Costs can change only if there are new different processes to solve the same problems.

Last week, I defined the characteristics of each new primary care model in America and, in the following post, determined the kind of person who would most benefit from each new model.

This is important because primary care is literally just a process. And you’ve got to design and build the process that’s best able to solve specific problems. Since we all don’t have the same problems, we all need different processes— not just the doctor in an exam room.

A process can be extremely streamlined and efficient, or…like in today’s traditional primary care, far from a well-oiled machine. Most importantly, the efficiency of the process is what determines cost.

Inefficiencies are expensive.

Remember prior to Uber, when you were traveling, and you needed a taxi? The steps to get a taxi were time consuming, there was no guarantee anyone would show up, and you never knew how much the trip would cost you. Uber made that entire annoying process as simple and transparent as possible and 3 minutes later, it worked like magic.

Uber became uber because they gave you one ridiculously simple online place to go.

And that place could take you to your friend’s dinner party a few neighborhoods away or to the airport on your two year journey around the world.

Primary care shares these two functions:

  • An entry point to get care for simple to moderate conditions
  • A launching point for more specialized care

The first thing that’s missing in primary care is the one simple online place to go to get care.

That’s the single required step that opens up a whole set of tools that power data-driven new efficiencies. Until that exists, healthcare will be stuck in the pre-Uber era.

The second thing that’s missing is the ongoing anytime/anywhere relationship that streamlines/coordinates downstream in-person care throughout all complicated health issues.

Ultimately, there is no way to affect costs in anything without a fundamentally new process.

An established auto assembly line can impact costs by, say, switching to an incrementally less expensive paint supplier, but that’s going to yield only tiny savings.

There is no way to affect costs without a fundamentally different way to solve the same problems.

Tesla invented a whole new product that solved the same problem in a different way— “What if the world’s fastest car didn’t run on old-fashioned gasoline?” It’s still a car and solves the same “get me from Point A to Point B” problem, but it uses an entirely new kind of energy and takes advantage of all those new things using a new energy source unlocks— like traveling from Point A to Point B with energy exclusively from the sun.

Primary care needs a new definition, a new process, and a new business model.

The traditional definition of primary care from the last 100 years goes something like:

“A singular doctor in an office located in a physical space using exam room conversations to solve your problems for a fee for every conversation.”

The updated definition should be:

“Let us communicate easily and help me solve my health problems as quickly, efficiently, and as cost-effectively as possible.”

The traditional process of primary care from the last 100 years is:

“Come to my office when I have a time slot for you, then pay me. Any time you need to talk with me, do that same thing over again. Every single thing is important enough to warrant an in-person meeting.”

The updated process should be:

“Go online first to get most issues treated conveniently. Because most health issues aren’t overly complex, 80% of issues don’t warrant an in-person meeting. If your issue needs in-person care, your doctor and care team will coordinate, on an ongoing basis, all of your care clearly, efficiently, and cost-effectively using online communication as the primary means of communicating and problem-solving for all of your issues, from simple to complex.”

Without this new definition and process, healthcare will be stuck in little to no incremental improvements.

Some will say this is the death of the doctor-patient relationship and all things healthcare stands for. First, consumers are speaking loudly that relationships are less and less important to them. The rise of the urgent care center over the last 10-15 years is overwhelming evidence. There are now ~7,000 of them doing hundreds of thousands a visits a day. The problem a patient hires an urgent care center to solve for them is “solve my problem quickly and conveniently and I’ll take any doctor they give me.” And, finally, I recently spoke with a CEO of one of the largest hospital networks in America who shared with me some internal data they found:

  • 50% of their patients reported “I do not have a primary care doctor.”
  • 25% of their patients reported “I do not want a primary care doctor.”

This means 75% of people do not value the traditional primary care solution.

Additionally, health insurance premiums are now, on average, over $28,000 per year per family. To offset costs, employers have shifted costs to employees with increasing premiums and deductibles. Less and less people have the savings to spend even $400 on care.

