Putting the “care” back in primary care: Trailhead offers a new model of family medicine

Maybe in another dimension, primary care physicians' broad knowledge and ability to treat a wide range of issues most patients deal with day to day is treasured by the healthcare system.

In this one, ruled by the almighty insurance company, doctors are realizing it's not. Some, like Grand Junction's Dr. Rob Boyer, are turning to new models of care to provide better experiences for doctors and patients.

After working at a hospital-based practice, Boyer remembers: "It just became pretty apparent that the healthcare system was … doing exactly what it was designed to do which is generate a lot of revenue, but it wasn't designed to take care of patients"

"Primary care is especially challenging, because our healthcare system doesn't value primary care," he said.

Family practice physicians have a vast knowledge of medicine that enables them to perform annual exams on patients and address issues ranging from mild fractures to moderate anxiety and even some skin cancers. They are often a patients' first stop for problems, and can treat many mild to moderate ailments and work with specialists when a problem falls outside of their scope.

"Being a good family physician is a lot about problem solving," said Boyer, founder of Trailhead Clinics.

At least, it's supposed to be.

However, primary care providers like Boyer, a graduate of UCLA's David Geffen School of Medicine, have been increasingly squeezed over the years by the nation's current healthcare system that nickels and dimes for each test, procedure and prescription.

He recalls at some practices getting hardly 15 minutes to spend with each patient while facing pressure to take on a high volume of clients due to declining reimbursements from insurance companies. These highly-trained generalists, he said, have been reduced to gatekeepers of specialists and medicine, spending their limited time with patients figuring out what prescription to write or what specialist to refer them to.

"You might only have time to send a referral, not evaluate someone and start them on initial treatment," he said.

Boyer said when primary care providers and specialists can work together meaningfully, patients have the best outcomes. But, he believes the decline in quality and accessibility of primary care is a major reason the U.S. spends so much on healthcare without seeing better outcomes than other developed countries.

So, fed up, he did some research and created a solution: Trailhead Clinics.

The subscription-based primary care service costs $99 per month for adult members, and includes a laundry list of medical services based around the idea of 24/7 access to a family practice physician.

The range of coverage is extensive: yearly physicals, basic blood work and well woman exams, urgent care, basic chronic disease and mental health management, minor procedures and more — we don't have room for the whole list.

For services Trailhead can't cover on-site, Boyer has worked to secure deals with outside providers to get discounts for his patients on things like imaging services and some lab work and procedures.

Boyer started his clinic in Grand Junction in 2016, and has grown the practice to include four doctors and two advanced practice providers (a term for nurse practitioners or physician assistants.) He's also opened two more locations: a small clinic in Glenwood Springs, and an office right here in Montrose at 401 S Park Ave., with one doctor and one APP.

"Our goal is to continue to grow the clinic to the needs of the area," he said. "My commitment is, if we have a bigger need and get more patients, we'll hire another provider. The goal is to fit the need of the community, each one is a little different"

Boyer noted in rural settings especially, access to healthcare can be a challenge. He prioritizes access, and patients can contact Trailhead's staff 24/7 for medical issues.

He noted that while some may view the clinic, with its wide-ranging services that check a lot of boxes for healthy individuals without underlying conditions, as an alternative to health insurance, that was not his intention.

"We're not really trying to position ourselves as an alternative to insurance," he said. "What we are trying to do is improve the access to primary care."

Boyer noted while the health insurance industry has greatly impacted the field of primary care, one he believes is essential to patient health, he wants people to understand they may still need insurance to cover emergencies or serious conditions that require the help of specialists. But, he said, even someone with the best insurance plan may only get a few minutes of face time with their primary care doctor each year, and making an appointment can take weeks.

He noted while most of the clinics' patients actually are insured, Trailhead does not bill insurance — everyone pays the same $99 per month subscription, with discounts for family plans.

"One of the reasons we charge what we do is to make it affordable for the average person," Boyer said. "We're not trying to just cater to the wealthy."

He said while the current structure of the health care system in the U.S. doesn't encourage clinics like his, he believes the demand for them is growing and he hopes to see more in the future.

Trailhead's Montrose clinic is still accepting patients, and its care team is headed up by Mayo Clinic veteran Doctor Robert Bonacci and Physician Assistant Aspen Flynn.

More information: https://trailheadclinics.com/