While growing up in Parsippany, N.J., Stephen V. Avallone, M.D., UHealth’s new director of executive health and concierge medicine, dreamed of becoming a physician. But as an 18-year-old heading off to the U.S. Coast Guard Academy in New London, Conn., he had to put his plans for a medical career aside because the institution didn’t offer a pre-med track. Instead, he chose civil engineering, a profession in which he later earned a graduate degree and worked for more than a decade.
“There are similarities between the two fields,” Dr. Avallone said recently. “Both require a precision approach to problem-solving that is grounded in science.”
Still, when a move to Miami offered him the opportunity to pursue his original goal at the University of Miami Miller School of Medicine, he didn’t hesitate. After graduating in 2000, Dr. Avallone completed his internal medicine residency training at Cleveland Clinic Florida. He began his executive health practice there in 2003, becoming the medical director of its Huizenga Executive Health Department in 2010, a position he held until joining UHealth in July.
“As an academic center, UHealth assembles the best practitioners and supports them with the best processes,” Dr. Avallone said. “This helps to build a solid foundation and powerful brand image for executive health and concierge medicine to succeed locally and internationally. We want to attract a strong local patient base, but I have seen that patients will come from far and wide to a program they know is good.”
Cristina I. Pravia, M.D., a long-time colleague at Cleveland Clinic Florida, joined Dr. Avallone as UHealth’s associate director of executive health and concierge medicine. One of his Miller School classmates in 2000, she completed her internal medicine residency at UM/Jackson Memorial Hospital. She joined Cleveland Clinic in 2003, where she built a robust internal medicine practice and joined the executive health department in 2010. A native of Puerto Rico whose family moved to Miami in 1987, Dr. Pravia is the holder of four degrees from the University of Miami and is proud to be “back home” on a professional basis.
“Our international location is important, and the university and the Miller School have evolved considerably over the past 10 years,” she said. “This is the perfect environment in which to build the two programs.”
“Drs. Avallone and Pravia will help us make UHealth a leading destination for top-quality executive and personalized health care with a global reach,” said Dipen J. Parekh, M.D., chief clinical officer of UHealth, and professor and chair of the Department of Urology. “Their expertise will make our programs second to none.”
Executive health and concierge medicine are two different models of care. Executive health involves a single visit of several hours with a set fee. The UHealth executive program consists of a thorough physical examination, blood work, cardiovascular screening and pulmonary evaluation, and consultations with a nutritionist and an exercise physiologist. There usually is not a continuity of care component unless something is uncovered that requires follow-up consultation or treatment.
“The individuals we see in executive health are high achievers who have a lot of stress in their lives, but only about half of them are business executives,” Dr. Avallone said. “The other half may be teachers or firefighters — people in other professions with long, demanding work schedules who don’t have a lot of free time for doctor’s appointments — and international patients who fly in to Miami knowing they can complete their examinations and tests in a single day. What they all share is a desire to take a proactive approach to their health care. They come to us for our expertise and to get peace of mind. Some of them may not have seen a doctor in years and are fearful of what the exam may find. Our first job is to build a relationship based on trust, to let them know that coming in was the right thing to do, and to give them as pleasant an experience as possible.”
“Maintaining proper sleep, diet and exercise are very important for all of us, but it can be a real challenge for our patients who travel a lot,” Dr. Pravia said. “Our experts can give them tips that will help them come home as healthy as when they left. And if the examination does turn up a medical issue, we can have them meet with a specialist. That’s the advantage of being at an academic medical center. The patients don’t have to be referred out and spend weeks going from appointment to appointment.”
By contrast, concierge medicine is a membership model in which patients pay an annual fee not only for an annual expansive physical exam, but also for 24/7 phone and email support toward patient health education and annual exam health goals. The smaller concierge practice panel and substantial electronic communication connection translates into easier scheduling of appointments — typically an hour, since plan reimbursement requirements are not restricting appointment length and annual exam goal coaching is included — with their physician. The two programs are not necessarily mutually exclusive; an executive physical patient may choose to become a concierge medicine member for ongoing health care needs.
“A physician in a typical practice might have 2,000 to 3,000 patients; a concierge practice physician might have 300 to 600 patients. This smaller and more connected practice model builds stronger doctor-patient relationships, providing health care in a more efficient, effective manner. You promote wellness and prevent disease, rather than trying to catch up with disease once it has developed,” Dr. Avallone said.
“As a clinician, you are able to spend more time with the patient and not be looking at the clock,” Dr. Pravia said. “You get to know the patient better and talk about health-related issues that might not come up in a shorter appointment. You can make more informed recommendations that result in better outcomes for the patient. That, in turn, helps build your practice. Word of mouth is essential, and if a patient likes their physician, they will tell their friends and family members.”
Both physicians find these personalized forms of medical practice extremely satisfying.
“As a doctor, keeping people healthy and helping them achieve optimal health is very rewarding,” Dr. Avallone said. “That’s our job, and it’s why most of us went into this profession. We’re here to make sick people better and keep healthy people well. If we do our jobs well, our patients benefit, the people around them benefit, and it makes for a healthier community to live in.”