Entrepreneurial Health Care Model
GRAND RAPIDS — Two years ago, they assured her she couldn't do it.
Yet, earlier this month she opened her first medical center.
Today, she is thinking about opening a few more.
It has been an amazing 24 months for Beth Boltinghouse, who conquered with a single resourceful idea what everyone said was unconquerable. Despite what Boltinghouse was repeatedly told, she created an innovative primary health care model for small businesses and individuals who have been priced out of the current coverage market.
The West Michigan Center for Family Health began operating in early June under the direction of Boltinghouse and Dr. John Lemke. The center charges patients a flat annual fee of $250 that entitles them to checkups, physicals, illness management, simple surgeries and other primary treatments. The center also has X-ray services, and offers prescriptions at cost.
Steeply rising health-care premiums were Boltinghouse's motivation to open the center. She is president of QCI Nurse Specialists, a six-year-old firm that employs nurses and aides full-time and sends them on assignments to area hospitals, mental health facilities and nursing homes. A few years back, however, it was becoming apparent to Boltinghouse that soon she wouldn't be able to offer health-care coverage to her health-care employees.
"We were looking at double-digit increases in premiums for insurance and the only way to hold down the cost was to either go to catastrophic coverage, or have ridiculous deductibles," she said. "And I had an issue with having health-care employees without having access to health care."
Boltinghouse told the Business Journal that many of her employees, who earn around $12 an hour, were having to pay about $100 each week to cover themselves and their families — even with QCI picking up half the total tab. She thought there had to be a better way to provide coverage for her 100 employees. So she contacted a lot of insurance agents and learned that if she set up a dual-fee system or a self-funded one, she wouldn't reduce costs for anyone involved.
"I have believed all my life that we have two choices. We can sit around and complain about something, or you can attempt to change it," she said.
"I wanted to come up with an affordable way that people could get basic health care, so this idea somehow got born and I can't explain exactly how. It was probably one of my epiphanies that I have in the middle of the night."
To make a system affordable, Boltinghouse needed a physician who would agree to be salaried. Enter Lemke. Knowing exactly what a physician would cost her let her figure out the center's other costs. Now Boltinghouse could conclude that the center could see up to 8,000 patients a year, charging $250 per patient, and keep the doors open.
But when Boltinghouse took a trek through the maze of legal tape surrounding health care she discovered that her flat fee became a published rate and her idea an HMO, despite only offering primary health services and not hospitalization insurance.
Now what to do? It came to her out of the blue, through another 2 a.m. epiphany.
"I sat up in the middle of the night and said if everybody else negotiates discounts, why can't we? So Discount Card of America was born, which is a company that sells a discount card to people who want discounted medical rates," she said.
"West Michigan Center for Family Health negotiated a discount with Discount Card of America to provide care for a pre-paid cost of $250 a year."
Sounds like a standard deal, right? Well, it wasn't. Discount Card of America didn't exist until Boltinghouse invented it. She started the card so she could open the medical center and not have the state view her business as an HMO — a pretty ingenious, late-night idea that has had a nice side effect. Other physician specialists, two dentists, a couple of social workers, and a massage therapist have agreed to give cardholders a discount.
"So now we have a network," she said.
With the discount card, Boltinghouse said small businesses and individuals can now have the cheaper catastrophic plans with those high deductibles and still get primary care through the center. She also said the differences between premiums could be deposited in an interest-bearing account and used to pay the deductibles.
"It really makes it much more affordable and much more controllable as far as you're only spending money that needs to be spent for care, as opposed to all of these incredible premiums for stuff that you probably won't use, and a whole bunch of deductibles on top of that when you use what you do use," she said.
But Boltinghouse added that if Lemke hadn't agreed to direct the center, it might not have opened. Lemke, Boltinghouse's personal physician and close friend, left Spectrum Health Primary Care Partners to become medical director at the West Michigan Center for Family Health. She said it wasn't just his ability as a doctor that convinced her to make him an offer; she felt he also had the right personality for the position.
"I have probably, over the six years that I've owned my other business, referred about 50 people to him who didn't have physicians. And not one of them has ever come back and said they didn't like him," she said.
That other business Boltinghouse referred to is QCI Nurse Specialists. Once known as QCI Staffing, which provided employees to nursing homes and mental health centers, she merged that business with one owned by Michael Fantin. His firm, called Nurse Specialists, provided nurses to hospitals. The merger took place last December.
Boltinghouse said she hopes to add more services to the center, such as a dentist, once it gets to the patient limit of 8,000. And rather than expand the center to, say, 20,000 patients, she said she prefers to locate new offices in different areas and serve other communities with the same model. Boltinghouse said people from Kalamazoo have already talked to her about bringing one there. Her current center has patients coming from as far away as Cadillac.
When asked whether she thought the Michigan Street center would take in enough revenue to be able to thrive on its own, Boltinghouse answered as only a true entrepreneur would — or could.
"Yes, I do. I'm betting my world on it. I have mortgaged my life to do this," she said. "I honestly believe that this will be successful."