Healthcare for the 1% and for the rest of us

The Wall Street Journal recently profiled Private Health Management (PHM), which they describe as an "ultra high-end" healthcare service for "high net worth individuals" working at private equity firms, hedge funds, and other places where Masters of the Universe congregate.

PHM provides a wealth of services ranging from collecting and organizing medical records to finding its clients super specialists. Their goal is to make life more convenient and produce dramatically better outcomes for their clients. Who wouldn't want such an Edenic service? And the cost of paradise? Well, if you have to ask, you probably aren't a potential PHM client.

Some years back when a member of my family was faced with a major healthcare crisis, I began searching for someone to help us navigate treatment and came across, largely by happenstance, one of PHM's competitors, PinnacleCare (PC). They sent not one but two RNs to our house. The presentation was professional, empathetic, and indicated that PC was clearly very knowledgeable about how to manage disease and ensure that we got access to the best doctors.

I did have to ask about the price. It was $40,000 to $60,000 per year. Frankly, I would have gladly paid it, though it would have been a substantial financial hardship. However, I had already spent eight weeks researching how to best diagnose and treat the disease in question. This involved learning a new language "“ Medicalese; learning the research tools of a new-to-me industry; and traveling around the country to visit with doctors (insurance generally does not pay them for phone consults). After PC's presentation, I discovered that I knew or was able to acquire (through friends and friends of friends) about 80 to 90 percent of the knowledge and access we needed.

PHM and PC both appear to provide outstanding service with the likelihood of improved results that comes with attention to detail and access to the best of the best. But, of necessity, this kind of high-touch service is extraordinarily expensive and out of reach to all but the lucky 1%.

But fear not, oh you 99%. A variety of services have popped up on the Internet "“ some free, some modestly priced that provide a version of concierge medicine and health advocacy for the rest of us. One of them, HealthTap, provides a free service where you can ask their volunteer doctors questions and the answers are posted in a searchable database. They also provide a free service where you can upload scanned copies of your medical files. But if you are thinking of using superglue on that cut of yours (you will need to register to get the last link), you will come away confused. Nine doctors felt you could use it most of the time, two said "it depended," and seven doctors thought it was a definite no, no.

Another service called JustAnswer lets you ask a question and one of the doctors currently online will answer it. Dr. Abby offered to answer my question about superglue on cuts for $35 if my need was of medium urgency ($25 if low and $55 if high). Before you pay up you know that Dr. Abby is female, board certified in something, and has a 99.9 percent patient satisfaction rating. I did not invest the $35, so I cannot tell you where Dr. Abby falls on the superglue spectrum.

As potentially interesting as these services may be, they take too limited an approach to the patient. In neither instance do you talk to a person. Nor does the doctor answering the question necessarily know much about you. Perhaps you are allergic to cyanoacrylate,the main active ingredient in superglue (5 percent of the population is). Do these doctors qualify their answers with this, or even inquire? They don't have your records and neither site provides vetted information from authoritative medical publishers.

So between a lot of assistance for a high price and a little help for no (or a small) price, is there a happy medium? My partners and I started First Stop Health on the premise that there is. We provide the ability to talk to a doctor on the phone 24 hours a day, 365 days a year on an unlimited basis. We also provide access to health advocates to help our members navigate serious illness, find second opinions, and deal with major insurance issues. We combine all these with a database of every physician, urgent care facility and hospital ER in the country, a database of thousands of medical articles on topics ranging from children's fevers to lung cancer (sorry we don't cover superglue), and an electronic personal health record that our member controls. All this is a few hundred dollars a year "“ less than what most people pay if they make an unneeded visit to an ER. Better yet, you can try it all out for just a buck. We hope you will.