One downtown office building has something unusual on the 28th floor. No, it's not the breathtaking view of Boston, the harbor, or sleek furniture. This one feels like a salon or spa, with music playing in the background and a killer magazine selection. Welcome to One Medical — the new face of healthcare that just opened a new practice in downtown Boston. Founder Tom Lee said he looked at the hospitality industry for inspiration.
“So what we’ve looked at is best of breed hospitality industry, restaurant industry and hotels, and asked ourselves, why doesn’t that exist in healthcare?” Lee said.
Health care that resembles restaurants and hotels may sound like a stretch when one thinks about the doctor visit. The whole thing can be a production. The rigmarole of finding a parking spot, checking in with the receptionist, and long wait time can be wearisome. Not to mention the decor — the uncomfortable chairs in the waiting room come in colors that could be named, “medical mauve” or “institutional teal." But one can distract himself by flipping through a worn back issue of People magazine. At One Medical, it’s a different story.
“For us, when you arrive, you’re seen on time. Most of our visits, over 90% are within the first few minutes of actually arriving. And then your visit with the doctor is much more extended, so you have more time to have a conversation and discuss what your personal issues are,” Lee said.
Nurse Technology Will See You Now
No wait time and longer visit? How does that work?
“So what we tried to do is design an economic model that allowed us to spend more time with patients,” said Lee. “And ultimately, the way we did that, we used technology to lower our overhead and that allowed us to then spend more time with patients.”
The staff that one typically sees in a doctor’s office — medical assistant, nurse practitioner, maybe a billing person are not there. The money that would go toward paying an office staff goes into One Medical’s technology and software. There’s even a triage app that patients can log into on their smart phones and inquire about symptoms, request prescriptions, or book their own appointments. Patients also can e-mail the doctors at One Medical anytime.
“Which sounds pedestrian in the modern era but in health care, it’s a big thing because of the way it’s structured and financed,” Lee said.
The Catch— Class Warfare?
That’s because doctors don’t get paid for the time spent e-mailing or calling patients. In a traditional practice a doctor sees 25-30 patients a day. The doctors at One Medical dedicate a chunk of time every day emailing their patients, so they are able to see an average of 15-16 patients in person, and this lets them spend more time with them. But this kind of access comes with a catch—a $200 annual fee. That may not sound like much to those willing to pay a premium for quicker and easier access, but that’s what concerns Joseph Gravel, President of the Massachusetts Academy of Family Physicians.
“The concern I have with people paying out of pocket like that for a fee is that you will start seeing the development of multiple tiers of healthcare. And I think that goes against what the country needs,” said Gravel.
Gravel is also the Chief Medical Officer of the Lawrence Family Health Center.
“A $200 fee or any annual fee really is cost-prohibitive for many people. Certainly for the patients that go to community health centers, $200 is a lot of money,” Gravel said. “Unfortunately, I think the model may not work in a lower income community. But I think what it really is saying is that people are having trouble with access. They’re having trouble with communication with their physician.”
Dr. Who Will Become Dr. Where
Another factor to the access problem is the growing shortage of doctors. The Association of American Medical Colleges says there will be a shortage of almost 66,000 primary care physicians by 2025. Gravel says the burnout element is leading to another problem — more and more physicians are reducing their hours because the workload is too overwhelming. Could One Medical’s model be a potential fix to deal with physician burnout? Gravel says while innovative, their model is only a temporary solution to a systemic problem.
“I think primary care in a large part is really dying a death of a thousand cuts,” Gravel said. “And these are band-aids to some of those cuts but what we really need is structural reform in how we pay primary care physicians, and that structural reform needs to take into account non-office-based work.”
New Model Meets Old Profession
Back at One Medical, on the 28th floor of 28 State Street, the moody pop rock of Arcade Fire spills out of the speakers as Tom Lee is framed by a panoramic view of Boston and the harbor — an untraditional though fitting backdrop for this new medical practice. While Lee agrees that systemic changes need to happen deep within the healthcare infrastructure, he’s moving forward with his model, opening One Medical’s 20th location by the end of the year.
“I think people are so used to one thing. You can either have this or this. And that’s the beauty of innovation — you can actually have higher quality care and service at a more affordable price,” Lee said. “It can also be lower cost for the system. And a big part of it is innovation, using technology, using a more creative process to make something work better.”
When it comes to an institution as huge as healthcare, any modification can be daunting, but the only way to find out if another model works better is by taking a risk and trying it out yourself.