Category: Physicians

DocChat puts ER docs online (podcast)

published date
November 19th, 2015 by


Dr. Steve Okhravi and his son Michael decided to do something about overuse of the emergency room. They founded DocChat to leverage telemedicine for triage and to counteract the forces of defensive medicine that send many patients to the ED that don’t belong there. Early results are strong and they are looking to scale.

I asked the Okhravi’s about their service in this podcast interview.

  1. (0:14) What unmet need are you addressing?
  2. (1:33) Are patients to blame for unnecessary visits to the ED, or do physicians deserve some of the blame?
  3. (4:26) DocChat uses emergency room physicians instead of primary care. Why?
  4. (7:00) Is DocChat appropriate for geriatric patients?
  5. (10:08) Your service is not covered by insurance. Who is the paying customer now and what do you expect in the future?
  6. (12:23) You offer a subscription service as well as charging per call. Is this the type of business where a subscription makes sense?

By healthcare business consultant David E. Williams, president of Health Business Group.

Concierge medicine 90210

published date
September 18th, 2015 by
LUX Health Network co-founder Akiva Greenfield
LUX Health Network co-founder Akiva Greenfield

LUX Health Network bills itself as “the most exclusive, personalized, and comprehensive health care experience.” Its concierge-style primary care and specialty physicians practice in Beverly Hills. It sounded interesting, so I interviewed co-founder Akiva Greenfield to learn more.

Concierge practices are typically primary care only, and I’ve often wondered about how they handle patients who need specialist care. So I’m interested to learn about the LUX model. How did you come up with the idea?

We talked with patients and we talked with physicians about what’s important in concierge style care. Patients told us that they certainly want great care from their primary care physician but, just as important, they consistently told us that they want outstanding seamless care from specialists as well. We believe this is a reasonable request, in fact it’s their prerogative.

So, I saw that this model of interdisciplinary care would fill a critical void in the concierge medicine marketplace. LUX Health Network has become the solution because we bridge the gap by providing highly-coordinated care among internists and specialists who all offer our concierge services.

LUX has assembled an elite network of specialist physicians who work as one team to deliver highly integrated, cross-disciplinary care, quickly and conveniently. LUX patients, who we refer to as LUX clients, have around-the-clock access to their team of specialists, who work in close coordination with their primary care physician to provide patients with a complete and synchronized healthcare experience. An added highlight of the LUX network is our client care coordinators who facilitate all scheduling and oversee insurance correspondence on their behalf, eliminating the stress and lost time that often precedes and follows medical appointments and procedures. Each member’s personal care team conducts periodic interdisciplinary conferences to discuss member needs, treatment, and progress to ensure full coordination of care.

Clients, especially those who are content with their internist, can also choose to pay for an annual retainer fee to receive concierge access to the specialist of their choice, who will work closely with their primary care doctor to develop a care plan tailored to client needs, and one that adheres to their preferences.

How does LUX compare to a typical concierge model? What are the similarities and differences?

We’ve been able to review and revise the way healthcare is delivered and managed from our unique perspective. LUX was not founded by physicians but by young entrepreneurs who have worked closely with doctors and thoroughly understand the healthcare industry. Other medical concierge models focus primarily on internal medicine. LUX is the first company to include internist and specialty medicine, where each physician practices independently and is not employed by us. We value their autonomy, as do they, and make the client-doctor connection, while keeping the physicians in full control of managing care. There are no limits to the number of concierge patients and/or families accepted by our doctors, a criterion imposed by other companies operating in this space.

To help support our network and clients, LUX’s client care coordinators serve as patient advocates and are at the patient’s disposal 24/7– no request is too big or too small. We even offer to correspond with insurance companies on behalf of clients so they can focus on what matters most to them. Additionally, our membership plans are fully customizable. We work with our clients to develop a mutually beneficial health plan.

Parts of our business model including membership-based concierge level access (same or next day appointment, unhurried visits, etc.), health and wellness options, and scheduling, is similar to that of other companies.

Typically primary care concierge practices convert their entire panels to the concierge model. Is that the case here as well? 

No. We do not require our physicians to convert their entire practices to a concierge style. Instead, they offer this extra level of care and access to patients who they believe can benefit from our programs. This allows the doctor to operate a hybrid practice, accepting both concierge and non-concierge patients.

It is often believed that a doctor with a hybrid practice will provide superior care to his or her concierge patients because of the promises made to them. Naturally, this can create an array of problems within a practice and to prevent such occurrences from arising, LUX works closely with doctors’ staff to reserve ample time on the schedule for concierge patients, well in advance of scheduling other patients. This alleviates the concern for non-concierge patients, knowing that patients paying an extra fee will not cut into their appointment time, and removes the burden from the doctors and their office staff by keeping the work day organized.

