The Next Wave of Medicine: When Transactional Medicine Becomes Personal

After spending over 20 years in traditional fee-for-service medicine, Dr. Alex Lickerman knew there had to be a better way. During that time, he worked with patients and in healthcare administration equally, providing him with a unique perspective. He saw our health care system from both the patient and the profit side.

Physicians usually spend around 20 minutes per patient and profits could only increase if a physician saw more patients. This snowballed into overworked physicians and underserved patients, prompting him to seek ways to practice medicine while putting the patient at the forefront of care — as a true partner in their lives, in both health and wellness. “I was curious about how I could engage the patient and understand his or her values,” says Lickerman. “How a patient’s disease impacts his or her life is much more interesting to me than the disease alone.”

In 2015, Dr. Lickerman left the hospital system and went into private practice. He was committed to creating a practice that profited both patient and physician.  ImagineMD was born as a direct primary care model, often referred to as concierge medicine. His patients pay a simple fee of $135 per month. This covers all of a patient’s office visits, no matter the number each month. It also covers access to same-day and next-day appointments, visits that last an hour or more, and 24/7 access every day of the year directly to Dr. Lickerman himself — even after hours. Since making this move, his practice has grown. He credits his growth to simplifying the patient experience while also improving the quality of care he’s able to provide.

Q: Why did you decide to establish your practice as direct primary care instead of the traditional fee-for-service model?

Lickerman: After spending 20 years in both patient care and administration, I’d gotten a strong grip on what patient frustrations were with our current fee-for-service healthcare system. I didn’t want to see more patients to earn a living practicing medicine. That would mean I’d have less time to spend with each of those patients. Direct primary care allows me to build my practice on a simple fee model and get money out of the way of building a relationship between my patients and the care I can provide.

Q: How has your current business model allowed your practice to grow financially?

L: Well, there are a few answers to this. They all work together to create the growth in my practice.

First, I don’t accept insurance. In traditional fee-for-service practices, I’d estimate that approximately 30% of both time and revenue go towards the complicated process of insurance billing. Involving insurance makes a project much more complicated. There’s intricate software and the staff you have to hire to manage billing. It’s also complicated to track where and when all of your revenue is coming in when it’s divided up between a myriad of insurance companies.

By taking insurance billing out of the equation, my direct primary care model allows me to operate with a very lean, patient-centric staff. I also don’t have to spend time on physician-to-insurer conversations. It takes up a fair amount of time in a fee-for-service model. This frees me up to spend more time with my patients.

Secondly, I have less administrative weight on each visit I have with a patient. In a fee-for-service model, I had to make sure that chart notes for each patient’s diagnosis were “insurance-ready.” I had to prioritize documenting their medical issues over their care. My current model, since insurance isn’t involved, means my notes are for the benefit of myself, the patient, and any future physician we might have to interact with for their care. Again, it translates to less administration and more time to spend on patient-centric activities.

Finally, because I am able to increase both the time and care that I am able to give to all of my patients, they’re incredibly happy with their relationship with my practice. The majority of our new patients come by referral from existing patients. When we keep our patients well taken care of, they send us more people who want that level of service.

Q: Did patient satisfaction increase with your direct primary care model?

L:When you’re a physician seeing 20 patients a day for 20 minutes maximum each, the patient feels that. There’s a disincentive to see a doctor when you’re not feeling well. This is because of time spent, an impersonal experience, and the co-pay. My practice model and flat fee structure lets patients access me when they need me without worrying about the cost.

This means my patients see me more frequently and reach out to me as a partner in their health. I have the time to spend answering their questions — in the office, via email, or via phone. I can build relationships instead of receivables, yet still operate a profitable business that grows each month. Most importantly, the patients are happy with the kind of care they receive and the level of interest I take in their overall health and lifestyles. It’s an attractive feature for patients to feel they can reach out or go see their doctor whenever they have to.


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