Something old, something new in the push to connect on healthcare
It is no secret that health care in this country is changing as pressure mounts to shed traditional thinking to keep people healthier and to find new ways to deliver care. Memorial Hermann Health System has unveiled a series of initiatives called Everyday
Dr. David James, senior vice president and CEO of Memorial Hermann Medical Group and an architect of Everyday Well, sat down with the Chronicle to discuss not only the program but also how it fits into the shift toward consumer-driven health care.
His comments have been edited for length. Q: How was Everyday Well born? A:
It’s taken about two years. It comes out of our attempt to provide multiple ways for people to get primary care. There are retail sites, urgent care, employer on-site clinics, convenient care centers and traditional physician offices. There is also the complete revamp of our patient portal and televideo. That’s a bunch of different stuff with different names. We wanted to express this to the general public as a suite of services under one umbrella. This is primary care for you every day because every day it’s something. Today it could be, my kid pulled out the physical form for a school physical and it’s Sunday. The next day it could be I slipped and I hurt my ankle. So with all of these access points, you can get all of those things done every day. Q: What is the difference between the services, such as retail versus urgent care versus convenient care? A:
Think of it as a series of circles. The largest circle is every form of care. There, you’ll find highly complicated care, such as what happens in an ER. Then a smaller circle within that circle — the moderate to high complexity stuff — that can happen in urgent care. Then you take a smaller circle that is the lower to moderate complexity stuff that can be served in a retail site or through televideo. Then you come down to routine, ongoing preventative and chronic disease management, which is what happens at the physician’s office. It used to be that the only way people could get this kind of on-demand access was to go to the ER, which is horrifically expensive. We want to guide you to the right place for the right treatment. Q: When did you launch? A:
Everyday Well was hatched, worked on and perfected throughout the calendar year of 2016. We launched at Super Bowl Live this year. Q: You have been operational for a few months. How is it doing? A:
We are doing well. Mind you, all of these things are in their infancy. We don’t want to oversell and underdeliver, so we started in markets areas. It’s different things in different markets. We have most of our televideo happening in our southwest corridor. We have some other things that we are testing up in the Woodlands. We now have retail sites in all 22 H-E-B locations. We are taking care of a group of people in a specific market, and if we do well, we will expand from there. Q: Why is this type of consumer-driven health care important now? A:
There used to be a huge number of people who had employer-based health insurance that covered everything, and it covered it 100 percent. And Medicare was covering people who were living to age 67 or maybe 70. Now everybody is living longer, and on top of that, we can do more and more to keep you going. So the business model started to change. It used to be fee-forservice, and we would charge what the market would bear, and everybody paid 100 percent. That made for very lazy consumers because they didn’t have to know anything. People had no idea what they were getting billed and they had no idea how it got paid. Now with all of the cost-shifting that is occurring, people are becoming real consumers of medicine. The other piece is the complexity of people’s lives. Time has become an amazing commodity. Q: Is there still a place for traditional brick-andmortar health care, such as doctor’s offices and hospitals? A:
Let me speak to the physician office part. That piece of bricks and mortar still has a place. While increasingly taking the walls off the medical model allows people to get access to care without going there, for about 15 percent of the population, there is still a need for them to be taken care of in a traditional setting. They are the elderly, the people on multiple medications with multiple medical problems. Those are the folks who need to be seen with some degree of frequency, and it’s too complex to just do over the phone or on a televideo visit. These people live on the edge, and to keep them in good shape, we will need those bricks and mortar sites.
Q: But what about hospitals? Why continue to build when the shift nationally is away from hospital-centric care?
A: Houston is an anomaly. I’ll speak just for Memorial Hermann. What we looked at was a confluence of events, and it was a gamble. We had to think long and hard. But some of our facilities at the Texas Medical Center had gotten to such an age that they would no longer be able to pass inspections, no longer be able to satisfy Medicare requirements, and we were constantly turning away patients because we were full. Building that extra tower allowed us to upgrade some of those old areas and provide the capacity that looked like it was desperately needed. The other building that took place was taking a look at very highvolume, high-growth areas that either we weren’t in or, again, we were reaching capacity. Even in this downturn Houston’s population grew. The projections for growth are still pretty astronomical. Still, you ask yourself, man, that’s a lot of capital to commit to. But the cost of the capital at the time was probably about as cheap as you were ever going to get. Q: Is there a concern that you could one day wind up with empty beds? A: I think everybody would have that concern. The good news about the newer hospitals is that they are being built leaner and meaner, and they are easier to operate than older ones. It’s entirely conceivable that somebody out there is not going to make it. We are moving toward micro-hospitals next. The big ones will be full of people who are sicker. We’re still getting a more aged population. So even if we keep you healthier longer, eventually something is going to happen to you.