Category Archives: Current Health

“Systemness”: Which Delivery Model is Best?

Systemness (sĭs’tə-m nes) adj.

  1. Arrange according to a system or reduce to a system
  2. The degree to which something shares the attributes of a system

Last week I attended the World Health Care Congress Consumer Connectivity conference in San Diego. The Twitter stream was at near flood capacity, and several excellent speakers were present to share their ideas. Conference attendance was affected by the economic climate but I believe the course of dialogue, the information shared, and value of the networking still proved worthwhile.

I shared a panel with Jordan Shlain, MD the founder and Medical Director of Current Health. I served as an advisor to the company through the late summer / fall and participated in their launch in December at World Health Information Technology Conference in Washington DC. Our presentation was intended to focus on “Millennial Technologies for the Medical Home” but given the light attendance, we essentially abandoned our traditional presentation given the intimate setting. After a brief introduction from me regarding the notion of Millennial Patients demanding Millennial Care, Dr. Shlain spent the balance of the session sharing some of the reasoning, thought, and opportunity behind the “direct practice” concept of Current Health.

During the presentation, several examples of “fortress medicine” were shared, including some which highlighted some individual failures and market perceptions with Kaiser and other large providers. The conversation took a couple of pointed turns as several Kaiser employees were in attendance (including an excellent Twitter follow in @janoldenburg). As Dr. Shlain would highlight individual cases which created opportunity for Current, they were countered by persuasive examples and initiatives from the Kaiser team. Abstracting out the tone, the content of the conversation was instructive in terms of alternative models of care.

Integrated health delivery systems deliver better results, period. The evidence is overwhelming as identified by the Dartmouth Atlas and countless other studies. We need to move our country to more “systemness”, which implies coordination, teamwork, shared learning, shared responsibility, and a long term perspective with aligned financial incentives. This is why I love the vision and the promise of true “health systems” like Kaiser, Intermountain Health Care, Group Health, Geisinger, and others.

However, Kaiser and all of these systems, are not perfect (nor claim to be) and despite systemic results that are superior there are individual failings (which seem to find their way into the sensational or anectdotal) that creat opportunities for viable delivery method alternatives. The notion of the medical home, or its complementary concept of Concierge Medicine, is also a “system” of care wherein a single physicians assumes the role of integration and patient experience. Assuming accountability to deliver this “virtualization layer“ enables these physicians to approximate the degree of integration that leads to better outcomes. These organizational delivery concepts have been created to remove the clinical and financial friction and frustration inherent in our current system and deliver personalized care that is safe, effective, patient-centered, timely, efficient, and equitable. We are also starting to see the positive results from these early studies.

The bottom line, we can no longer tolerate our uncoordinated, fragmented, silo’d delivery mechanisms. We must create “systemness” through all the appropriate means as any production organization has had to do as well. The culture of quality and outcomes must be built into the health care processes themselves and their must be rigorous, ongoing improvements with shared learning as the results are captured. This systemness, by any means necessary, will be good for our nations health.



Filed under Current Health, Direct Practice, Health 2.0, Innovation, Leadership, Medical Home, Value

Hamster Wheel Medicine – Getting off the treadmill

Treadmill  (trĕd’mĭl) n.

  1. An exercise device consisting of a continuous moving belt on which a person can walk or jog while remaining in one place.
  2. A similar device operated by an animal treading a continuous sloping belt.

Today, Dr. Jordan Shlain and I opened the morning session of the 2009 WHIT Conference by introducing the notion of Direct Practice as a model for enhancing access, reducing costs, and improving quality. For this particular audience and presentation, I set the stage by introducing three themes:

  1. Health Care in Crisis
  2. Patients as Consumers
  3. Direct Practice as a Response

[splashcast c LPWW4807QZ]

This then set the table for Dr. Shlain to share his 10 year experience as a pioneer in this field. He described very intimate stories of the deep relationships, the personalized service, and the exceptional outcomes achieved. It was a truly powerful way to introduce what we believe will be the next wave of innovation in health care delivery. He closed by publicly unveiling for the first time Current Health (which I profiled yesterday) as the first branded primary care experience coming to a west coast location near you.

