What’s the Future of U.S. Medical Care?

First Republic Client, Dr. Jordan Shlain

August 3, 2015

The U.S. medical system is undergoing intense surgery right now. The Affordable Care Act has changed the way doctors and healthcare systems get paid based on patient outcomes. New technologies and models of care are changing how doctors interact with and treat patients.

Dr. Jordan Shlain, a San Francisco doctor, is a nationally renowned expert on new models of health care. Dr. Shlain, a First Republic client, runs a private medical practice at which patients pay an annual fee in exchange for more time and personalized care from their doctor. He recently answered questions about how the doctor-patient relationship is changing and the future of U.S. private medical care.

Q: How has U.S. medical care changed over the past decade?

Dr. Shlain:  Medicine used to be a cottage industry where doctors had their own individual offices. What happened is that doctors organized themselves into groups and these groups grew larger.  The latest trend has been that hospitals have been on a binge to acquire physician practices of all sizes. The fee-for-service ‘transactional’ model of medicine has really driven the quality of care into the ground.  For the past three decades, insurance companies have been decreasing payment by an average 2% a year.  This means that to maintain the status quo, doctors need to see 2% more patients per year. This, in turn, has led to more patients per day, more patients per hour and sadly, less time doctors can spend with their patients—often just seven minutes. It’s hard to solve someone’s complex medical issue in seven minutes.

Q: How is this problem being solved?

Dr. Shlain: We’re seeing more models of care emerging that attempt to address the issues of outcomes rather than focus on transactions. Concierge physicians and private practices like the one I run have evolved to preserve quality of care.  Private medicine is experiencing a renaissance that is creating new pricing models where patients pay the physician’s office an annual fee, which is typically based on the number of patients per doctor and level of services offered. Fees can range anywhere from $2,000 to $40,000 per patient per year.  Our practice considers itself a ‘family office’ for health that focuses on providing patients with greater access to doctors and more services. We're kind of like asset managers to patients, meaning that we rebalance their portfolio every year and look at all of their medical issues holistically. We look at macroeconomic trends and at macro-medical trends and micro-medical variables in their life. We give them a personalized annual report every year. Other practices in the private physician space may charge lower fees but take on more patients and provide fewer services.

Q: What do you think the next 10 to 20 years will bring in medical care?

Dr. Shlain: Technology that helps empower patients is beginning to take off. The Apple Watch, the Sense device and other sensors connected to mobile apps are becoming available and helping patients and their doctors better monitor patient health. There are now services where you can press a button a talk to your doctor in five minutes via a video chat. Private health care practices have adopted an on-demand mentality, and I think we’ll see this grow significantly in coming years.

Q: How do you see wearable technology affecting patient care?

Dr. Shlain: Already, we’re seeing things that can plug into your iPhone, like a blood pressure cuff, an otoscope, a thermometer, and an electrocardiogram (EKG). These technologies can provide patients and their doctors with a continuous stream of data that can help us improve quality of care, and often remotely, with the patient using those apps and devices to check their own vital signs. This is already changing how doctors and patients interact. I think what technologies are giving physicians—and the healthcare system at large—is the ability to service more people with less frequent face-to-face visits. Patients, on the other hand, get the ability of being empowered with knowing what to do and being given technology and resources that they previously would have had to go to a doctor's office and wait for.

Q: Given all of these new technologies and new models of care, how do you see the doctor-patient relationship changing in the future?

Dr. Shlain: The doctor historically has been an interventionist, but I think the doctor of the future is going to function as an expert advocate. Patients are going to be empowered with so much personal health data at their fingertips. They’re just going to need someone to tell them the best thing to do given their particular situation. We’re just starting to see this relationship changing—but I expect it will change dramatically over the next decade. 

The views of the author of this article do not necessarily represent the views of First Republic Bank.

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