In the world of healthcare, there are many innovative ideas that aim to improve patient wellness while lowering costs.
One such idea was Turntable Health, a membership-based primary care practice in Downtown Las Vegas. The clinic offered a unique approach to healthcare, with patients paying a flat monthly rate for access to a “wellness ecosystem” that included same-day visits, 24/7 physician contact, health coaching, and group therapy classes.
However, despite its success in providing superior quality outcomes and high patient satisfaction, Turntable Health was forced to close its doors in January 2017.
In this article, we will explore the reasons behind the clinic’s closure and what it means for the future of healthcare.
Why Did Turntable Health Shut Down
Turntable Health was founded on the idea of providing affordable and comprehensive healthcare to patients in Las Vegas. The clinic’s member-based model allowed patients to pay a flat monthly rate for access to a range of services, including same-day visits, 24/7 physician contact, health coaching, and group therapy classes.
Despite its success in providing high-quality care, Turntable Health was unable to sustain its operations economically. Insurers were hesitant to cover member fees, preferring more traditional reimbursements that contradicted the clinic’s long-term health strategy. As a result, Turntable Health was forced to close its doors just three years after opening.
The closure of Turntable Health is not an isolated incident. Qliance, another direct primary care provider, also shut down this year due to financial difficulties. The demise of these clinics has raised questions about the viability of the direct primary care model.
Direct primary care is a controversial movement where physicians start membership-based practices and charge patients directly, eschewing third-party payers. Many of these practices use telemedicine, behavior change, and other digital technologies to increase efficiencies and drive down costs so they can keep the business sustainable.
However, the healthcare industry represents 19 percent of the GDP of the United States, which means that entities with a lot of money and power are not about to give those up without a fight. This resistance from the system has made it harder for clinics like Turntable Health and Qliance to survive.
The Birth And Success Of Turntable Health
Turntable Health was founded in 2013 as part of Zappos CEO Tony Hsieh’s $350 million economic revitalization project in Downtown Las Vegas. The clinic was the brainchild of Zubin Damania, who was recruited by Hsieh from the Bay Area to lead the project. The clinic was made in partnership with and in substantial part modeled on Iora Health, an innovative primary care chain led by Rushika Fernandopulle.
The clinic used a population health and disease prevention approach to improve patient health and lower costs over the long term. Unlike traditional fee-for-service models, Turntable Health charged per patient per month capitation to sponsors, or $80 monthly membership fees to members. This allowed physicians to spend 45 minutes or more in patient consultation, as opposed to the 13-16 minutes typical of a more traditional primary care setting.
The clinic quickly gained popularity, with members granted same-day visits with providers, 24/7 access to their doctor (by email, phone, or video), and a personal health coach. Using a similar model, Iora had experienced 35-40% lower hospitalization rates and 12-15% lower total healthcare costs than their community peers.
Turntable Health had been featured on TheNextWeb as one of “eight startups changing the healthcare industry,” and there were plans to expand and build new locations as the clinic approached a capacity of 5,000 patients.
Despite its success in providing high-quality care, Turntable Health was unable to sustain its operations economically. Insurers were hesitant to cover member fees, preferring more traditional reimbursements that contradicted the clinic’s long-term health strategy. As a result, Turntable Health was forced to close its doors just three years after opening.
The Challenges Faced By Turntable Health
Turntable Health faced a number of challenges that ultimately led to its closure. One of the biggest challenges was the reluctance of insurers to cover member fees. Turntable Health’s capitation model, where patients paid a flat monthly rate for access to a range of services, was not the traditional reimbursement method preferred by insurers. This made it difficult for Turntable Health to sustain its operations economically.
Another challenge faced by Turntable Health was the economic realities of the Las Vegas market. Despite being touted as an affordable alternative to insurance-based healthcare, the economic challenges of the Las Vegas market no longer allowed Turntable Health to viably and sustainably offer care in its Downtown location.
Additionally, Turntable Health’s refusal to compromise when pressured by payers to offer fee-for-service options or to begin charging a co-pay also contributed to its closure. The clinic firmly believed that healthcare is a relationship, not a transaction, and was unwilling to compromise on this principle.
