Disrupting primary care with Dr. Juliet Breeze
The future of primary care is shaped by multi-hyphenated individuals who create their own path because they see the world differently. Dr. Juliet Breeze, a family medicine physician and CEO of Next Level Medical, is one of those people. In the following interview, Dr. Breeze reflects on her career and shares her vision for disrupting primary care.
What’s your career trajectory been like?
Even in family practice residency, I was struck by the inadequacy of most patients’ healthcare experience and the inefficiencies of care in the hospital setting. Those initial observations planted a seed that has guided my career. As a physician and then later as a healthcare entrepreneur, I was always focused on creating a better experience for the patient and for the provider. Whether I was developing or consulting for specialty practices or developing facilities like surgical centers, specialty hospitals, or primary patient care service businesses, creating a better experience has been a main focus and driver. About 12 years ago, I added another dimension to my healthcare improvement obsession. I started to become deeply interested in care costs and access as significant obstacles to appropriate care. The interest in cost and access combined with my commitment to improving the experience of care led me to launch the two businesses I work in today. I am currently Vice President of Vantage Hospice, an organization that provides hospice and palliative care services in a variety of care settings. I am also the founder and CEO of Next Level Medical, a care model providing acute, primary, and preventive care seven days a week in-person or virtually. Next Level has served as an incredible opportunity for me to focus deeply on the things that have mattered to me most throughout my career.
What kind of problems are you focused on solving right now?
Three problems are taking center stage for me right now.
Patient engagement. With Next Level, I have finally solved for the barriers of cost and access since our centers are open seven days a week and our patients pay nothing because the membership is provided by their employer. Yet, there are still patients who do not make use of the free and convenient services. Being told you have a chronic illness or even the fear of being told you might have a chronic illness keeps many from getting care that could add years to their lives. Also, let’s face it, who wants to spend their time going to the doctor? The challenge is how to create an experience that provides more reward than discomfort. That is not an easy task.
Pharmaceutical costs. Currently, our membership includes lab, immunizations, durable medical equipment, x-ray, and all basic medical care but at the end of the day, if patients can’t afford their medicines, all those free evaluations did was diagnose the issue. Medications are still a large part of the solution. Pharmaceutical costs also drive up costs for employers. That spend could definitely be put to better use.
Collaboration within the healthcare ecosystem. I am interested in removing redundancy, improving communications, and creating ease for patients moving from our setting to a specialist office, therapist or a hospital.
Which value proposition resonates most strongly with employers?
When we started out, the whole conversation with employers was around total cost of care and how much we could save them money by providing an alternative to high-priced emergency rooms, hospital-based laboratory tests, and hospitalizations for chronic illnesses that were being ignored. But lately, as the competition around labor has increased, we have had more conversations regarding the value that patients ascribe to free basic medical care provided by their employer and how our program can improve retention and employee loyalty.
Why do some employers hesitate to engage with the direct care model?
As an employer, buying healthcare benefits is so complicated that most of us use a broker, consultant, or advisor to help choose the right plans. Unfortunately, many of the people “advising” us have financial incentive to recommend certain products and services. There are certainly enlightened brokers and advisers out there who believe in the direct care model but there are still many who guide their clients toward traditional insurance models. Many employers are just not confident enough to choose against what is being recommended.
How do you see primary care evolving in the next 10 years?
Primary care will evolve to be less visit-based and more about comprehensive team care. The fee-for-service model will be replaced by a more patient-centric economic model that encourages more utilization of basic care and less referral.
More healthcare will happen outside of the office setting. I also think that mental and behavioral healthcare will be an expected service from the primary care team.
What’s one resource you wish you had right now that would help you move forward?
I would love a full technology development team at my disposal. I’m working on that right now. I know we can create better technology solutions to drive engagement, efficiencies, and experience improvements. Right now, I spend a significant amount of time reviewing solutions others are creating but I would love the opportunity to create some of our own.
If your colleagues could ponder a single question that would nudge primary care in a new direction, what would it be?
If we knew exactly what diseases our patients would ultimately get in their lifetime, how would we change their care today?