New visions for fixing health care

As a young internist working his way through rounds nearly a decade ago, Pranav Kothari grappled with what he saw as a broken delivery system. "When someone has a rash or strep throat, we do a pretty good job, the system works," he says. "But we tend to under serve those who need it most - those who are sick with chronic conditions. The frustration of the slow process of evolution and health care continued to nag at me."

After working as a reform-minded health care policy consultant, Kothari in 2004 joined with a colleague, Dr. Rushika Fernandopulle, and opened a new type of primary-care practice outside of Boston. Their clinic, which offered clients 24-hour access to physicians and same-day appointments, accepted a roster of about 1,000 patients. Patients paid a monthly fee of $20 to $40 a month to join the practice, which the two doctors used as an R&D lab for trying out new concepts of delivering primary-care service. Their first marketable idea: The Ambulatory Intensive Care Unit (AICU), a more affordable approach to serving the 20% of patients who fall into the highest-risk segment of the population.

Today Kothari and Fernandopulle act as consultants - their clinic was absorbed into Massachusetts General Hospital several years ago - and have launched AICU pilot programs in six cities, working with hospitals, clinics, and large employers such as Boeing to deliver a more streamlined version of primary care. Doctors are relieved of dealing with administrative work such as processing referrals and prescriptions, allowing them to spend more time taking care of clients. A support staff of non-physicians act as "health coaches," developing expertise on individual cases and staying in frequent contact with their clients by e-mail and phone.

"We're talking about cases where the health care is so complex, it's hard for patients to navigate," says Kothari.

While Kothari says that it's too early to yet see any cost-savings data, patients seems satisfied. Eventually, Renaissance Health hopes to move its AICUs beyond the pilot stages, opening permanent units in several cities.

"It's going to take a lot of non-traditional policy-making to cure our health care system," Kothari says. "There's a lot to learn from the smaller, nimbler companies - the quicker we get their dialogue into the system, the better the likelihood we'll see significant improvement."

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