By John George, Philadelphia Business Journal
MAY 8, 2014 – Dr. Scott Bralow remembers the day his wife, a primary-care physician, came home near tears after a tough day at the office.
“She said she was spending more time at the computer (dealing with electronic medical records) than she was with her patients,” said Bralow, a nephrologist. “She said it wasn’t what she signed up for.”
Vicki Bralow, who said she was inspired as a child to become a doctor while watching Marcus Welby on television, confirmed her husband’s account.
“I always wanted to be a doctor,” she said, “but the way medicine is today, there are all these barriers between the doctor and the patient. By the time I get to see patients, they have already interacted with five other people. People getting their insurance information and other people taking their blood pressure and doing the initial screenings. I get in there and get to spend five minutes with them, then it’s on to the next patient.”
The married doctors thought there had to be a better way.
So, at the start of this year, they launched a new company called Affordable Care Options LLC. They provide workplace-based health services to employers. The companies pay a monthly fee and workers get access to care with no deductibles or co-payments.
All they need to practice site is about 300 to 400 square-feet of empty office space — with cable and phone hook-ups and an electric outlet — that can be converted into an exam room and small reception area. The company is responsible for any physical renovations, such as putting up walls, that are needed. Affordable Care Options brings in an exam table and any necessary medical equipment.
“We know how to run a medical practice,” she said. “It’s what we do for a living.”
The cost to a company varies by how many employees they have and how often they want a doctor on-site. The Bralows are open to creating one practice site in an office building or office park that would allow multiple companies to share the costs.
For a company with roughly 350 employees that wants a doctor on-site five days a week, the annual cost would be between $300,000 and $500,000.
Vicki Bralow said the fee pays for itself with increased productivity by workers who otherwise would have to leave the office for doctor appointments to get lab work done. In addition, she said, by making it easier for workers to access doctors and comply with follow-up care, a company’s employees are more likely to receive medical attention that can prevent a minor health ailment from becoming a major — and more costly — illness. Lowering the dollar amount of claims filed by employees, she said, can also help a company lower its health insurance premiums.
The current system is often much different. Employers are increasingly shifting more health-care costs to their employees, sometimes in the form of high-deductible plans that require more be paid out-of-pocket before the insurance coverage kicks in.
“Patients come in with $2,000 deductibles,” she said. “They have to pay (the full costs) for the office visit all the time because they have these big deductibles. They get annoyed.”
What often happens, Vicki Bralow said, is a patient will come in with a problem like high blood pressure. She’ll put them on medicine and ask them to come back in a month to see how they are reacting to the medicine. That means taking time off work and paying for another office visit. “They don’t come back,” she said.
The Bralows said they are not out to replace workers’ family physician, and will share test results and treatment decisions with them.
Scott Bralow said they first got the idea to start their company after reading about QuadMed, a Minneapolis company that provides office-based health care. QuadMed grew out of a single location inside Quad/Graphics, which decided to hire its own doctors who would provide care to the company’s 9,000 employees in a move to give the business more control over its rising health-care costs.
Affordable Care Options isn’t the only Philadelphia-area company embracing the direct-care model, where services are provided directly to patients without a health insurance company serving as an intermediary. R-Health in Philadelphia and NewPath MD in Exton, Pa., are among the others.
The Bralows started their company in January and have spent the past few months talking with companies and groups representing employers. They have two proposals under review with potential clients.
Scott Bralow noted how decades ago manufacturing companies commonly employed company doctors to provide occupational health services to injured workers. What Affordable Care Options is looking to do, he said, is adopt that service to the 21st century to provide on-site primary care, population health and wellness services — all hallmarks of the Affordable Care Act.
“What we are doing is the company doctor 2.0,” he said. We’re not employees of the company. We are the subcontractors.”