In an important endorsement of innovative new medical services popping up across the nation to address shortcomings in the health care system, Microsoft has begun offering at-home medical care to its employees, Washington CEO has learned.

Seattle-based OnSiteDocs will send doctors to the homes of Microsoft employees who require urgent care for themselves or their family, but cannot get an appointment with their primary care physician, according to doctors who have been recruited for the effort. The goal is to reduce time-consuming and costly visits to the emergency room.

OnSiteDocs CEO Ralph Derrickson would not confirm the deal with Microsoft, but said offering home calls to employers is an important growth market for the company, which has long offered onthe- job medical services for companies such as Costco Wholesale Corp.

“OnSiteDocs combines the best of modern medicine with the service and attention of an old-fashioned house call,” says Derrickson, who managed the venture capital arm of Paul Allen’s investment company, Vulcan Inc., before joining the company. He recently raised $6.25 million in venture capital for OnSiteDocs.

The company is one of a handful of companies that are stepping outside the lines of traditional health care delivery to improve medical treatment.

“OnSiteDocs is on a roll,” says Garrison Bliss, a physician at Seattle Medical Associates and president of the Seattle-based Society for Innovative Practice Design, a national association of “retainer” physicians who offer health care outside the traditional medical system. “They have discovered that people like to receive health care at home.”

Bliss says a new generation of companies is responding to the deteriorating conditions in the medical system to offer innovative services that are changing the health-care landscape. “The whole area of consumer driven health care is taking off,” says Bliss.

The trend toward “consumer-oriented” health care began in 1997, when Seattle-based MD Squared began charging its patients $1,000 a month for more personalized attention from a doctor. The practice, now known as “Retainer” or “Boutique” medicine, has since taken off. Patients typically pay a monthly fee in addition to their regular insurance payment, in exchange for more quality time with their doctor, sometimes at home. Bliss launched his own retainer practice soon after MD Squared to get away from the grind of working long hours at an HMO and having little time to spend with each patient.

Physician John Kirkland is another disciple of retainer health care. When he started at Virginia Mason’s Lewis and John Dare Center in 1976, he and his colleagues saw eight patients a day and billed insurance companies $100 apiece. The doctors received $95 back from the insurance company. By the late 1990s, however, insurance companies were giving them only $40 for the same $100 bill. “In order to stay even, the number of patients we saw per day had to double,” Kirkland explains. “There was a point where I went on tilt and thought there’s got to be a better way.”

Now, patients pay the Dare Center $3,000 a year and, in exchange, Kirkland and his colleagues provide 24/7 care and make house calls when necessary. While an HMO doctor must typically serve 2,500 to 4,000 patients, physicians at the Dare Center care for no more than 300.

“Physicians got into medicine to practice good medicine,” says Bob Perna, director of health care economics at the Washington State Medical Association. “For a lot of physicians, the cost of operating a practice starts to outstrip their revenue stream,” and they have to make changes.

At the other extreme, cheap medical services are now being offered at many drugstores and retailers. SmartCare Family Medical Centers, a Colorado-based company, for example, is one of several across the country using nurse practitioners to offer basic medical care at many retailers. The company recently announced it will offer the service in Seattle this fall at Fred Meyer stores.