How Intuitive Health is combining urgent care and emergency care

In an interview with Chief Healthcare Executive, CEO Thom Herrmann talks about the company and his ambition to take the hybrid concept nationwide.

Thom Herrmann says he can relate to those who don’t know whether to go to an urgent care center or a hospital’s emergency department.

A few years ago, Herrmann’s son had a 103-degree fever and he took him to a local urgent care center. After a while, the doctor thought it wasn’t too serious but suggested he go to the emergency department to be safe. After a few hours at the hospital, Herrmann was told his son would be fine and it was indeed nothing serious, but it made for a long night.

A few weeks later, he received an $1,800 bill for the emergency department visit. And he spent $200 at the urgent care facility.

“I fortunately can afford it,” Herrmann said. “But there's a lot of families, you talk about an unnecessary $1,600 or $1,800 bill, that’s a mortgage payment. That’s a lot.”

Herrmann now aims to offer better choices to patients. Herrmann is the CEO of Intuitive Health, based in Texas. Intuitive partners with hospitals to offer urgent care and emergency departments in one location.

The company started as Legacy ER & Urgent Care in the Dallas area, but the organization changed its name to Intuitive and broadened its ambitions. Herrmann outlined the company’s goals in an interview with Chief Healthcare Executive.

“I wanted to take this concept and bring it within 15 minutes of every household around the country," Herrmann said. "That’s not going to happen overnight, but really, that’s our long term objective is to make sure no matter where you live, you have access to this more intuitive type of care.” (The story continues after the video.)

The Intuitive urgent care/ER facilities are open around the clock, seven days a week, making it easy for patients to get care when they need it.

“Our focus in general is how do we build our service, not around the provider, but around what the patient needs,” Herrmann said.

Adding locations

Intuitive has been striking more partnerships with health systems across the country. The company operates the combined urgent care/emergency facilities, but the facilities carry the name of the local hospital system.

The company operates 16 hybrid urgent care/ER locations and has more than 50 others in development. Intuitive manages facilities in Texas, New Mexico, Arkansas, Florida, Ohio, Oklahoma and Indiana. The company is building new locations in Arlington, Virginia, Delaware, Arizona, Kentucky and Washington State.

Intuitive has partnered with healthcare organizations such as OU Health in Oklahoma, UF Health and Baptist Health in Florida, and Presbyterian Health Services in Albuquerque, N.M. Earlier this year, Intuitive reached an agreement with Virginia Mason Franciscan Health in Washington state.

Herrmann said Intuitive is aiming to treat 1 million patients per year by the end of 2024, and he says the company is on track to meet that goal.

No surprises in billing

Intuitive is banking on billing transparency as a key differentiator. Herrmann said if patients go in for urgent care, they are only billed for an urgent care visit.

“Over 70% of patients walk out with an urgent care bill,” Herrmann said.

If a doctor determines the patient needs emergency care, the patient receives an acknowledgement form explaining why the doctor has ordered additional tests or services. The patient signs it before the additional test is done.

“There’s never a surprise on the backend if they end up getting an emergency-level bill,” Herrmann said.

Patients using Intuitive’s facilities are getting in and out more quickly, he said. For those who only need urgent care, patients are typically done in less than an hour, while those receiving emergency-level services are in and out in under 150 minutes, he said.

“We focus on the amount of time the patients spend in the facility,” Herrmann said. “They don’t want to be in a healthcare setting any longer than they have to, but they also want to get appropriate treatment.”

At the same time, he said Intuitive isn’t working to cut the time patients spend with doctors.

“The one area we find patients really want more time, not less, is time with the provider. When a provider comes into the room, the last thing we do is hurry up that interaction,” Herrmann said.

“We want to make sure that the patient has ample time to ask all the questions, to talk about their condition, to get feedback from the provider.”

Herrmann said Intuitive is getting high marks in customer satisfaction, which he attributes to the time patients get with providers.

Intuitive is using the Net Promoter Score (NPS) system utilized by many retailers and companies to evaluate how they are doing with customers. Intuitive’s NPS score last year was 83, placing it in the top 1% of all retailers, not just companies in the health sector, Herrmann said.

“Patients felt like they were heard,” Herrmann said. “They really did feel better when they walked out the door.”

Challenges in expansion

As Intuitive aims to enter more markets, the company faces some challenges.

Herrmann said acquiring the right locations for new facilities isn’t easy. He said the company operates by the “gallon of milk” principle, meaning that consumers should be able to quickly find an Intuitive location if they go for a quick errand.

“Real estate has become a challenge,” Herrmann said.

“We’ve developed over time a very specific target for the type of location that we want to place our facilities so it can reach the most people,” he said. “We want to make sure it’s really easy to get to.”

However, he added, “We’re not the only ones that like those locations.”

Staffing has become another challenge, Herrmann said.

Healthcare organizations around the country have bemoaned the difficulty in finding nurses. Since Intuitive is working with local hospital systems, Herrmann noted that the company must avoid adding to their partners’ labor woes.

Intuitive has also dealt with staffing issues during the COVID-19 pandemic, with some staff members contracting the virus and others needing to take a break.

To address those staffing challenges, Intuitive has worked to provide staff with more flexibility in scheduling.

Intuitive is striving “to make sure we’re really an attractive place for people to work.”

“That’s helped us weather the storm,” he said.

Designed around patients

Herrmann said he hopes Intuitive can play a role in improving health equity by offering more access points to healthcare.

“It’s certainly not the silver bullet,” he said. “It’s one additional part of the solution. There’s no appointment required. You’re going to get access to high-quality care. You can walk in, any time of day. We’re open 24 hours a day, 7 days a week.

“You’re going to get the right level of care, at the right price, and you’re going to get in and out really quickly with the care you actually needed.”

He pointed out some of Intuitive’s urgent care/ER sites, including locations in Albuquerque, are in areas with long wait times in local hospital emergency departments. “We’re finding a lot of success in these areas, some of them may be described as healthcare deserts,” he said.

Intuitive can be appealing to health providers moving toward value-based care, Herrmann said. The company’s model works with providers who are paid for efficient healthcare and managing patient populations, as opposed to being paid for each service they provide.

Herrmann said Intuitive’s facilities can lower costs by keeping patients from going to emergency departments, which can be expensive.

“If those patients ended up coming to us, most of those patients are going to walk out with a much lower cost service, an urgent care level service, unless they truly need emergency service,” Herrmann said.

“That’s a way to mitigate inappropriate ER utilization for those patients, and reduce costs, which then really fits well into making sure they are able to manage the health of that patient population at a lower cost.”

The Intuitive model of round-the-clock care also appeals to patients who want options other than seeing a primary care provider that is only available Monday through Friday during typical business hours.

“People that have grown up with technology, they’re used to things being built around them, not the other way around,” Herrmann said.

“As a healthcare system, we really need to shift that mindset and adapt to the needs and demands of our patients,” he added. “That’s really part of our mission.”