Do the specialists also convert their full panels? If not, what are the implications? If so, how many patients do you need in the LUX network to make that possible?

At LUX, specialists concierge model operates just like primary care model. They may keep their traditional care patients, while adding concierge style clients to their practices. The only change we request to be made is for them to cater to our concierge clients with the breadth of LUX services, which is agreed upon prior to them joining our elite network.

What happens to a patient if their specialty isn’t represented within the LUX panel? And doesn’t the idea of having access to just a few specialists run counter to the goal of maximizing choice? It sounds like it might be just another narrow network (albeit a gold-plated one). 

Most major specialties are represented by quality physicians in our LUX network. However, if a patient needs a specialist that is not represented in our network, we do our due diligence to find a doctor who is willing to join our network, and meets our admittance criteria outlinee by our Physicians Advisory Board, to serve the client. We are expanding our network of physicians to include other specialties like pediatrics, neurology, and psychiatry. It is also pivotal to our business to have larger numbers within each specialty, which is another area we are currently developing.

What happens when a patient is hospitalized? Does LUX have concierge hospitalists?

The client’s LUX primary care and/or specialty physician(s) will visit the hospital to ensure continuation of care.

One concern I have about concierge practices is that they appeal to physicians who want an easier lifestyle. I don’t begrudge them that, but concierge patients may actually prefer that their physicians are totally dedicated to the job. What do you think?

LUX network physicians are totally dedicated to their patients. In fact, I think that practicing medicine through the concierge model allows physicians to be more dedicated because they have more time to allot to each patient. Concierge medicine compensates physicians for the time spent to build a strong physician-patient relationship, thus allowing them to be more successful at their job and the care of their patients.

All your doctors are in Beverly Hills. Can the model work elsewhere or is this setup just for the rich and famous?

Our innovative approach to concierge medicine is designed for those who put a priority on their health and wellness and value their time. We plan to expand our model to other cities in California like San Diego and San Francisco as well as nationally. Although our main target audience tends to be a more affluent population, our plans are not designed exclusively for them. Our custom pricing is contingent upon the client’s medical needs and we do our best to match that. Our prices also reflect the caliber of physicians we’ve selected to be a part of our network. Each one has a stellar reputation among patients and other clinicians.

By healthcare business consultant David E. Williams, president of Health Business Group. charges in to healthcare with Health Cloud — interview with CMO Joshua Newman

published date
September 3rd, 2015 by
Joshua Newman, MD --Salesforce's Chief Medical Officer
Joshua Newman, MD –Salesforce’s Chief Medical Officer announced its move into healthcare this week with Health Cloud, which aims to help providers manage patient relationships, not just patient records.

I asked Joshua Newman, MD, MSHS, who is Salesforce’s Chief Medical Officer and GM of Healthcare and Life Sciences to comment in more detail.

1) I think of Salesforce as a platform for sales teams to manage their leads. But it sounds like you have gone beyond that. Please explain.

Yes, that’s correct. We started in sales force automation (SFA) and are now the world’s No. 1 customer relationship management (CRM) company, which means that we help our customers connect with their customers — everything from sales to service to marketing to analytics. But it’s not like we just woke up one day and decided to take on healthcare. As healthcare becomes consumerized, organizations are in need of better CRM tools to connect and engage with patients. We’ve been serving healthcare companies for more than 15 years now, starting with life sciences firms — who obviously have a lot of salespeople — and now with many of the top providers and plans in the industry. It’s just that these companies previously needed to customize our products to work in their environments, and with Health Cloud we’re building much of that functionality out-of-the-box for the first time. We’re taking our experience in CRM and applying it to patient relationship management.

2) What is Health Cloud?

Salesforce Health Cloud is a cloud-based software designed for healthcare organizations. Built on Salesforce Service Cloud — the world’s #1 customer service and support application — the product gives providers a more precise view of a patient’s demographic, lifestyle and health information to better serve their needs. In doing so, it provides a complete view of patient data, including EMR information, medical devices, wearables and more. And Health Cloud also enables smarter care decisions through features like the Timeline view to visualizes a patient’s health over time. Finally, it allows providers to connect to a patient’s full care network, whether inside or outside the hospital. The Patient Caregiver Map visualizes relationships, and enables providers to collaborate with outpatient clinics, home caregivers and others to ensure the patient receives consistent, high-quality care.

3) How does Health Cloud differ from the offerings for other verticals? What’s unique about health?

