HL20: Tom X. Lee, MD—Reinventing Primary Care

Tom X. Lee, MD, took an unusual route after finishing his residency: He went to Stanford University to earn an MBA. Lee credits this path for enlightening him on how to run a medical practice with greater efficiency and more focus on the patient. Now he is CEO of One Medical Group, which uses technology to help keep costs down and allows for a far more efficient workplace.

In our annual HealthLeaders 20, we profile individuals who are changing healthcare for the better. Some are longtime industry fixtures; others would clearly be considered outsiders. Some are revered; others would not win many popularity contests. They are making a difference in healthcare. This is the story of Tom X. Lee, MD.

This profile was published in the December, 2014 issue of HealthLeaders magazine.

"Primary care physicians are busier than they need to be, and I was looking for a model that provides them hope."

When Tom X. Lee, MD, finished his residency at Brigham and Women's Hospital in Boston, he did something unusual: He headed to Stanford University to earn an MBA.

Lee says he took this detour off the traditional path to figure out how to run a medical practice with greater efficiency and more focus on the patient. "When I went into medicine, my goal was to take care of patients in a primary care setting," he says. "It was pretty clear that primary care was a broken system, and I felt there was fundamentally a better model in terms of delivering high-quality care."

In 2005, Lee launched One Medical Group in San Francisco, which has since grown to 32 sites in six markets, including Boston, Chicago, Washington, D.C., New York City, and Los Angeles. To support the practice, patients pay an annual membership fee in addition to the cost of their insurance coverage—that fee ranges from $149 to $199, depending on location. In exchange, they can make same-day appointments online or through the One Medical smartphone app, which they can also use to email their physicians directly, view lab results, access their electronic health record, order prescription refills, and request treatment for common health concerns.

Creating a high-tech, nearly paperless environment was one major step toward achieving the kind of efficiencies that drive down the cost of running a primary care office, Lee says.

"The premise was to see if we could better organize care administration to lower the overhead costs of managing a practice," he says. "That would allow us to reinvest those savings in higher-quality care and in spending more time with patients … I really examined everything we were doing in the primary care setting and focused in on patients and what was needed from the quality of care perspective and the population health perspective."

Because One Medical's physicians don't have to spend their time on maintaining paper-intensive legacy systems, they are able to focus more on patient care. Rather than seeing 30 patients a day for 15 minutes at a time as is typical in most primary care practices, One Medical's physicians see an average of 15–16 patients a day for 30-minute appointments. Patient response to this model has been "extremely positive," Lee says.

"Patients have gotten a little demoralized with what is traditionally being offered to them in healthcare today," he says. "When a new model is introduced, most people find it refreshing and compelling. We have tried to design something that is intuitive for patients. Once people come in and meet our team, they realize it's a very different experience."

This primary care model benefits physicians as well, Lee adds. "Primary care physicians are busier than they need to be, and I was looking for a model that provides them hope," he says. "We are showing there is a way to make this model work. There is a long way to go, but having a model that works for broad demographics and allows us to care for patients thoughtfully and design new systems as we evolve care processes and technologies will have a positive impact on primary care as a profession."

While Lee acknowledges the difficulties involved in reengineering a primary care practice, he encourages other physicians to do it for the sake of improving patient care.

"Don't underestimate the challenge of redesigning primary care because it is a lot more difficult than people realize to execute all the details," he says. "But if you trust your intuition and your gut on what is best for the patient, you can use that as a guiding compass through all the complexities in primary care. If we design models around the patients in a thoughtful, high-quality manner, it will lead us in the right direction."