Last month we described the growing momentum behind telemedicine and virtual visits. We also discussed how this new approach could threaten urgent care and retail clinics because patients can be cared for at home rather than driving to the nearby retail store, medical office building or standalone urgent care facility.

This month we introduce another concept, called WhiteGlove House Call Health, that is the latest potential threat to walk-in medicine. It is essentially a mobile MinuteClinic and more, providing primary care and urgent care services, using nurse practitioners.

And this isn’t concierge care for the rich. It is a membership service being marketed to employers to try to cap their acute care and chronic care costs, while offering employees and dependents an exceptional healthcare experience — making the service especially attractive to self-insured employers and those consumers on consumer-driven health plans.
WhiteGlove was co-founded in Austin, TX, by Robert Fabbio and William Rice, M.D. It launched in September of 2007 and now serves members in seven metropolitan markets, including Austin,Dallas, Fort Worth, San Antonio, Houston, TX; Phoenix, AZ; and Boston, MA. Plans are now in place to expand across the U.S.

The service has two economic components: an annual membership fee, ranging from $300 per member for an employer or insurer, to $420 for individuals; and a flat per-visit fee of $35.

The Member Experience

From the member’s perspective, WhiteGlove can best be described as a mobile primary care service. If you feel sick and want medical care you either go online or call a toll-free phone number to schedule a time to have WhiteGlove come to your home, work, hotel room, or wherever you happen to be in their service area.

A nurse practitioner comes to your door with an iPad, medical bag, and supplies. They’ll have all of your medical history prior to the visit. They will hand you the iPad to get your consent to treat, perform the exam, prescribe and dispense meds and leave you a “well- kit” that includes chicken soup, crackers, Jello, Advil, Tylenol, ginger ale, cough drops, and tissues. At the end of each visit, they hand the you the iPad again and ask what you thought of their healthcare service.

“We carry 98 percent of what they’ll ever need in the vehicle,” says Bob Fabbio, the company’s co-founder and CEO. “In the rare case that we don’t have what the provider needs because we don’t carry it or we’ve run out, or if they want a brand med, we’ll order it. Depending on the market or situation, we either deliver it or they go get it at the pharmacy of their choice.”

A list of the prescription drug formulary is listed on WhiteGlove’s web site.

Lunch with Myself

Fabbio came up with the idea while he was between one of his many successful ventures. “I literally had lunch with myself and concluded I was too young to retire,” he says. “I knew I didn’t want another high-tech venture. I wanted to launch a service business that was focused on a large, messy market, that had complex subject matter, and could leverage my technology background. Essentially, a complex, messy service industry that was in need of disruption.”

Soon after he got sick and had to go to the doctor. “Between driving to a 9 a.m. appointment, waiting in the waiting room, waiting for the doctor, waiting for labs, waiting to be discharged, driving to the pharmacy, and waiting for a prescription, and then going to the grocery store, it was 2 o’clock in the afternoon by the time I got home,” he says. “I realized this was the messy, complex service business that was ready for disruption. It was healthcare.”

To work through the details of disaggregating the entire process of delivery care with the intent of putting it all back together in a highly automated way, Fabbio turned to his friend and co-founder Dr. Rice, and the rest is history.

Like retail clinics, WhiteGlove’s business model is deceptively simple. But behind the scenes it has all of the logistical complexity of a next-day delivery service like FedEx. So technology plays a significant role in putting expensive professionals in the right place at the right time, along with knowing exactly how many of those professionals you need ready on any given day. It is essentially one big algorithm that looks at members, employers, labs, pharmacies, inventory, and labor.

“The technology allows us to automate the business and clinical treatment plans, eliminate costs and errors, deliver unique member value, and erect significant barriers to entry,” says Fabbio.

Value to Employers

“We quietly went to work signing up members in the early going,” says Fabbio. “We initially thought the market was busy soccer moms and busy professionals. But it became immediately apparent that if we were going to grow this rapidly, we needed to figure out how to sign up large groups of members.”

According to Fabbio, the model enables self-insured employers and insurance plans to cap their costs in chronic care and acute care. But he also says WhiteGlove membership services can be married together with a high-deductible health plan (with or without health savings account (HSA) or health reimbursement account (HRA)), making the transition away from a richer preferred provider organization (PPO) much more palatable to employees and their dependents.

