Healthcare Simplified - Episode 4
August 7, 2017
Despite being a physician, Dr. Florin Selaru knows the frustrations of a patient.
He’s experienced the two to three week wait to get his children to a doctor. He knows what it’s like to see them have only 10 minutes allocated to them once they’re there, and to receive a high-priced bill that doesn’t always clearly match the quality of the appointment.
As a physician, he also has recognized the limitations of the system. So his mission was to figure out a system that works better for patients.
In the latest episode of Healthcare Simplified, Dr. Selaru discussed how his company, Clarii Health, is trying to revolutionize population health management and employer concierge care.
How Clarii Is Trying to
Revolutionize Primary Care
In Dr. Selaru’s mind, primary care plays a huge role in the healthcare of every individual.
If primary care is compensated in a fee-for-service model, where seeing more patients translates into more revenue, then we shouldn’t be surprised that primary care becomes a high-volume business. Doctors have to play by the rules of the game.
This is what sparked his attempt to figure out a system that works better for patients.
“The primary care doctor should be available to the patient 24/7,” he told us. “Even for a small question or clarification.” The reason is, primary care that is available curbs the cost of more expensive healthcare, such as seeing a specialist or unnecessary tests.
As patients, if we had a provider in our corner take the time to get to know us and understand the intricacies of our health, the situation would translate into a better health state with less need for complex and expensive healthcare.
The difficulty is that primary care today, for the most part, is paid for in a fee-for-service model, which again augments the incentive for a volume-based—not quality-based—service.
The 4 Pillars of the Clarii Model
The Clarii model addresses the time a physician has allocated to each patient in a very simple way: they limit the panel of patients that each physician has. Instead of having 3,000 or more patients, they limit it to 1,000 or less.
1) This results in more time allocated to each patient. That’s the first fundamental Clarii principle.
2) The second is that they want to communicate with their patients through any means possible. If they have the ability to communicate with them through text messaging or email, why wouldn’t they? Why make them come in to the office and waste half their day for a 10-minute face-to-face?
3) The way their physicians are compensated is by means of a “capitation model,” meaning a flat fee per patient regardless of how many cases that they treat per month. In that way, they remove any incentive to increase the volume in the business.
Their providers, starting with front desk and medical assistant physicians, are in a bonus system based on patient reviews and satisfaction. They want to stimulate this system, because that should be the business, not volume.
4) The last pillar of their philosophy is data. They like to work with third-party administrators and take care of employers for their employee population. In doing so, they have access to claims data and can see patterns before they turn into huge medical problems. So they use the data to perform population health management and primary care.
Referrals and Engagement
What is Clarii’s strategy on referrals and engagement, since engagement truly is the holy grail of managed care?
First, it may be hard to appreciate how well-trained primary care doctors actually are. We are used to the current system, in which primary care doctors are in a rat race. If they see less than, say, 70 patients a day, they don’t even break even. So they have to allocate 10 minutes to every patient or they’ll be out of business.
To the general population, it may be a surprise to learn that primary care doctors are very well-trained and can do a lot of what is traditionally referred to a specialist. Then, when PCPs feel that their area of expertise is not sufficient, they will indeed refer to a specialist. That’s a medical decision that they are trained to make.
In terms of the patient wanting to go to their recommendation or not, what Dr. Selaru finds is that it is typically not a problem, because of the rapport created with patients. Their patients trust their providers and trust that they have no other interests.
“What we want is better health outcomes,” he said, “because that’s what keeps people happy and healthy. That’s what decreases the cost of healthcare for everybody involved.”
Patients learn that quickly, and they learn to trust their doctors.
In terms of engagement, that’s where everybody is trying to learn to do better. In Dr. Selaru’s view, the secret is simple: trust.
Again, patients need to trust you. You tend to take a friend’s advice, even while you may ignore the same advice from someone you don’t know as well.
Their physicians spend the time with patients to understand their likes, health, and diseases and build trust. There is no magic formula for engagement; you can’t just engage people. They have to trust you.
Reach Out to Dr. Selaru
Listeners interested in deploying these strategies can call Dr. Selaru on his cell phone at (410) 274-9506 or email him at email@example.com.
An ideal customer for them is a self-funded employer. They can work with smaller employers, although they can’t do an on-site clinic. If you have 500 employees and up, it makes sense to have an on-site clinic. Give him a call to learn more.
This post is based on a podcast interview with Dr. Florin Selaru from Clarii Health. To hear this episode, and many more like it, you can subscribe to Healthcare Simplified. If you don’t use iTunes, you can listen to every episode by clicking here.