Healthcare is such a different beast. The industry is ahead in the technologies used to conduct medicine — genetic testing and targeted cancer drugs and diagnostic imaging– yet woefully behind when it comes to the technologies used to manage patient relationships. Fortunately, for the first time in history, healthcare IT is shifting toward the patient. Payment and reimbursement is also distinct in healthcare. The Affordable Care Act (ACA) is pressuring providers to compete for patients like never before. And outcome-based reimbursement means providers receive Medicare and Medicaid funding based on process and quality metrics and not merely by the number of procedures. Finally, patient expectations in healthcare are slightly different and are shifting. Uber, Amazon and others have defined what a quality experience can be. Yet healthcare still often fails to consider patients as if they were customers. We think Health Cloud is the product for this unique moment, for this unique industry.

4) As a patient, am I a sales prospect?

Yes and no. As I said, providers are treating patients as customers for the first time in this environment — or “prospects,” as you say. And this is really a good thing, in that it means they are competing for their business in the way they communicate and the quality of care that they deliver. That is resulting in part to improvements in patient experience and outcomes.

5) What opportunities does health reform present? How are you addressing them?

With both the Affordable Care Act (ACA) and employers demanding more healthcare transparency, health providers need stronger patient engagement. ACA enabled health insurance for 16 million Americans, and subsequent court cases secured coverage for 6.2 million. This means that healthcare providers need to take lessons from consumer companies, as more people than ever before are prospective patients. Healthcare providers have an opportunity to change how they approach patient relationships. Salesforce Health Cloud also helps providers meet patients’ tech-savvy demands through its mobile capabilities. It enables providers to give concierge medicine focused on patient preference and satisfaction. Caregivers can follow up with patients once they leave the clinic, whether it’s an email, phone call reminder or message on a mobile app.

6) How does the health cloud offering differ from partner solutions —like Evariant and Veeva— that are build on your platform?

We’ve obviously built a partner ecosystem around Health Cloud, whether it’s companies like MuleSoft who help with integration into legacy EMRs, or systems integrators like Accenture and Deloitte who assist with content, implementation and more. It’s true that some aspects of partner solutions may compete with some aspects of Health Cloud — this is inevitable in the technology industry — but for the most part, we consider Health Cloud to be a platform for other partners to extend the product’s functionality. And, at the end of the day, it’s about giving customers what they want, so we leave it up to them to implement the solution that best fits their needs.

7) There are a variety of healthcare IT solutions out there, and many providers are investing heavily in EHR. How does health cloud work in that environment? What is the level of integration, cooperation, and rivalry?

EHRs do an important job. They are critical for ensuring the right data is captured for internal processes like billing and procedures within a clinical environment. But they do not help organizations manage the complexities of patient relationships. Today’s health systems need to make the shift from revenue cycle management and electronic health records, to building stronger patient relationships. With our open API, metadata-driven platform, providers can use Salesforce as an engagement layer on top of their legacy EMR systems. It gives them additional CRM, mobile and social capabilities, and they benefit from new innovations from Salesforce delivered three times a year.

8) Can you provide a couple of success stories?

Centura Health is using Health Cloud for several unique use cases. Centura Health’s oncology nurse navigators work in silos and leadership lacks visibility into the volume/ROI of work. Centura will use Health Cloud to align all oncology nurses onto a single platform, standardizing workflow and reporting to achieve better patient outcomes. Also, Centura Health has entered into bundled payment agreements with Centers for Medicaid and Medicare (CMS), and is turning to Health Cloud to track metrics for the post-acute portion of this process to include stays, outpatient therapy, home care, and avoidable emergency department revisits or readmissions.

9) What unexpected challenges have you faced in health?

I think the biggest challenge is extracting data from legacy EMRs, as they aren’t built with open APIs like most modern cloud-based platforms. Of course, we’re also seeing many middleware companies tackling this API problem, whether it’s replicating EMR data into separate data stores or building new interfaces to modernize the approaches of EMRs. The other challenge is the conservative culture and slow pace of change in medicine.  We are actually all very grateful for this culture. It served us very well in an era when people were literally selling snake oil.  However, we as patients need faster innovation and responsiveness to the changes in the world, and frankly, my colleagues in medicine have been clamoring for a more agile and nimble processes also – Learning System is how the IOM terms it. The healthcare industry has worked a certain way for so long now — and frankly has fallen behind in certain aspects — that it’s going to take great tools to enable change and the strength of consumerization and reimbursement changes to push providers into changing their ways. We’re excited about the possibilities, so is the industry.

10) How are customers implementing Health Cloud? Is it all or nothing or are there ways to experiment?

Health Cloud hasn’t officially launched yet, so it’s hard to tell with 100 percent accuracy. But I think we’ll see a similar adoption path to how cloud-based CRM technology — like that of Salesforce — was adopted years ago. Organizations tested Salesforce on certain use cases and departments, and eventually it spread to entire companies, buoyed by its ease-of-use and popularity with end users. I think we’ll see the same thing with Health Cloud.

