MinuteClinic pioneered the concept of convenience health care more than 15 years ago. Since then the number of walk-in clinics in retail stores, supermarkets and pharmacies has exploded nationally. Now several companies around the country are taking convenience a step further with low-cost primary care that includes house calls.
One example: a Minnesota company called RetraceHealth. Nurse practitioner Kate Estrada sees patients by video and in their homes. She says she can begin diagnosing strep throat with a smart phone app.
"Pretty easily, actually," she said. "You just get a big open mouth and you lean back a little bit and you definitely have to have the flash on."
Estrada says patients can even swab their own throats to send in for lab tests. And she says that's just one of many things people can do at home instead of schlepping to the doctor's office.
"I've done physicals by doing a home visit," she said. "We've done stitches removal — that's a home visit for sure. A lot of the rashes or bug bites or ticks — things like that don't need a home visit and we can do that remotely."
Thompson Aderinkomi, RetraceHealth founder and CEO, came up with the idea of clinic-free care a few winters ago. He and his wife had to make four trips to the pediatrician in frigid weather and spend more than $650 to nail down a pneumonia diagnosis for their infant son.
"I started to think there's people being affected by this, not just me, and someone should do something about it," he said.
Aderinkomi, a former MNsure board member with no clinical background in health care, points out that his new company is licensed, registered and insured just like a conventional clinic, but that he can offer better prices. He says a typical clinic spends five times more on overhead.
"In our business model only about ten percent is going to 'admin' because we're using the latest 21st century technology," he said. "Everything is digital. There's no paper. We don't have any brick and mortar. We don't have any buildings."
Similar services are popping up around the country. Pager offers physician house calls for $200 in New York and San Francisco. Heal, which began operating in the Los Angeles area earlier this year, recently secured $5 million dollars in venture capital and hopes to expand to 15 markets over the next year.
Research in Minnesota suggests there's consumer demand for more convenient care options. A Minnesota Community Measurement survey found only about six in ten Minnesotans were happy with their access to care.
John Militello, management professor at the University of St. Thomas, sees promise in the new primary care model. As people pay higher and higher deductibles, they will demand more convenience for their money, he says.
"The reason why you start a new venture is you see the weakness in the old systems and I think people are seeing that more and more," he said.
But conventional care providers urge consumers to be wary of home visits.
"There is really no control over the clinical environment. What is in the air?" said Alan Ayers with the Urgent Care Association of America. "If they're doing procedures over the kitchen table, is that a clean surface?"
Ayers also says it doesn't make sense to dispatch doctors and nurses to people's homes at a time of a provider shortage. He says clinicians can help more people if they care for them at one location designed for office visits.
Aderinkomi responds that about seven in 10 RetraceHealth visits are handled electronically, and clinicians take steps to ensure a clean environment during house calls. He says home visits reduces the risk that patients will pick up infections from others.
Twin Cities accountant Kimpa Moss is a satisfied customer. She signed up her family with RetraceHealth, and liked the service so much she bought memberships for all 70 of the employees in the high deductible health plan of the accounting firm where she's a partner.
"We believe it will actually hold down our and our employees overall health care costs," she said.
Moss says her employees can use RetraceHealth for basic things they otherwise might avoid because of the expense in time and money of clinic visits.
"This takes a lot of stress off our employees," she said. "Our employees can be here in our building and have a RetraceHealth appointment via Skype. They don't leave the premises. They didn't have to go out and fight the traffic to get anywhere and they can get quick answers and great care."
Flat-rate care, as it's sometimes called, is still in its infancy. The firms are small, and have yet to prove their long term viability. They're also trying to compete with many long-established and deep-pocketed institutions like hospitals, which own many physician clinics.
But Thompson Aderinkomi of RetraceHealth doesn't sound intimidated. He's all but predicting the demise of the traditional physicians clinic.
"We all woke up one day and there was no more Blockbuster. It just happened because of Netflix dominance and Amazon's dominance and the same thing is going to happen in health care."