s what we like to see.
How to help employees take advantage of advances in healthcare
Whether they tell you or not, your employees are feeling the pain of engaging with today’s healthcare system. They may be putting off care because appointments are hard to schedule, because they don’t know how much it will cost – or simply because they don’t know where to start.
One way to solve this problem is to help employees take advantage of the advances in healthcare that we just talked about. New models of primary care and dentistry are opening up around the country, and their main goal is to make it easier for patients to get the care they need, when they need it, without jumping through hoops.
How do you do that? Let us show you the way.
Ask your health insurer
Major payers increasingly cover visits to these new types of care providers – meaning your employees could be using these services right now. Like their employer clients, payers see value in making preventive care easily accessible. It helps to prevent costly episodes of care, and it makes members happier to boot.
Make it a covered benefit
If your health insurer doesn’t cover these services, then perhaps you should. In fact, many of these primary care providers are happy to contract directly with employers located in their markets and offer a bulk discount rate. Over time, you may see enough of a decrease in overall healthcare spending to be able to offer membership to employees and their beneficiaries free of charge.
Spread the word
Make sure employees know that they have new primary care, urgent care, and/or telehealth options that are less expensive, easier to use, and much less scary than a trip to the emergency room. Hit ‘em with the facts – and make it part of your year-round benefits communication strategy, not just something you mention during open enrollment.
One way to encourage employees to use the new primary care benefit is to get everyone talking about it. Ask employees to talk about the positive experiences they have had and share the good news via email newsletter, video, podcast, or all-hands meeting. When employees hear it from their peers, they’ll know it’s worthwhile.
Don’t hide it
Too many employee benefits go unused. This shouldn’t be one of them. Make the new primary care or dental service front and center wherever you connect with employees – the intranet, the browser home page, your benefits engagement solution, you name it. The more your employees see it, the more likely they are to use it, appreciate it, and tell others about it. That will boost utilization, which will lead to happier and healthier employees and ultimately put more money in their pockets – and yours.