By Elizabeth Hayes, Staff Reporter
Back in the late 1990s, a group of four Portland primary care physicians got together to try to solve a problem.
Convinced that there was a better way than the traditional “visit-centric” model, they spent a year figuring out how they’d design primary care if they could start from scratch.
In 2000, they came up with a template they believed would increase access and convenience, as well as quality. By offering memberships, patients could reach their doctors 24/7, by phone or secure messaging, if not in person.
That template emerged into what is today GreenField Health, a fast-growing Portland clinic that accomplished 15 years ago what the rest of the industry is tackling today in the second year of health reform.
“It led to fundamental design principles. Most of what primary care can do for patients doesn’t require a visit,” said Dr. David Shute, GreenField’s medical director and one of the doctors that dreamed up the idea, though he joined the organization after it was established.
“This is a medical system that respects their time,” Shute said. “We don’t make them wait or come in unless there’s a reason to.”
GreenField doctors focus instead on building relationships with their patients, with whom they’re on a first-name basis, and consistently delivering quality care.
Today, GreenField has 5,000 members, up from 3,800 three years ago. They, or their employer, pay a tiered membership fee based on age, ranging from $12 to $65 a month. GreenField bills the patient’s private insurance or Medicare Advantage for certain services, including certain office visits and lab tests.
Clinic Administrator Anita Walker declined to disclose revenue, but said it has grown at least 10 percent a year. A 2012 Business Journal story pegged it at $4.5 million at the time.
The membership fee gives the clinic the resources to do remote consultations, for which insurance doesn’t traditionally reimburse. And it allows longer, more comprehensive face-to-face visits, when needed. A new patient visit lasts 90 minutes, an annual exam an hour and an office visit at least half an hour.
“One of the things that became clear is we needed a revenue stream to deliver care in the way it should be delivered for maximum efficiency, to get out of the volume-funded model we liken to a hamster wheel, where people experience short, rushed visits,” Shute said. “That burns out physicians, that high production environment.”
The clinic created a Comprehensive Health Exam, which is more in depth than a typical annual physical, Shute said. The clinic tries to stick to Evidence Based Medicine guidelines and avoid bloodwork and procedures that don’t have proven value, such as an annual cholesterol exam for a healthy person.
“We take the science and integrate that with the patient’s needs, family history and personal preferences,” Shute said. “We’re better at looking critically at what are things that help people be healthier and what are things that aren’t helpful.”
Intel and Laika like it
A lot of the precepts that govern GreenField have since spread to other clinics that have earned the designation of Patient-Centered Primary Care Home, because they work as teams to manage patients’ chronic conditions and emphasize preventive care.
“In our design 15 years ago, we built in a lot of things health reform is asking for,” Shute said. “We feel like the market is catching up to us in terms of what we designed.”
The practice employs 11 salaried physicians who work out of two locations, one in the Rose Quarter, another in Southwest Portland.
GreenField doesn’t use nurse practitioners or physician assistants as primary care providers, but physicians team up with health coordinators. The Rose Quarter office is co-located with Life’s Work Physical Therapy, which helps in coordinating care for patients with musculoskeletal issues. A certified diabetes educator and dietitian are also on the team, and Shute said a behavioral specialist is next on his wish list.
While GreenField has a waiting list, the clinic is careful not to overload the physicians. The standard is to get patients in the same day or the next, when medically appropriate.
“We could cram them in, but then we’d be back to a productivity model we try to avoid,” said Walker.
Several prominent companies in the Portland metro area provide a GreenField membership as a benefit to employees — Intel Corp., Enli Health Intelligence and, starting in January, Laika Entertainment LLC. Walker said the clinic is “actively looking” for more employer groups.
“That’s a big growth opportunity,” she said.
GreenField tracks a variety of metrics, which it shares with employers and the government. Intel employees give it high marks — 100 percent — in patient satisfaction, Shute said.
Two-thirds of Enli employees have taken advantage of the benefit.
“GreenField’s whole thing is, ‘Let’s get beyond the appointment,” said Enli CFO Kurt Koehler. “It seemed like a great idea from an employer perspective. Instead of running off to the doctor all the time, you could email them. Whenever I’ve needed them, they’ve been incredibly responsive. They’re more flexible. They’ll take your phone call.”
The company: Greenfield Health
What: A membership-based primary care clinic
Where: Two clinics, one at 9450 S.W. Barnes Rd. and the other at 700 N.E. Multnomah St.
Revenue: Not disclosed
Founders: Dr. Chuck Kilo, Dr. Steve Gordon, Jill Arena
Elizabeth covers health care for the Portland Business Journal. Sign up for her Health Care Inc. NW newsletter to keep tabs on what's happening in the rapidly changing industry.