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, email
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 followup.
“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.