Business Columns & Blogs

Health care without bureaucrats’ assistance

For all the debate over health care in this country – how much it costs, who pays for it – there’s remarkably little change. The debate never ceases, and the costs keep going up.

But poke around behind the scenes a bit and what you’ll notice is considerable restructuring of the health care industry – how and where it’s delivered and how it’s priced.

It’s not one thing that’s going on, it’s multiple and separate efforts, ideas, ventures and experiments, some by established players in the health care industry, others by new entrants, still others by combinations of the two.

Taken as a whole, though, they represent a trend that could provide some answers to the vexing questions of health care – or else collide with accepted notions in such as a way as to make the current arguments over health care seem subdued by comparison.

One such idea is the freestanding urgent-care clinic for routine procedures and minor illnesses and injuries, the stuff that needs more immediate attention than a scheduled visit to a doctor’s office but doesn’t need to clog up a trauma-level emergency room.

What were once colloquially referred to as “docs in a box” aren’t a new concept. They’ve been around for several decades, in fact, but growth has been slow in coming.

They are catching on with established health care providers and newcomers alike. MultiCare operates eight urgent-care clinics in the region (its website will even tell you how many minutes the wait is at its locations), as well as two Express clinics. Franciscan Health System has two urgent care clinics, branded as PromptCare, and is planning a third.

Others see potential in the market. Towson, Md.-based Doctors Express has two locations in Washington, including one recently opened in Kent, and is looking to open more franchised locations.

Retailers too have been interested in the possibilities of adding health care services, in the form of walk-in clinics. Walmart has a clinic in a Federal Way store, while Walgreens, Target and Rite Aid, among others, have opened clinics in stores.

That’s one approach, oriented at consumers. Employers are trying out affiliations with clinics that, for a monthly fee, provide primary care (individuals also are eligible to join). The employer can then back that up with insurance coverage for major stuff such as surgeries.

Denver-based Paladina Health, a subsidiary of DaVita Inc., has a clinic in Tacoma and plans to open more in the region. Another company pursuing much the same model, Seattle-based Qliance, also has a Tacoma clinic.

For higher-end medicine, a Bellevue company, MD2, promises concierge medicine with doctors who care for just 50 families each.

How much these ventures grow and influence the health care debate depends on how well they deliver on their promises to deliver faster, more convenient, more personalized care, and potentially at a lower cost. They will require consumers to make some changes too, giving up established relationships, doing more research, rethinking how they access medical care, even paying more out of their own pocket. They’ll also have to deal with knowing exactly what health care costs, an issue that often gets obscured with third-party payers and the industry’s complex pricing systems.

Employers, too, will need to consider whether these new options are preferable to absorbing ever greater benefit costs, trying to shove some of those increases off on employees or ditching health care coverage entirely. But the potential in those promises is huge. If this stuff works as hoped and the employer and consumer markets like what they’re getting and ask for more, it could well turn out that the politicians will one day look up from their wrangling over health care, only to find that while they were fighting, consumers and providers went ahead and solved the problems on their own.

Bill Virgin can be reached at