Last week was a big one for CovenantMD as we launched our website on Tuesday. Since then, the site has had over 500 visitors! I've met many people that I hope will be my future patients.

I also posted my first blog entry last week, titled “What is Direct Primary Care?”, in order to give readers an idea of what CovenantMD will be about. In that post, I talked about three distinctives that will set CovenantMD apart from other practices: time, access, and value. At the end of last week's post, I talked about time. In this post, I'll talk about access.

So what do I mean by “access?” Put simply, it’s how patients engage their primary care provider in order to get a question answered, or to be seen for a medical problem during business hours, or to be seen for an acute problem after business hours or on holidays or weekends.

If all things were equal, and you had ideal access to primary care, what would it look like? It would look like this:

Your doctor would answer the phone when you call. No middlemen.
You would get an appointment when you want it, even the same day. You would even be able to schedule yourself online using a secure portal.
Your doctor would be available 24/7 by phone, or text, or email. That includes weekends and holidays.
"Access" might not necessarily mean a visit. Maybe you just need a phone call, a text, or an email.
Your doctor would be available to see you after hours, saving you trips to the ER and Urgent Care.
Your doctor would be able to come to you, at home or work.
Your doctor would ensure continued excellent customer service by limiting his patient panel.
You would be able to see your medical history via a secure online portal, so as to ensure that your doctor has accurate information.
Prescription refills would be prompt, and streamlined with technology.

Ease of access to your primary care provider can vary quite a bit by practice, but in general, our current healthcare system does not put a high premium on primary care. The reasons for this are multifactorial (and these would fill up a few posts), but I think it boils down to the fact that primary care doctors tend to be person-focused, viewing health as optimal wellness, whereas the rest of medicine tends to be disease-focused, viewing health as the absence of disease.* You may think this is abstract at first glance, but this dichotomy is the very thing that determines “where the money is” in medicine, and where it is not.

So in the current healthcare system, you, the primary care patient, face two challenges related to access:

1) You have poor access to care. There are middlemen shielding the doctor from you. There are delays. You have to wait for an appointment tomorrow, or next week, for the pain or fever that’s bugging you now. Even if you can get a quick appointment, you might not be able to see your doctor -- it will have to be another doctor, or PA, or nurse practitioner, who might not know your history. You may miss pills due to untimely prescription refills. And what if your 3-year-old daughter gets a croup attack at 3AM on a Sunday morning. Who do you call? You probably won’t call anybody, but just pack her into her car seat and speed to the nearest Emergency Room. And then brace yourself for the bills that trickle in a few weeks later.

2) Your healthcare is fragmented. You see your primary care doctor for minor or chronic things, an ER or urgent care doctor for acute things, a dermatologist for skin things, a gastroenterologist for stomach things…the list goes on. Our system likes it this way. Because it is “disease-focused,” it prefers to farm you out to technicians that specialize in certain diseases, who order expensive tests and do expensive procedures. One of the downsides to this fragmentation is that there is very poor (or nonexistent) “cross talk” between all of these different providers, so that your story (remember last week’s post?) is getting lost in the chaos.

Our goal at CovenantMD, utilizing the Direct Primary Care Model, is to bring your access to care as close to the “ideal” situation as we can. We’ll offer 24/7, secure access to the doctor by phone, email, or text; your doctor will answer the phone (or quickly return your call if he's with a patient); your doctor will be available for after-hours care; you will enjoy same-day appointments (with extended visit times); we’ll have a discounted in-house pharmacy in order to streamline new prescriptions and refills. We’ll “cap” our patient panel at no more than 800 (the typical patient panel for a primary care doctor is 2500), so as to continue to offer high-touch, high-quality primary care for the life of your membership. We'll do house calls. We can see you after hours (for an extra fee, but still way cheaper than Urgent Care). And when you need to see a specialist, we have a cool way of doing that, too -- we can use RubiconMD for specialty e-visits, getting a specialist opinion within hours. You won’t have to wait 3 months to see the Dermatologist! And when we think it would be beneficial for you to see a specialist in person, we can facilitate that, too.

Improved access to care is one of the reasons Direct Primary Care is exploding in America. If you have any questions about access to care, or anything else about CovenantMD, feel free to give me a buzz at 717-287-1983, or email me at pmr@covenantmd.net. If you haven’t done so already, sign up for our email list. Later this week, I will post the last part of my “What Is Direct Primary Care” series -- a discussion about value.

*Family Medicine Should Shape Reform, Not Vice Versa. Starfield B, Fam Pract Manag, 2009 Jul-Aug; 16(4):6-7