Over the past week, I have been acquainting myself with the healthcare system in California. It has been an enlightening experience, filled with valuable insights. We decided to opt for an HMO policy through California Blue, as we were unsure about the quality of doctors available and still relied on our concierge doc in Scottsdale for most of our prescriptions. Our plan is to give it a year to navigate our way through before deciding whether to switch to a cash pay system.
The mention of HMO often elicits a negative reaction from most individuals. It implies involvement in a capitated or managed care structure, where there is limited freedom to select preferred doctors due to regulated cost arrangements with providers. However, this may not necessarily be a negative aspect as long as the providers deliver quality care.
Our insurance has enrolled us in the Scripps provider network, which is an extensive network encompassing hospitals, post-acute care, and outpatient doctors’ offices. I recently had the opportunity to meet my primary care doctor for the first time, and I must admit, it was quite a unique experience. For the first time in my 39 years of living, I felt a sense of aging as my doctor appeared to be 10-years old. Surprisingly, this didn’t bother me in the slightest. In fact, I found it rather endearing, as he exuded humility and a genuine passion for his profession. It was refreshing to witness a doctor who was yet to be consumed by the demands of the system.
The doctor generously divulged the inner workings of the organization to me. He mentioned that he didn’t possess a complete panel or book of business, but instead followed a straight salary draw + bonus structure. Unlike most organizations, he wasn’t required to reimburse this amount. He elaborated on how he effectively managed his $300k student loan debt through this approach.
He explained to me how he receives bonuses by addressing the “care gap”. Care gaps refer to medical services that physicians are encouraged to prescribe in order to maximize insurance reimbursement for their practice. For me, this included a hep B test, an HIV test, and another test that I can’t recall. He showed me on his EMR interface three red buttons that serve as reminders for him to prescribe these services, ensuring his compensation aligns with the goals of the organization. Personally, I didn’t have any objections to this.
I am prescribed five medications, although I must admit that I tend to be a bit of a hypochondriac. Among these, two are hormonal, two are for mental health, and one is for metabolic optimization. Usually, I have to visit two different doctors to obtain all five medications. However, one doctor was surprisingly comfortable overseeing my entire medication regimen. This arrangement proved to be quite convenient for me as a consumer, and I found it intriguing that the doctor was willing to take on this responsibility. It was evident that he aimed to be a one-stop-shop for all my medical needs. Not only is this beneficial for his business, but it also enhances my overall experience. I must say, I didn’t mind this arrangement at all.
To obtain my bloodwork, the doctor requested that I visit a Scripps Lab. I made a lighthearted remark about having the freedom to choose, and he chuckled. It was convenient for him since they shared the same EMR system. For me, it wasn’t a big deal as my wife had informed me that Labcorp had a two-week wait. Clearly, Scripps had implemented a vertical integration strategy to capture downstream revenue. As long as it provides a better experience for me, I don’t mind. I accessed their app and received all my records on the same day, along with the referrals for my lab tests. They even sent a referral to a dermatologist through their system, and their office actually called me to schedule the appointment. It was truly remarkable. The wait time to see the specialist was longer, but that was expected. Moreover, the app notifies me of any cancellations and offers the possibility of earlier appointments.
Scripps is a healthcare enterprise that excels in financial management. While some may find this notion offensive, claiming it goes against patient desires and needs, I hold a different perspective as a satisfied customer. My experience was remarkably well-organized, efficient, and technologically advanced. As of now, I am a content and happy customer!
