Garnet mobile health clinic. Courtesy photo.
by C.B. Hall, Vermont Business Magazine Essex Junction-based Garnet Healthcare is all about finding the niches. Amid the almost incomprehensible complexity of the US health care system — and what commentator Bill Schubart recently called the “sprawl of free-market businesses” in the sector, the interstices are many.
Those gaps present challenges for people needing medical care, but also offer opportunities for entrepreneurs — a seedbed for enterprises such as Garnet.
Garnet’s several moving parts include a new mobile clinic service branded as Direct Care and incorporated as Garnet Clinical Services. That initiative got going in January, with the hiring of a full-time medical director. Winooski-based Twincraft Skincare, which manufactures soap and other personal-care products, became the venture’s first client in early September.
In a November 7 interview, Garnet CEO Ryan Ferris said Twincraft was Garnet’s only participant — so far — in the mobile clinic program, describing the company as Garnet’s “launch client.” The clinic-on-wheels [see photo] is staffed by a physician who also works in the UVM Medical Center’s emergency department. When she’s on duty there, a certified physician assistant staffs the vehicle, which “looks just like a doctor’s office as soon as you close the door,” Ferris said.
Photo: Ryan Ferris, President and CEO of Garnet Healthcare. Courtesy Photo.
The Direct Care benefits provided to Twincraft employees include an 8-to-5 telemedicine service.
“When we’re not in the clinic, they still have access to telemedicine,” Ferris explained. “If someone needs to be seen, we schedule them for the next clinic day, provided it’s not an emergency. “In the future, the Direct Care offerings will be rounded out with a mobile urgent care unit — shooting ultimately for a 24-hour urgent care service, which is not being done at all, so far as we know, by anyone else in Vermont.”
He anticipates a 2023 rollout for that service, which will come to patients where they live or work.
With Direct Care, he said, “we can provide what your doctor provides at an office visit.”
The services range upward to “basic point-of-care labs”; for more complex work, the clinic refers patients elsewhere.
“Severe shortness of breath, chest pains, active seizures — anything that would be serious enough to warrant a 911 call and being taken to the ER” — lie beyond the reach of the model, he said.
The Time Factor
Direct Care has thus moved into one of those gaps in the health care system. The business model also takes some of the heat off other providers, overtaxed emergency rooms being the obvious example.
Direct Care also saves time, Ferris said, referencing a study published by the American Journal of Managed Care that found the average doctor’s visit consumes 121 minutes, including just 20 minutes with the physician. Travel time and time spent waiting in the doctor's office comprise the rest.
Photo: Garnet mobile health clinic interior exam room. Courtesy photo.
In the Direct Care model, the client company pays for the service through self-insurance.
“In our current arrangements, the employer pays us a pre-agreed fee and a small per-person monthly access fee,” Ferris said. “There’s no insurance company involved, but our providers are credentialed by some insurers.”
He mentioned certifications from Blue Cross and Blue Shield of Vermont, Cigna and United Healthcare, adding that credentialing is in progress with several other insurers.
As to Garnet’s competition, Ferris said, “The closest in terms of employer-sponsored health care would be Marathon Health, but they only do near-site or on-site clinics. Garnet provides on-site, non-fixed infrastructure clinics that are designed to be modular and flexible for clients, both from an operations and financial perspective.”
In another sense, however, Marathon is very close to Garnet. The former company, which operates clinics in 42 states, maintains its head office in Winooski. But, Ferris noted, Marathon has a relatively small footprint in Vermont. “They’re much larger in markets outside New England,” he said.
Marathon did not respond to requests for comment.
For businesses, another alternative is to hire in-house providers. In Vermont, Ferris said, “there are a couple of organizations that are large enough to have their own medical staff. The practice is somewhat rare though — it’s more popular in areas (of the country) where there are larger businesses.”
From Twincraft, An A-Plus
In a telephone interview, Michele Asch, Twincraft's vice president of leadership and organizational development, had nothing but praise for Direct Care.
“We have 300 employees, we’re self-insured, and as a company that’s self-insured, health care costs are rising dramatically and it’s hard to recruit employees,” Asch said.
She said Twincraft had used Marathon for two years.
“That didn't work out for us, for a whole host of reasons,” she said.
She mentioned the need to go to the provider, rather than have the provider come to Twincraft.
“We always look for win-wins,” Asch said. "Garnet Healthcare checks both the boxes; in essence, we provide a concierge medical program for our employees and reduce our company’s costs. Garnet gets an A-plus — 100%.”
She divides Garnet’s services into three elements: 1) the mobile clinic that travels to the company’s Winooski plant and Essex campus on alternating Tuesdays, performing routine medical services such as administering blood tests and removing a mole; 2) telemedicine “triaging”; and 3) urgent mobile care, expected to launch in 2023, to reduce the strain on nearby emergency room facilities that often see waits of seven hours or more.
“The cost to go to the ER — remember, we’re self-insured — is much higher than Garnet,” Asch noted, adding that several other area employers are considering contracting with Garnet.
Photo: Garnet mobile health clinic exterior. Courtesy photo.
Bringing Back The House Call?
Garnet currently has 85 full-time, part-time or per-diem employees.
“Our primary footprint is Vermont — and, right now, Chittenden County — for our medical practice,” Ferris said. None of the Direct Care medical practitioners are contractors; all are employed directly by Garnet.
Ferris, who is trained as a paramedic, said his company currently embraces four operations: an ambulance service, launched in 2018 as Garnet Transport Medicine; a laboratory division, Direct Care, which began during the pandemic (“People weren't being moved between hospitals, so we had to find other sectors of health care to get into.”); a first-aid products division; and a multispecialty physician service.
“Things such as urgent or acute care are things we’re looking at,” he said.
Garnet provided COVID testing under a state contract during the pandemic, but that contract expired in June. The company still performs COVID testing for individuals and offers COVID and flu vaccines at locations in South Burlington and St Albans.
First-aid products represent another business niche that needed filling. Such equipment is not a one-size-fits-all proposition, Ferris explained; it is often tied to the nature of a company’s work. Green Mountain Power, for example, requires first-aid gear tailored to cutting out blowdowns or working high in the air, he said.
“We don't manufacture anything,” Ferris said. “We actually source products from various vendors, and we build first-aid kits for various purposes.”
Garnet’s next major initiative, Ferris said, is providing around-the-clock urgent care, a service akin to a doctor’s house call that people of a certain age remember from their youth.
“Say it’s 10 or 11 on a Saturday night, and you get a call,” he said. “The patient would be evaluated or triaged by telemedicine and, if clinically appropriate, their care would be rendered virtually. If the medical complaint fell outside the scope of telemedicine, we would dispatch a mobile care team to evaluate and render treatment.”
Summarizing Garnet Healthcare’s evolution, Ferris said, “The reason we’ve gone down this road is somewhat out of necessity and somewhat out of opportunity. We’re seeing where we can fill in the gaps with traditional brick-and-mortar hospitals and health care.”
He called his company’s development “a sort of natural progression of what we learned from COVID — to make us more diversified and thus equipped to handle quick changes, to deploy resources that we’ve accumulated in the last couple of years.”
Garnet’s business idea, in other words, is to fill in the cracks that reveal themselves in the health care sector.
C.B. Hall is a freelance writer from Southern Vermont.
