Then Dougher began visiting Halford, because Halford has no way of visiting her previous primary care doctor. On this particular visit, Dougher takes her blood pressure, checks the healing pressure ulcers that afflict many bed-bound patients, and does a careful inventory of her medications, checking the bottles and tubes she has against the list of medications in the electronic record. It turns out that her mail-order pharmacy service is sending pills she stopped taking months earlier, so Dougher makes a note to tell Halford's case manager.

On inspection, Dougher notices a red ulcerated region under Halford's nose where she wears her oxygen prongs at night. Concerned that it might be an early infection, he cultures it with a swab from his bag, labels it by hand, and then shows Halford how to use one of the antibiotic creams she already has to prevent the sore from getting worse while he waits for a definitive diagnosis from the laboratory.

Although Dougher attends to Halford's medical conditions with the studied approach of an experienced clinician, he keeps up an ongoing dialogue with Halford and her son, who visits each afternoon, that allows him to assess the support structures in place to keep Halford safe in the home she loves. Before he leaves, he injects her annual influenza vaccine.

Dougher trained as a family physician and then saw patients in a traditional office setting for 19 years before trading in the exam room for the SUV. His practice had skewed toward elderly patients for years due to a natural affinity, and he had always made house calls -- one or two each week -- as part of his practice, so he jumped at the opportunity to lead HealthCare Partners' home visit program.

Now, instead of 30 to 40 patients per day, Dougher sees six to eight. His team of two physicians and four nurse practitioners have divided the greater Los Angeles area up into districts, and have become the temporary primary care physicians to 700 patients who cannot make it to a doctor. Four trained medical assistants and three social workers support their activities from the central office, coordinating services like infusions, wound care, and skilled nursing, and communicating with the primary care physicians who took care of these patients before they became homebound, and who will resume their care when they are agile again.

What all of Dougher's home-visit patients have in common is that they are members of a Medicare managed care plan that has a full-risk contract with HealthCare Partners. What that means is that Dougher's employer receives a fixed fee each month for each senior citizen enrolled in the plan, equivalent to what Medicare would pay for a similar patient, and is responsible for paying for all of their medical care, from doctors visits to hospitalizations to surgeries.