Finally, the direct primary care model itself has faced resistance from the healthcare industry. The industry represents 19 percent of the GDP of the United States, and entities with a lot of money and power are not about to give those up without a fight. This resistance from the system has made it harder for clinics like Turntable Health to survive.
Despite these challenges, Turntable Health was successful in providing high-quality care to its patients. However, the clinic’s closure highlights the need for a sustainable and viable path for member-based healthcare in Las Vegas and beyond.
The Role Of The Affordable Care Act In Turntable Health’s Demise
The Affordable Care Act (ACA) was signed into law in 2010, with the goal of expanding access to healthcare and reducing healthcare costs. While the ACA did not directly impact Turntable Health’s operations, it did have an indirect effect on the clinic’s ability to sustain its business model.
One of the key provisions of the ACA was the establishment of accountable care organizations (ACOs), which are networks of doctors, hospitals, and other healthcare providers that work together to coordinate care for patients. ACOs are incentivized to provide high-quality care at a lower cost, which can result in financial bonuses for participating providers.
However, ACOs also compete with direct primary care providers like Turntable Health for patients and revenue. Insurers may prefer to contract with ACOs, as they are seen as a more traditional and established model of healthcare delivery. This competition for patients and revenue may have contributed to Turntable Health’s financial difficulties.
In addition, the ACA’s emphasis on preventive care may have made it more difficult for direct primary care providers to differentiate themselves from traditional primary care providers. The ACA requires insurers to cover certain preventive services without cost-sharing, which means that patients may not see the value in paying a monthly fee for access to additional preventive services offered by direct primary care clinics.
The Future Of Membership-Based Primary Care Practices
Despite the challenges faced by Turntable Health and other direct primary care providers, the future of membership-based primary care practices remains promising. The concept of providing affordable and comprehensive healthcare to patients through a membership model is still attractive to many patients who are looking for an alternative to traditional insurance-based healthcare.
One potential solution for membership-based primary care practices is to partner with larger healthcare systems. By joining forces with established healthcare providers, clinics like Turntable Health can access resources and funding that they may not have had access to otherwise. This can help them to expand their services and offer more comprehensive care to their patients.
Another potential solution is to continue to embrace digital technologies and telemedicine. These tools can help clinics to increase efficiencies and drive down costs, making it easier for them to provide high-quality care at an affordable price. By leveraging technology, clinics can also reach a wider audience and provide care to patients who may not have been able to access it otherwise.
Ultimately, the success of membership-based primary care practices will depend on their ability to adapt and evolve in response to changing market conditions. While the closure of Turntable Health and other clinics is certainly a setback, it is not the end of the road for this innovative approach to healthcare. With the right strategies and partnerships in place, membership-based primary care practices can continue to thrive and provide much-needed care to patients across the country.
Lessons Learned From Turntable Health’s Closure
The closure of Turntable Health highlights several important lessons for the healthcare industry. Firstly, it emphasizes the need for innovative and sustainable business models that can provide affordable and high-quality care to patients. The traditional fee-for-service model may not be the best approach for primary care clinics that focus on prevention and long-term health outcomes.
Secondly, the closure of Turntable Health underscores the challenges faced by direct primary care providers. While this model has the potential to increase efficiencies and reduce costs, it also faces significant resistance from the healthcare system. Insurers and other entities with power and money may not be willing to support this model, making it difficult for clinics to sustain their operations.
Finally, the closure of Turntable Health highlights the importance of collaboration and partnerships in healthcare innovation. Turntable Health’s success was due in part to its partnership with Iora Health, which provided guidance on population health and disease prevention. Collaboration between primary care clinics, insurers, and other stakeholders may be necessary to create sustainable and viable business models that can provide high-quality care to patients.
In conclusion, the closure of Turntable Health serves as a cautionary tale for the healthcare industry. While innovative approaches to primary care are necessary, they must also be financially sustainable and able to navigate the challenges posed by the healthcare system. Collaboration and partnerships may be key to creating successful models that can transform healthcare delivery in the United States.
