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House Calls 2.0 Come Knocking

 |  By Philip Betbeze  
   June 17, 2011

I know what you're thinking: Is this just another headline designed to get me to click only to find out it has nothing to do with the story? No such deception here. In fact, bringing the house call back to healthcare might be an interesting idea whose time may have come--again.

As you know, long before health insurance, HMOs, capitation and Medicare, much of medicine depended on the house call. It was a simple, all-cash (or barter) business. But gradually, as more employers began to provide healthcare benefits in lieu of raises to their employees, the practice faded away.

Patients no longer had to take much responsibility on the financial side (or personal responsibility side, for that matter) for their care. In many cases, customer service went out of style in healthcare at about the same time. Still, many patients remained satisfied. They made the quick transition to making an appointment and going to see the doc, and the best part was, they never (or rarely) saw a bill.

Those days are long gone now for most people, so the time might be right for the house call to make a comeback. End of history lesson and enter Bob Fabbio.

Fabbio has no reason to jump feet first into healthcare (he's already rich from starting a company from nothing and selling it to IBM) other than the fact that he was angry that more than half his day was wasted on a 2006 routine trip to his primary care physician's office.

"I got up to go to doctor, left at 9 a.m., and between all the hassles, I didn't return until 2:15 p.m.," he says. "As I was coming down my driveway, I realized the messiest market in the world is healthcare, and wouldn't it be nice if routine visits could truly be made routine."

With that in mind, he started WhiteGlove Health in Austin, TX, in 2006. The gist of it is this: the company charges around $400 a year for its service, and $35 per house call. Patients see registered nurses or nurse practitioners (not physicians) who bring with them a care package of fluids, OTC meds and healthy snacks, and provide any needed prescriptions--outside of narcotics--necessary to treat the patient's illness. It's available from 8 a.m. to 8 p.m., 365 days a year.

"Patients don't seem to actually mind about not seeing a physician," he says. "In many cases in primary care settings, you often will only see nurse practitioner anyway." 

Insurance, as you might guess, is not involved.

Companies, however, are. Many have agreed to pay the yearly membership fee because Fabbio's proprietary analytics (he is an IT guy, after all) show it's a good investment. About 46% of the company's visits are to workplaces—cutting down on absenteeism. In case you might think this is a passing fad, WhiteGlove is rolling out a chronic care service with essentially the same structure, and counts not only individuals as clients, but an impressive number of companies in the markets where it operates—currently Austin, San Antonio, Dallas, Fort Worth, and Houston in Texas and in Boston and Phoenix. It may have added other markets as I'm writing this, but on the horizon for the rest of 2011 are: Tucson, Denver, Columbus, OH, Hartford, CT and Nashville. And, by the way, they've filed for an initial public offering to complete the build-out.

The point is not whether White Glove has a good idea or a sustainable business model. The point is that companies like this, whose leaders have little experience with healthcare, aren't letting that stop them. They're showing leadership and an innovative spirit, and they just might be horning in on what you've considered your territory.

Entrepreneurism is alive and well in healthcare, and it seems as though just about everyone with a big wallet and bigger ideas is bidding that their idea to make healthcare better, faster, and cheaper is knocking on the virtual door to be let into the game.

Why? Lots of people have opinions, but mine is that the rush to create something new in healthcare delivery is finally happening because it's gotten so expensive that most regular people are finally having to pay for much of it out of their own pockets. That allows entrepreneurs with a good idea to potentially do an end run around the seemingly boundless bureaucracy that in the past has easily encircled and strangled innovation in healthcare. Suddenly, faster, better and cheaper actually matters.

It might be time for you to get on that bandwagon too.

Philip Betbeze is the senior leadership editor at HealthLeaders.

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