A doctor gets sick and visits his doctor friend. The sick doctor is in a very weird situation where he is uninsured this month (long story) and has to spend cash on determining a diagnosis and getting treated. So, he and his doctor friend talk through the situation with two goals in mind:

How can we confirm the diagnosis at the lowest cost?

How can we treat this illness at the lowest cost?

If you take any healthcare issue and run it through this scenario, you will always see the most creative, lowest cost way to diagnose and solve a health problem. This applies to everyday issues as well as end of life issues.

Can we all agree that healthcare costs stem from doctors’ orders? In effect, through our orders, we as doctors are actually spending money on behalf of you and your employer.

We’re the ones who prescribe medications, order tests, determine when a specialist is needed, decide what procedures to do and when, weigh the benefits of one treatment strategy vs. another, decide to prescribe an antibiotic, etc, etc, etc..

That means, in order to affect how money is spent (aka, how care is delivered), we have to get into the minds of doctors.

Some doctors order lots of tests to protect themselves from missing a diagnosis because they missed a diagnosis 3 years ago and they vowed to never do that again.

Some doctors prescribe the newest medications without trying the older, more established ones. They were moved by the ad on the TV promising wonderful results.

Some doctors add general anesthesia to colonoscopies. They want that bonus to buy that new Mercedes they’ve wanted for years.

Almost all doctors (but not all!) are doing their best to care for their patients. But, when you get paid more for doing more, it’s often a challenge to do what’s right for the patient vs. build that new in-ground pool for the kids.

But there’s a sizable percentage of doctors who think healthcare is fundamentally broken. On the first day of medical school, they embarked on a mission to, first, truly care for people, and second, sustain themselves financially. Most importantly, they understand the connection between a patient’s financial health and their physical and mental health. Over time, as they practice in a system that incentivizes them to do more to get paid more, they increasingly see how that incentive is the root of the problem. It only takes a few bankrupt patients to open your eyes, especially when you became a doctor to help people.

All that being said, some doctors are on a mission to order the right care at the right time, not too much, not too little. These are the doctors who thrive in Integrated Delivery Networks like Kaiser and Intermountain. Some of them will work for ACOs like Aledade. And, of course, Sherpaa also gives them a home. In fact, the doctors who work in places like these love working in those environments to avoid all the conflict of interest issues. It frees them up to ethically practice medicine, simplifies their life, and helps them avoid the 40% of a typical day a fee-for-service doctor spends on documenting oral conversations to maximize reimbursement. What can we say, we’re borderline idealists and, we too, think healthcare is pretty broken.

But when employers offer health insurance to their employers, the networks they contract with have no mission (unless they’re contracting with an IDN like Kaiser). Generic networks (like you find in the BUCAHs) do not serve as aggregators of mission-driven doctors. It’s just a financial arrangement with the entire spectrum of doctors. Some companies have sprung up to help employers cherry-pick lower cost, higher quality doctors and facilities. But if an employer has zero power over the minds of physicians making all the decision for how and why to spend money, there’s very little they can do to steer patients toward lower cost, higher quality doctors.

It’s literally all about employers partnering with mission-driven doctors who want to practice ethical medicine.

That’s why it’s absolutely vital for employers to offer all of their employees a new care process powered by doctors who are on a mission to deliver the right care, not the most care. Employers have to invest in a process that prevents most fee-for-service issues and, for when in-person care is necessary, direct a cost-effective treatment plan, and drive employees to the higher quality, lower cost local specialists and facilities. Virtual Primary Care doctors have the tools they need to help them spend your money wisely. And those tools will only get better and better over time.

It’s literally all about giving employees one simple place to start their care process. Instead of playing catch up after the fact through claims analysis, get ahead of poorly delivered, inefficient care, prevent most fee-for-service care from happening and make all in-person care as strategic as possible.