[splashcast c SYDW7482IU]

Given the time constraints, we were not able to take all the audience questions. I will post responses to these on shortly:

  1. What application are you using to send data to your iPhone?
  2. How do we get Americans to take care of themselves?
  3. You are speaking about General Practitioner from 80 years ago?
  4. You seem to be talking about non-universal healthcare?
  5. If more primary care docs see fewer patients with your model, how will we meet the burgeoning primary care needs of America?
  6. How many patients do you see at any one time?
  7. How does your model handle emergencies?


Filed under Conferences, Current Health, Direct Practice, Innovation, Medical Home, Quality, Transparency, Uncategorized, Value

Democratizing Concierge Medicine: First Look at Current Health

Current Health (kûrənt helth) n.

  1. Membership based, comprehensive primary care practice based in San Francisco area with plans to spread branded clinics throughout the West.
  2. Millennial version of the classic vision of a trusted physician who makes house calls.

As I have mentioned previously, I have been involved in some really cool projects recently that I believe are at the forefront of the wave of change that will soon wash over the health care industry as the “time for change” appears to be now.

<i>Current Health - Guardians of Your Health</i>

Current Health - Guardians of Your Health

With that preamble, I am thrilled to introduce you to Current Health (formerly San Francisco On Call) – The Primary Care Specialists. I have had the privilege to work with Dr. Jordan Shlain, David McKie, Vy Le, and the excellent team of physicians over the last six months to help transition the practice from a house call / urgent care focus to a membership-based, comprehensive primary care “medical home” for individuals and families who value their health as an asset.

The macroeconomic reasons for this transition at this time are well known. The American health care systems is in shambles. The United States currently spend 17% of Gross Domestic Produce on health care, a number which is anticipated to balloon to 25% over the next 15 years. Despite leading the world in terms of absolute and relative spending in the health care sector, the United States ranks ~35th in health metrics tracked by the World Health Organization. Serious questions have also been appropriately raised regarding the quality, efficiency, safety, and outcomes achieved by the US health system: 100,000 preventable deaths due to medical errors annually, approximately $700 billion spent in ineffective/unnecessary treatment, and consistent estimates of 30% waste associated with administrative inefficiencies.

These systemic challenges are compounded by a employment-based insurance model that has continued to fray as companies have been forced to reduce their health care offerings in order to remain competitive in the new global economy. This has resulted in real wage decreases, increased numbers of uninsured individuals, spikes in medical bankruptcies, increased costs due to delayed care, and misallocation of limited health resources. These challenges have directly affected health care providers who have experienced decreases in wages, job satisfaction, and control over the way they deliver care. Primary Care physicians have been particularly hard hit, and their former role as guardians of health has been minimized, displaced, or eliminated. This has lead to current and predicted severe primary care physician shortages at the same time that primary care has been identified as a necessary pre-requisite to low cost, high quality, and best outcome health care systems. Even if this shortage began to be addressed today, it will take approximately a decade to close this primary care gap.

Current Health is a response to the health system crisis in general and impending break down of the primary care speciality specifically. Our business focuses on elevating the nature of the patient physician relationship by creating a practice design whereby the patient, the provider, and optimal health outcomes are aligned. Current Health is a membership-based, direct-practice, comprehensive primary care delivery model. Our direct financial, administrative, and clinical relationship with the patient provides both the freedom and the flexibility to deliver optimal health care.  In its most basic form, it is a fresh perspective on the classic vision of a trusted physician who makes house calls.

Members pay an affordable membership for access to our practice and our physicians and are rewarded with a single point of health care accountability for all aspects of care. Members are assigned a care coordinator who oversees followups and proactive health maintenance. Members are invited to participate in their care through several engagement techniques as well as access to their personal health record which serves as the medium of communication with Current Health. Given our intense focus on delivering an unrivaled customer service experience, we ensure that our Members are informed, empowered, and connected to their physicians and the practice at all times.

Current Health plans to become a leading primary care brand that delivers on the promise of high touch service paired with unprecedented access to physicians. Our direct practice model, including centralized support of all health stores and effective use of technology, enables Current Health to democratize the concierge medicine experience for an entirely new generation of patients. Current Health creates an environment where clinical excellence, administrative efficiencies, and financial alignment can lead to best outcome care.

We look forward to documenting our journey in the coming months in this blog and other places. There will be alot of interesting things to discuss – providing conceirge experience for the masses, fee for service model, direct practice model, patient care coordination – and I look forward to helping each of you become Current.


Filed under Change Agents, Consumerism, Current Health, Direct Practice, Entrepreneurship, Healthcare, Innovation, Medical Home, Value