The Doctor Will IM You Now

Appointments run $150 for the first hourlong meeting, and $200 an hour after that. If a patient has health insurance, they can submit the receipt for doctor's visits and any tests or outside procedures they need to their insurer, but they have to handle all that themselves. As a result, about 50 percent of the few hundred patients are insured. Parkinson and his team recommend that patients pay for high-deductible catastrophic insurance to cover hospital stays, but rely on Hello Health for their day-to-day care. Catastrophic plans typically only cover health-care costs of more than $10,000 or so, but can cost as low as $100 a month for individuals, a fraction of what a comprehensive health-care plan would cost.

For some, including many of the med students listening to Parkinson that night, there lies the rub. Many health-care activists and self-described "idealistic" medical students believe that universal access to comprehensive health care is of paramount importance, and nowhere does Parkinson mention that issue. Under his system, patients have to pay out of pocket, up-front costs to get preventative care and, as problems arise, they must continue to pay for tests, treatments and the like. "Any time you create financial barriers to care, there's a problem," says Richard Kirsch of Health Care for America Now. "Moving toward catastrophic plans is the total wrong direction for health care. What happens if you get a diagnosis [from Hello Health's doctors] and you don't have the other $900 to treat it? This is a stopgap measure to deal with the fact that the system is so screwed up. It's not a long-term solution."

Kirsch's organization is advocating for something close to universal health-care coverage that would work with traditional insurers, what President Obama is also trying to push through. But that plan does not begin to solve the problem of the dearth of primary-care practitioners in the United States. And primary care is the key to the preventative medicine that Obama's plan is counting on to reduce health costs.

In the United States, roughly 75 percent of doctors are specialists—in most other countries, 75 percent of doctors are in primary care. Practicing primary-care medicine isn't nearly as lucrative as specialties, and doctors spend the bulk of their days dealing with insurance claims, or packing in as many patients as possible in order to keep their practices in the black. Massachusetts recently passed a universal health-care program, but it's facing a tremendous shortage of doctors. Only 10 percent of primary-care doctors there are accepting new patients, and the average waiting period to see a primary-care physician exceeds 30 days.

Parkinson says his strategy could help fill this gap. At Hello Health, doctors are able to practice primary-care medicine at specialist salaries. And Parkinson is not shy about his capitalist instincts. The students at Mt. Sinai, brimming with youthful idealism, are a tougher sell. "How much are you guys in debt?" he asks them. "I'm in $220k. Doctors take home 11 percent of the money spent on medicine in this country. It's all middlemen. But the essence of the health-care system is you meeting with your doctor in a room." There are 4.5 people hired per every doctor at a doctor's office, he tells them. "We don't need receptionists anymore," he says. "We don't need fax machines anymore. We don't need paper anymore. We have the Internet. We can do it ourselves."

With virtually no overhead, Hello Health doctors who have a full eight-hour day of appointments will bring home $1,600 a day before taxes. With two weeks of vacation time, that's $400,000 a year, more than twice the average made by family-medicine practitioners. But a huge reason they're able to do that is their refusal to deal with insurance companies. For patients who are insured, the onus is on them to submit the receipts and get reimbursed. Other patients pay out-of-pocket. But Hello Health says they refer them to providers that do testing for the lowest possible costs.

Kirsch concedes that the current bureaucracy is getting in the way of care. "The insurance companies are absolutely maddening in terms of collecting payments," he says. "But rather than saying, 'They're so maddening, we just shouldn't deal with them,' let's have a system in which there's electronic billing and standardized claims. Providing good primary care is one thing, but you want a system in which people get good primary care without financial barriers." In today's tough economic times, paying hundreds of dollars for a procedure or examination that may not seem entirely necessary can be a detriment to ensuring comprehensive and preventative care. And according to Kirsch, it's in everyone's interest to get more Americans treated before they get sick and place burdens on hospitals or emergency rooms.

Parkinson has heard these arguments before. But his primary focus is on improving the efficiency of health-care and doctor-patient communication through technology, which he thinks will greatly benefit medicine. A team of Web developers is putting the finishing touches on the Hello Health Internet platform, set to launch on July 1, which will make their communications system available to doctors at other practices. His partner company Myca will get 7 percent of the revenue generated from the visits the doctors schedule online. The platform will also offer a social-networking function for doctors that will enable collaboration beyond just friending. Like doctor-focused social-networking sites Sermo and Medscape Physician Connect, doctors will be able to consult to each other by posting images of, say, a skin disorder and ask rosacea experts if they agree with that diagnosis. They'll also use text messaging to collect important ongoing data from patients--diabetes patients, for example, will get texts three times a day asking for their blood-sugar levels. That data is collected on their personal pages, and can be referenced later by any member of their team. Groups will be created so that patients dealing with similar diagnoses can communicate with each other, and doctors can send them new studies and information immediately.