🔒Greater Hartford healthcare partnership focuses on personalized care

During her 20 years as an emergency room nurse, Sharon Gauthier, founder of Avon-based Patient Advocate For You, noticed a common trend among patients. “We'd provide the immediate medical care necessary and send the patient home,” she said, “and often they'd be back within a week.”

It's the same readmission trend that drove Dr. Paul Guardino to found Farmington-based Personal Care Physicians LLC, a concierge-style primary care practice designed to provide more detailed patient-focused care.

Now both businesses, recognizing the synergies between their respective operating models and patient populations, have begun collaborating. “My company's client base is nearly 50-60 percent homebound patients,” Gauthier said. “Our team of nurses can assess each patient's problems and provide that information to Dr. Guardino's team for direct service.” Both have privileges at a number of Hartford area hospitals too, including St. Francis Hospital and Medical Center and Hartford Hospital.

Concierge medicine — which provides access to doctors with a smaller patient base for an annual fee — is a small, but growing trend in the healthcare industry. The number of concierge practices nationwide has grown from less than 200 in 2005 — the year Guardino founded Personal Care Physicians — to more than 5,000 today, according to Concierge Medicine Today, which tracks trends in the industry.

As part of Guardino's concierge practice, patients can schedule immediate appointments and get access to home visits, services that are aimed at elderly clients with health and transportation challenges, he said.

“I wanted to be in primary care on the front line,” said Guardino, “but that's hard to do [effectively] in a traditional practice.” That's because, Guardino said, as the level of reimbursements for medical care from insurers and the government continues to decline, many physicians need to see more patients to generate the same revenue. In fact, according to the 2013 Physician Practice Preference Survey, more than 30 percent of physicians polled cited reimbursement decreases as the primary challenge to their income stream.

Guardino's practice — which features two other full-time physicians and one part-time worker — has less than 300 patients. A typical primary care practice may have 3,000. A doctor in the traditional practice, Guardino said, may need to see 30 patients a day, roughly five or six an hour. “It's hard to investigate and ask questions face-to-face, order tests, and follow up when you're seeing that many patients,” he said. “Now, I never schedule any appointment for less than an hour.”

Guardino's concierge model charges an annual fee — ranging from $2,750 for individuals to $4,500 for a couple. Each appointment also has a separate cost that can be covered by traditional insurance, but Gauardino says the selling point of the concierge model is less about money and more about better quality care.

“By having more time to focus on each patient in the primary care phase and having someone who fully understands the patient's background,” Guardino said, “you can avoid a lot of the unnecessary testing and defensive medicine that occurs today and save the U.S. healthcare system billions.” Research by the Harvard School of Public Health, for instance, estimates that nearly 30 percent of the $2.8 trillion spent nationwide on health care is wasteful.

Guardino points out that a physician who has time to fully understand a patient's medical background may be able to adjust treatment and better assess safety concerns. “A complex patient may have 15 different medications,” he said. “Is anyone looking at the [drug] interactions? Are they all necessary?”

Those are the same types of concerns that pushed Gauthier to start her patient advocacy business. Since its 2008 founding, Gauthier's company has grown from eight clients and $40,000 in revenue to more than 200 clients and nearly $500,000 in 2014, a revenue figure she expects to double this year. “Families today are often out of state, and it can be difficult for adult children to care for their parents,” Gauthier said. That is where Gauthier says her business provides real value. “Our nurses [who all have more than 20 years of clinical experience] can help patients navigate the system,” she said. “We don't make decisions for a family, but we educate them so they make informed medical choices.”

One of the biggest benefits of a concierge approach to the patient and hospitals, Gauthier said, is the knowledge about the patient that her team has. “It's very useful to the hospital, especially with elderly patients,” she said. “We know their medical background in detail.”

That benefit comes at a cost: a $175 per hour fee. Gauthier said patients typically purchase her company's services in eight hour blocks.

Some clients, she said, use her company's services on an ongoing basis, while others, for a lower cost, use the company as an emergency contact.

After six months, Gauthier said her company's collaboration with Guardino's concierge practice is working well.

“We are able to provide the assessment, and Dr. Guardino has the [proper] time to provide the right care at the right time,” she said.

The strategy seems to be working so far: Gauthier said she's seen no readmissions among her clients.