As evidence that the value proposition is significant, Aetna, United HealthCare and Humana are paying the membership fee on behalf of their members in Texas. If that happens in other states, WhiteGlove’s business will shoot up quickly.

Take the following example: a small employer with 35 employees can no longer afford to offer a PPO plan to its employees. They decide to move to a high-deductible HRA on a full-replacement basis with an individual deductible of $2,700 and a family deductible of $5,400. By doing so, the cost of the total plan, including employees and dependents, drops from $236,000 to $150,000, for an annual savings of $86,000 or 35 percent.

But instead of leaving a hole for employees to cover their “first dollar” expenses, the company adds WhiteGlove membership service at a cost of about $15,000 per year to cover both employees and dependents. Employees only have to pay $35 per visit, including generic prescription drugs. Compare that to the $25 office visit co-pay and $10 prescription drug co-pay under the PPO plan and it’s a wash. Plus the member never has to leave home or work – saving more time and money. At the same time, the company has a net savings of more than $70,000.

“A lot of employers are moving to high-deductible plans, particularly in the small- and medium-group market, and there are various ways to ease the transition for their employees,” says Tom Seltz, partner at insurance brokerage Marvin A. Address and Associates, Inc. in Washington, DC. “I think this is a good example of something employers will take seriously when they move to a high-deductible plan. But employees will expect a rapid turnaround and high degree of responsiveness, or they won’t use it.”

Barriers Facing WhiteGlove

WhiteGlove is still only in five states makes it difficult to gain traction with large employers who have people spread across the country. However, that will begin to change in a significant way this year.

“We’ve had some clients look at it,” says Tracy Watts, a partner at Mercer, the national HR consulting firm. “But until you can offer it to the vast majority of employees across the country, most large groups are going to hold off.”

That same “chicken vs. egg” phenomenon faced MinuteClinic and Take Care when they were starting their market expansions during 2006 through 2008 and were looking for employers to jump on board. But eventually big retail clinic operators covered the majority of top markets, like Charlotte, Chicago, Nashville, St. Louis, Philadelphia, Washington/Baltimore, New York, Cleveland and Detroit. However, WhiteGlove does not have brick and mortar. This attribute, combined with its technology, means the company will not need anywhere near the amount of capital required to open up new markets, as was the case with retail clinics like MinuteClinic, Take Care, RediClinic and The Little Clinic.

Another barrier could be regulatory. WhiteGlove uses nurse practitioners exclusively. But the retail players have already paved the way, in large part through the Convenient Care Association.

“Every state is different,” says Fabbio. “But our view was if we can be successful launching in Texas, we can be successful anywhere.”

Any business that has a clear value proposition, as WhiteGlove does, eventually overcomes the inevitable barriers to success. Not only do we believe WhiteGlove will become successful, we believe it will eventually see lots of competition in the same space. As for retail and urgent care clinics, this could create significant competitive head winds.

If you’d like to speak directly to a WhiteGlove representative about your potential business savings you can use our corporate contact form or let me know what you are interested in via email.

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Download the PDF of this report: ConvUrgentCare Report-April 2011.

Tags: chronic care, consumer driven health plans, CVS, CVS health, CVS healthcare, drive-up clinic, drive-up medicine, economic components, fabbio, FastCare, health at walmart, healthcare at walmart, healthcare experience, house call, house call health, medical house call, member experience, membership service, metropolitan markets, minuteclinic, mobile health, mobile healthcare, nurse practitioner, nurse practitioners, old-fashioned house call, RediClinic, retail clinic, retail medicine, service-driven health plans, TakeCare, target, Target Clinic, telemedicine, texasredi clinic, The Little Clinic, urgent care clinic, urgent care facility, virtual visits, walk-in clinic, walk-in medicine, walmart, william rice

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For those that have a primary care physician, we augment the care that you receive from your regular physician.

And, of course, you are able to share your medical records that we capture with your primary care physician. If you do not have a primary care physician or they are not available when it’s convenient for you, we are available 365 days a year, 8am to 8pm, within hours of contacting us to get-well.

If it is early morning or late afternoon during the week or over the weekend, you are unlikely to be able to see your primary care physician in a timely manner. In that situation WhiteGlove can be a new choice for you. There is no need to spend a fortune seeking routine care at an emergency room or urgent care center.  Just call us and we will come to you at your office or at your home, saving you time and money!

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