The Primary Care Crisis: How We're Failing Patients | with David Kinzler

This video provides an in-depth exploration of the crisis in U.S. primary care and presents a solution centered on relationship-based, accessible healthcare, featuring David Kinzler, CEO of One-to-One Health. The core thesis is that the current fee-for-service model creates perverse incentives, high costs, and significant barriers (financial and time-based) that deter patients from accessing necessary primary care, leading to worse outcomes and higher catastrophic costs down the line. Kinzler advocates for a return to the "Marcus Welby" model of primary care, where the physician is the trusted, accessible quarterback of a patient's health journey.

One-to-One Health addresses this crisis through two main avenues: physical on-site or near-site clinics, and TextCare, a scalable virtual primary care product. The TextCare model is highlighted as a revolutionary approach that leverages simple text messaging to connect patients with a dedicated care team, promising a human response time under five minutes (with an average of 1.9 minutes). This accessibility is crucial, as Kinzler argues that if they are not accessible, they cannot help. The service is designed to remove all friction points—no co-pays, no deductibles for primary care—positioning primary care as essential maintenance (like an oil change) that should not be covered by catastrophic insurance.

The discussion details the operational challenges and successes of scaling TextCare. By allowing patients to text about anything (from pink eye to benefits navigation), the service builds trust and ensures high utilization. A key operational insight is the importance of routing: while the front end is always a human, sophisticated routing ensures that primary care providers focus on high-value medical tasks, while navigators handle administrative or benefits questions. Kinzler shares a powerful case study involving his own son's appendicitis scare, demonstrating how immediate, coordinated access to a trusted physician prevented an unnecessary and expensive ER visit, instead guiding the patient through timely, cost-effective outpatient surgery and imaging.

Kinzler emphasizes that the direct-to-employer model is the most effective route for scaling this solution, as employers ultimately hold the keys to healthcare spending and are demanding better value. The company has proven that this model works, citing high retention rates among employer clients and strong utilization data. The future vision is for this model—where primary care is free, accessible, and relationship-based—to become the de facto standard for healthcare access in America, replacing the current "Google-ER path" that patients often take when faced with uncertainty or illness.

Detailed Key Takeaways

• The Death of Transactional Primary Care: The market is seeing a decline in transactional, one-off primary care visits (like those offered by some virtual or retail clinics). Patients ultimately desire a recurring, relationship-based connection with a primary care doctor who knows and cares about them, which is essential for managing chronic conditions and changing behavior.
• Primary Care as Essential Maintenance: Healthcare consumers should separate health insurance (for catastrophic risk) from healthcare delivery (for routine, preventative care). Primary care should be free at the point of service, similar to how car insurance is not used for an oil change.
• Correlation between Supply and Value: Primary Care is unique in the healthcare system because an increase in its supply is directly correlated with improved patient outcomes and lower overall costs, unlike building more hospitals or specialty clinics.
• Texting as the Optimal Medium: Text messaging provides the necessary accessibility and personalization for modern primary care. TextCare maintains a strict service level agreement (SLA) of under five minutes for a human response, with an average of 1.9 minutes, ensuring immediate support when patients need it most (e.g., late at night or on weekends).
• Building Trust Through Accessibility: By allowing patients to text about "anything and everything," including non-medical issues like benefits navigation (e.g., "How do I use my Orange Theory benefit?"), the service builds trust. This ensures that when a serious medical issue arises, the patient’s first contact is the dedicated care team, not Google or the ER.
• The Power of Coordinated Care: The TextCare model acts as the true quarterback, intentionally coordinating every step of a patient's journey. The example of the appendicitis scare showed the provider guiding the family away from an expensive ER trip to a physical exam, followed by a referral to an independent, lower-cost imaging center, and finally, an independent pediatric surgeon for outpatient surgery.
• Operationalizing High Utilization: The company uses granular utilization data (e.g., 10-15 patient messages per minute) to accurately forecast staffing needs, noting specific spikes (e.g., 9-10 AM due to follow-up messages, and the day after major holidays like Christmas). They staff 24/7, with a ratio of 1.1 after-hours providers for every daytime panel owner.
• Challenges in Direct-to-Consumer (D2C): While D2C marketing for symptom-based care (like UTIs) is cheap and effective, it faces two major challenges: D2C users often lack insurance (creating awkward spots when in-person care is needed) and they tend to "sign up, pay, cancel" after one visit, making member management difficult.
• Focus on Employer-Driven Change: The most viable path to scaling this model is through the B2B direct-to-employer channel. Employers are the ultimate payers and are increasingly demanding innovative solutions to curb rising costs, making them the most effective change agents in the current system.
• Seamless Integration with Existing Benefits: The solution must integrate seamlessly with an employer's existing benefits stack (e.g., MSK solutions like Hinge Health or Sword Health, or navigation platforms like Garner). One-to-One Health aims to be the front door to health, navigating patients to the employer's existing best-in-class vendors rather than trying to replace every specialty service.
• Mental Health Delivery Complexity: While mental health integration (talk therapy, medication management) is valuable, it is significantly more expensive to deliver in a virtual, unlimited model due to the required time commitment (45-60 minutes per session) and extremely high utilization rates, often making employers hesitant to fully fund it.

Key Concepts

• TextCare: A virtual primary care product developed by One-to-One Health that provides text messaging access to a dedicated care team with a guaranteed human response time under five minutes. It serves as a scalable version of concierge medicine.
• Relationship-Based Primary Care: A model focused on establishing continuity and trust between the patient and the provider, contrasting sharply with transactional, one-off visits. This relationship is critical for long-term health management and behavior change.
• Fee-for-Service (FFS) Perverse Incentives: The traditional healthcare payment model where providers are paid for the volume of services rendered, which often acts as a deterrent for patients (due to cost/time barriers) and incentivizes unnecessary procedures or tests.
• Panel-Based Function: The operational strategy used to staff providers, where a few thousand employees are assigned to a specific provider and their supporting team, ensuring continuity of care and manageable workload.

Examples/Case Studies

• The Appendicitis Scare: Kinzler’s son experienced right lower quadrant pain on a Sunday. Instead of rushing to the ER (the "Google-ER path"), Kinzler texted his primary care doctor (Keith), who advised against an immediate ER visit, coordinated a physical exam the next morning, directed them to a lower-cost independent imaging center, and connected them directly with an independent pediatric surgeon for outpatient surgery. This demonstrated superior patient experience and significant cost savings compared to a hospital admission.
• School System Engagement: One-to-One Health tested TextCare on a school system client (6,000 employees) with low clinic utilization. By sending personalized text messages to unengaged employees offering a "no cost physical," they achieved a 33% physical visit rate, proving the power of communicating through a convenient medium.
• Benefits Navigation: The care team received a text asking, "How do I use my Orange Theory benefit?" Although non-medical, the message was routed to a navigator who provided the answer. This demonstrates the strategy of being helpful on all fronts to ensure the patient returns for critical medical needs.