Source: Modern Healthcare

By Caroline Lewis

June 28, 2016

It's not hard to see the appeal of urgent care centers: They're open evenings and weekends, you can walk in without an appointment and, in some neighborhoods in New York City, they're becoming nearly as ubiquitous as Starbucks. While critics say urgent-care patients miss out on the quality of care that comes with a long-term doctor-patient relationship, these walk-in centers have set a new precedent for convenience and customer service that the city's public health system and other providers are trying to replicate.

Atlanta-based urgent care chain GoHealth has 23 urgent care centers in New York, and plans to almost double its presence here by the end of the year. But it isn't trying to compete with primary care doctors, said Todd Latz, the company's chief executive officer.

"We've driven more people back into primary care than we've taken from it," said Latz, during a panel discussion on urgent care at Crain's "Disruption at the Doctor's Office" health care summit Monday. He added that GoHealth's relationship with Long Island-based health system Northwell Health allows it to direct patients to specialists or other types of providers if necessary.

Desk clerks at GoHealth always ask patients if they have primary care doctors, and ask those who don't if they want one, Latz said. Some people do accept GoHealth's offer to help them find a primary care doctor whom they could visit for more continuous care, but he said millennials are generally not interested.

"They generally view health care as episodic in nature," he said.

Urgent care resonates with people who are used to the on-demand nature of other industries, agreed Dr. Michael Goldstein, a Manhattan ophthalmologist and president of the New York County Medical Society. "The same person who decides they need to order shoes online at 12 o'clock at night goes to the urgent care center," he said.

But there are downsides to episodic care that many patients are unaware of, Goldstein argued. Urgent care centers—which are often staffed by physician assistants or other mid-level professionals, rather than medical doctors—won't necessarily be able to catch serious medical problems. They may also be more prone to misdiagnoses and are less equipped to help patients handle chronic conditions like diabetes, said Goldstein.

NYC Health + Hospitals, the city's public hospital system, is working to adopt the ease of access and customer service offered by urgent care at its outpatient centers, said Steven Bussey, chief of ambulatory care at H+H. That means extending hours and rapidly adding new locations.

But Bussey emphasized that the health system's main objective is to improve patient health over the long term—a goal that also has financial motivations. Increasingly, Medicaid and other insurers are devising payment models that reimburse providers based on improvements in the health of their patients.

"If you're not delivering outcomes, you're not going to get paid," said Bussey. He said the key is to coordinate patients' care and educate them about their medical needs.

Dr. Richard Park, chief executive of urgent care chain CityMD, which has more than 50 locations in the metro area, insisted his chain also aims get patients to change their behavior for the better. The way to do that is by generating a high level of trust, he said.

"I'm not talking about just any level of trust," said Park. "You need to create Oprah-like trust."

Asked whether the involvement of private investors in urgent care could present a conflict of interest, Latz and Park said they simply make sure they choose partners whose missions align with their own.

"If you can't deliver the appropriate level of care, engage with patients and create an environment that they want to return to, it won't matter what your original financial investment thesis was—it won't be successful," said Latz.

Working with private investors isn't off the table for the city's public hospital system, said Bussey. He noted that the state has been looking into the role of private investors in health care for many years.

"It's a tough conversation to have," said Bussey. "It depends on the circumstances and how you make it lucrative to the partners on both sides."

"Do urgent care centers have your best interest in mind?" originally appeared in Crain's New York Business.