By healthcare business consultant David E. Williams, president of Health Business Group.

Computer aided diagnosis for mental health: two important strides

published date
August 28th, 2015 by
Advancing the state of the art
Advancing the state of the art

Researchers are using modern technologies to develop advanced tools to assist with the assessment of mental health problems. We hear a lot about “big data” and genetic sequencing, which can be expensive and complex, but there are also promising tools that are not so pricey or complex, even if they do employ components of big data and genetics.

Two examples caught my eye this week:

  • A speech analysis program that predicted with 100 percent accuracy who would develop psychosis
  • A blood test and app combo that predicts suicide risk with 90 percent accuracy

The speech analysis program was tested on 34 subjects, so we’ll have to see if the results hold up. But the idea makes sense. Well trained clinicians can already assess disjointed speech patterns and reach similar conclusions. But the computer seems to do an even better job, and more importantly, could ultimately make such techniques feasible for a much broader population who don’t have ready access to psychiatric services. And all while lowering the cost of assessment dramatically.

I’ve always thought it was quite primitive and even bizarre for clinicians to assess suicide risk by asking patients if they were thinking of killing themselves. So I’m pleased that a new tool combines a series of questions about energy level, feelings and accomplishments and uncertainty with a blood biomarker test. Again, this approach could ultimately be simpler and cheaper to administer, and more consistent than existing methods.

We won’t be replacing physicians any time soon, but these new approaches are emblematic of what we can expect as developers make better use of available data, analytics approaches, and distribution methods. I’m most excited about increased diagnostic accuracy, earlier availability of information, more widespread availabilty, and lower cost.

Image courtesy of Ambro at

By healthcare business consultant David E. Williams, president of Health Business Group.

You might be covered, even if your doctor sends you a bill

published date
August 4th, 2015 by
Am I covered?
Am I covered?

Kaiser Health News published an informative Q&A today, posing and answering three common questions about the practical aspects of health insurance. I’ve been working in healthcare for 20 years but I still like to read these pieces. Often the answers to the simple questions are not so simple, and sometimes I learn something new.

One of the questions caught my eye:

Q: I have insurance coverage through the health law’s marketplace. When I visited a cancer clinic for a routine blood check, I asked upfront three times (first over the phone and again when I was there) if all services would be in-network. The answer was “yes” each time. Afterward I received a bill from an out-of-network lab for $570. Is there anything I could have done to avoid this charge?

The column answered that theoretically the patient should be able to find out where the blood work is being sent and check if it’s in network, but realistically that’s a lot to ask.

From where I sit I think it’s unreasonable to expect the patient to have to do so. At a minimum I would complain to the clinic and would also considering leaving feedback on a ratings site to let others know.

But I also want to draw attention to the last part of the reply:

“In the meantime, check with your insurer… It’s not unusual for providers to bill patients for services that are ultimately covered by their plan.”

That’s a very important point, and fits with my own experience. Providers will typically bill the insurance company and if they get turned down or not fully paid they send the bill to the patient. This process can take a while, and that sometimes means the provider is sending a statement, not a bill, by the time everything is settled. When I see a balance for $176.45 that’s 60 days old –as I did recently on a provider statement– what does it really mean?

Here are a couple recent examples from my experience:

  • A dentist sent a bill for my dependents, which had been rejected by the insurance due to lack of eligibility. I called the insurance company, which assured me coverage was in place. Eventually it was re-billed and went through. The same thing happened at the same office for another family member, and it was also corrected after I inquired. I never figured out who made the mistake or what exactly occurred between the office and the insurer.
  • A dependent needed frequent eye exams due to a drug treatment he was undergoing. The first visit was paid but then other visits were denied. Some time passed before I received the bills and figured out insurance wasn’t paying. I called the ophthalmologist’s office and was told the visits had been coded as routine eye exams –which have to be a year apart to be covered. When I explained it should not have been coded that way they said it was too late to change it, the insurance company wouldn’t go back and fix it, and oh by the way if I paid over the phone they’d knock 50% off what I owed! Rather than accept that deal I called my insurance company and they took care of it within a week

A friend told me she is consistently billed for co-pays that she has paid at the time of the visit, but because it’s such a hassle to document her payments and to work to get them reversed, she just drops it. Although I pay all my co-pays at the time of service and have not had this trouble, I told her about other people I know who refuse to pay any co-pays at the time of service –for fear of this exact problem– and instead wait for the bills to come in the mail.

Bottom line: Don’t let the provider be the one to tell you you’re not covered. If you think you may be covered, call your health plan. Often it works out.

Image courtesy of digitalart at

By healthcare business consultant David E. Williams, president of Health Business Group.