BY BARBARA PINCKNEY
A Clifton Park physician and his Rensselaer
County-based partner have created a health care
model, based on affordability and convenience,
which they say may be the first of its kind in the
nation.
Dr. Michael Bibighaus and Keith Algozzine, a
physician assistant from Averill Park, formed Upstate
Concierge Medicine about a year ago, but went
live in September following several months of beta
testing. Both men work out of their homes, although
the business uses a Clifton Park mailing address.
The model combines telemedicine, through
which patients receive medical assistance over the
phone or computer, with concierge healthcare, in
which the patient pays a monthly or annual retainer
to see a physician as often as they wish.
“So the phrase that I coined is concierge telemedicine,”
said Algozzine, who is CEO of Upstate
Concierge. “No one is doing this across the country
that we’re aware of, so we’re the first. But we believe
this is actually the right way to treat patients.”
Bibighaus, president and chief medical officer of
Upstate, and Algozzine were part of the team that
founded one of the country’s largest telemedicine
companies, and still are part owners of that business.
Algozzine said that while the national “dial-a-doc”
model has its place, he and Bibighaus wanted to
create something that was more local and personal.
With Upstate Medical, patients pay a monthly
fee of $12 for an individual and $14 for a family to
obtain access to healthcare professionals 24 hours
a day, 7 days a week. Most interactions take place
over the phone, although videoconferencing, e-mail
and text messaging–sending photos of a rash, for
example–are also available.
The idea is to prevent someone with a relatively
simple, and easily diagnosed, complaint from having
to take time away from their job or family to go to
a physician’s office. If necessary, prescriptions are
sent to a local pharmacy for pick-up, or the patient
is referred to a specialist, imaging center or lab.
In some cases, Algozzine or Bibighaus will make
a house call, usually as a follow-up.
“For example we had a patient with a bad leg
infection,” Algozzine said. “He was local, so we
told him we would stop by his house in two days to
check on him.”
At the very least, any patient with an acute
problem gets an automatic call back within three
days to ensure treatment is working. Clients also
are given their own patient portal, where all their
medical records are housed electronically.
Algozzine said the monthly retainer was kept low
to make Upstate Concierge accessible to as many
people as possible.
“We want the grocery bagger who doesn’t have insurance to be able to afford it, as well as the rich
man or woman living on the hill,” he said.
The practice also has a model for businesses that
want to sign up their employees, on the theory that
concierge telemedicine saves time, reduces absenteeism
and may lower insurance costs by avoiding
the claims that go with office visits. The price is
$160 a year per employee, and Algozzine said several
businesses, of all sizes, have expressed an interest.
Upstate Concierge went live with a few hundred
patients, but Algozzine said the company hopes to
build to several thousand clients. It is accepting
memberships from anywhere in the state, but is
focusing on an upstate area Algozzine defined as
running from about Glens Falls down to Columbia
County, and west to about Amsterdam.
“That is where we have the most local expertise,
and can do a home visit if we need to,” he said.
“Where I can tell you the best cardiologist to go to
if you need it, where I can send you to this imaging
center if you need an x-ray, or to this lab if you need
a test. Really the highest level of service we can give
is in that region.”
At the moment, the Upstate Concierge team
consists of Algozzine and Bibighaus, who together
cover about 90 percent of calls, as well as a few
other providers and support staff. Most technology
is outsourced, and an answering service screens
all calls to be sure the person is a paying member.
“We are going to keep it small,” Algozzine said.
“You’d be amazed. With a few hundred members we
only get one or two calls a day, even on a 24-hour
basis. So it is not overly difficult for one or two people
to handle it. When you move up to 10,000 members,
like in our previous [national] model, even then you
get maybe 15 calls a day. So even when we get up to
bigger numbers, we will be fine with five, six, maybe
seven doctors taking turns on call.”
Both telemedicine and concierge care are growing
nationally, in large part, because of a shortage of
primary care doctors. This situation was made worse
by the Affordable Care Act, or “Obamacare,” which
increased the pressure on physicians by adding more
people to the insurance rolls.
“There are not enough primary care doctors to
adequately take care of all of the people that need it
to the level that they need it,” Algozzine said. “Even
if you have a pretty good primary care doctor, he or
she is only open four or five days a week for limited
hours. So there are automatically limitations with
a brick and mortar building. We are able to provide
an immediate access point for these quick and easy
problems.”
That does not mean brick-and-mortar is out of
the question for Upstate Concierge. Algozzine said
offices are a possibility in the future, depending on
patient demand.