Alexandra Sifferlin
Aug 08, 2017
The future of health care in the U.S. is far from
settled, but how people receive it now is also undergoing a revolution. Health
records are antiquated, there's a shortage of primary care physicians and
access to birth control and emergency contraception is limited in some places.
Health and technology companies operating largely outside of the
standard health care system are attempting to solve these and other problems
with alternative approaches. Whether they have staying power remains to be
seen, but here are four compelling methods on the rise.
Video
chatting your doctor
It can take more than three weeks to get an appointment with a
new doctor, but now, people in all 50 states can visit a physician through
their smartphone. “Telemedicine has been touted as the next big thing for
several years, and I think it’s finally getting to a stage where adoption is
kicking in,” says Hill Ferguson, CEO of Doctor On Demand, an online video
chat app. The app provides a platform for more than 1,000 doctors and more than
one million users, Ferguson says.
Whether that means obtaining a prescription from your couch
or chatting with a therapist for 10 minutes at the office, video chat
visits are becoming increasingly common: By 2020 there could be an estimated
45.6 million virtual consultations performed in the U.S., according to data and
analysis company IHS Markit. Ad option of telemedicine in health care has
increased from about 54% in 2014 to 71% in 2017, and the use of telemedicine in
health care increased 9% from last year, according to April 2017 research from
HIMSS Analytics, a global healthcare IT market research group.
Telemedicine is also becoming a greater part of health care
treatment in rural areas, and more hospitals are embracing video
consultations. A May 2017 study found that from 2004 to 2014, use of
telemedicine for mental health visits among rural Americans on Medicare
increased an average of 45% per year. Virtual medicine is becoming more
specialized, too; Maven, a digital clinic catering to women that launched
in 2015, offers lactation specialists and midwives, for example.
There are some downsides to telemedicine. Rather than seeing a
consistent doctor or team of health care providers, telemedicine apps connect
people with physicians that happen to be available, though some allow users to
chat with specific doctors they like. Some research suggests that
virtual visits may not necessarily reduce health care spending, since more
people may obtain care for minor illnesses they wouldn't have otherwise, and
some doctors argue that reimbursement in some states isn't enough to invest in
the technology. But while it may never fully replace in-person appointments,
telemedicine could help cut down on unnecessary and costly trips to the
emergency room, especially now that more insurance companies are covering
digital appointments. Medicaid offers some level of reimbursement in 48 states
including D.C., and most private insurers do as well.
Birth
control delivered to your door—even without a prescription
Several online services are making it easier for people to get
access to birth control and other reproductive health needs, like Plan
B or PrEP, by delivering them. Companies like Nurx allow
people to order birth control online without a visit to a doctor’s office.
(Instead, a doctor remotely reviews the request.) Nurx prescribes and delivers
more than 40 brands of birth control pills, as well as the ring, patch and
emergency contraception. Shipping is free, and if people have insurance, the
service is free. For people without insurance, it’s priced at $15 per month.
Hans Gangeskar, the CEO of Nurx, says that while they're trying
to lower the price, Nurx is still a cheaper option than paying for a doctor’s
appointment and contraception. “It’s a two-to-three minute online interaction,”
says Gangeskar. Other similar services include PRJKT RUBY and The
Pill Club.
Pay-per-month
personalized care
Medical centers that accept cash, rather than insurance, are
on the rise, and they now number in the thousands. These primary care practices
are a way for Americans to get around high-deductible insurance plans . While
some centers charge flat fees for each procedure, another model is gaining
popularity. A clinic in San Francisco called Forward offers
comprehensive health exams and around-the-clock access to doctors for a monthly
membership fee.
Forward does not accept insurance. Instead, members pay $149 a
month for access to doctors' appointments, vaccines, generic medications, blood
tests, genetic screenings, around-the-clock chat privileges with a doctor and
other services provided on site. By working outside the insurance model, Adrian
Aoun, the CEO and founder of Forward, says the company is beholden to patients
instead. "We are the opposite of traditional health care," he says.
"You can come in as often as you need—instead of seeing your doctor once
or twice a year, they're in your pocket."
Some experts take issue with Forward’s use of full-body imaging
scanners, due to the negative consequences of over-screening where
there is always a risk for false positive results and over-treatment . But
Roeen Roashan , a senior analyst for digital health at IHS Markit, says he
believes that if the cost could be brought down to closer to $99, the approach
could take off. “More people will disconnect from institutional health care and
go to these independent providers who have nothing to do with the government,”
Roashan says.
The
return of house visits
A centuries-old health care approach is popular again. Concierge
medicine, where a doctor visits patients at their home, is regaining traction.
Heal, a medical concierge company available in California,
Washington D.C. and Northern Virginia, has been called the “Uber for Doctor
Housecalls.” Users download the Heal app and schedule an appointment with a
primary care physician who will visit them in their home (or wherever they
are). “ Traditional healthcare is mired in bureaucracy, inefficiency and
overload, so doctors push papers rather than see patients," says Nick
Desai, CEO and co-founder of Heal. "Patients either overuse the ER or
avoid doctors altogether. Understanding the home environment and having more
time with patients translates to savings for all.”
Heal doctors are available seven days a week, and the service
accepts insurance from major providers. Without insurance, an appointment is
not cheap, at a flat fee of $99. Heal is currently available in 200 cities, and
over the next year, Desai says he plans for Heal to be launched in 8 to 10
more. Other medical groups are taking advantage of the concierge model, too. In
August, the Home Centered Care Institute announced that it is
launching an education program to train 5,000 new doctors how to care for
elderly people in their homes. Training programs include prominent hospitals
like the Cleveland Clinic and Northwestern University Feinberg School of
Medicine.