Soon, consumers will have to make a choice:

Do they want to spend a premium on in-person relationships (the traditional definition of primary care)?


Do they want to solve their health problems in a new way, without the old-fashioned relationship?

The good thing is they actually don’t have to sacrifice the relationship. Think of it this way. What if, when you summoned an uber, and 90% of the time, within 3 minutes, your favorite driver showed up? Of course, uber can’t do this because your favorite driver might be over in Newark when you’re in the West Village. Their time and availability are geographically limited. But what if an Uber driver could teleport to you?

Ninety percent of the time, with Virtual Primary Care, you will communicate and problem-solve with the same doctor and members of their care team. This is because:

  • Virtual Primary Care doctors work full-time at their Virtual Primary Care practice and that practice isn’t a physical practice it’s a virtual practice not restricted by geography.
  • The vast majority of communication and problem-solving happens during business hours and
  • 95% of communication works more like email so doctors don’t have to have set times for appointments. Because they are not pre-occupied with patients for a dedicated time slot, doctors and their care team can see all the communication and activity happening in their practice at once on their dashboard, and then triage their responses and handle time-sensitive issues quickly while responding when they can to issues with no time-sensitivity.

New models of primary care are simply solving the same problems using fundamentally different processes.

With Virtual Primary Care, primary care goes from being a neighborhood-based, 7 minute time slot to:

“You and your doctor and care team are going to communicate and solve your health problems online and 95% of the time you’re going to just send messages back and forth. You are free to communicate at any time of any day and expect communication within minutes…and we’ll coordinate and serve as the glue that holds together all these in-person visits with specialists and local facilities we’ll use only when absolutely necessary. By the way, you don’t pay me for each communication. It’s a flat rate per problem, no matter how long it takes to optimize your health.”

This isn’t an issue of consumers don’t want the equivalent of an uber-like experience in healthcare.

It’s just healthcare isn’t known for its innovation— they are currently not given the option to choose. McKinsey just released a report suggesting consumers have been ready to interact with their care in a manner outside of the exam room.

Healthcare has always been 20 to 30 years behind the times.

It’s about time for an upgrade. As a broker, benefits consultant, CFO, or someone in charge of healthcare strategy for a company, Virtual Primary Care offers both a new care delivery process and a new primary care business model. The fee-for-service mandated exam room visit has its place, but let’s partner together to reserve that for the exceptions, not the everyday.

There’s a very simple way to get started with a new care process:

  • Decrease pre-paying for traditional inefficient processes via slightly lower premiums/slightly higher deductibles (for example, increase the deductible on each plan offered by $200-300)
  • Use those savings to offer plan members virtual primary care at no cost to them (Virtual Primary Care ensures all users only spend toward their deductible when office visits are absolutely necessary— 80% of Episodes of Care do not need traditional fee-for-service in-person visits)
  • Work with Sherpaa to promote Sherpaa as the simple online place to begin care

Here’s what this world will look like for employees and plan members.

What’s the outcome for your company or group?


It’s been 16 days since Sherpaa launched within a company of 800. Four days ago, on Day 12 post-launch, 62% of employees had enrolled in Sherpaa and learned when and how to use virtual primary care. When Sherpaa is communicated according to our best practices we’ve honed for the last 7 years, we’ll expect 50 to 60% of employees will use Sherpaa for at least one Episode of Care per year. The average user will create 2.7 Episodes of Care per year, which is on par for average doctor visits.

A different utilization pattern

See how 1,000 members use traditional care vs. Virtual Primary Care. In summary, far more virtual engagements with their primary care doctor and far less in-person fee-for-service traditional visits.

Happy employees

Employees who appreciate a far more convenient, more cost-effective way to get ongoing primary care.

I’d really like to talk with you about how to work together. Please feel free to set up a time with me to discuss Virtual Primary Care.