We all know – many of us too well – that healthcare is notoriously slow to change. While some areas move faster than others when it comes to innovation, there are those that have remained quite stagnant, like primary care. Consider this sobering statistic: A recent survey of 15,000 physicians found that the burnout rate for Family Medicine was 46% (above the overall average of 42% across all of healthcare).
The primary culprit of this higher-than-average rate of burnout: Administrative burden. Primary care has been struggling to manage increased demands and competing priorities – from Electronic Health Records (EMRs) to volume-based compensation, population health metrics and ever-present insurance conglomerates.
While slow, the innovation landscape in family medicine hasn’t been completely barren. We have seen pockets of innovation over the years; for example, as many primary care physicians have turned to Direct Primary Care models (DPC) to mitigate burnout and improve patient satisfaction. This model provides a more direct physician-patient relationship – and removes the insurance company altogether – allowing the physician more time with each patient for a flat or variable direct payment that typically includes all in-office services.
But the biggest evolution happened recently, with the near-ubiquitous adoption of telemedicine as offices had to close due to the pandemic, but patients still needed access to care.
Keeping the momentum going
Since March, we have seen a dramatic spike in the number of people who receive care virtually. One recent survey found an increase from 17 percent in 2019 to 70 percent in 2020.
While this is an impressive example of adaptability and how quickly we can change when needed, we must keep going. To lay a solid path for the future of primary care, we need to accelerate and focus in on the kinds of innovation that will improve care delivery – for both patients and providers.
The proactive change for which we need to strive
Primary care should be more focused on holistic, preventative team-based care of populations than reactionary care for acute problems. For example, I should be able to easily track all my patients with chronic conditions like diabetes and heart disease to know how they are meeting certain metrics. In real time, I should be able to make pre-emptive medication or treatment plan changes to help prevent a more acute or serious health episode. This ability to monitor, track and manage populations from a higher level will allow primary care physicians to move away from the current inflexible and burnout-inducing model of having to see patients in the office every 15 minutes. (And, from the patient perspective, this future ideal model would enable the holistic and preventative care that is so critical to optimize outcomes and quality of life.)
Innovation that will drive change
So how do we get there? First, the biggest drivers of change will be the start-ups who are challenging the status quo. These disrupters and pioneers – including 98point6, OneMedical, Iora Health and Firefly Health – are demonstrating alternative and innovative ways to deliver primary care that seek to drive better patient outcomes. From team-based care and new payment systems to fully virtual care delivery models, these companies are pushing the envelope on what’s possible, and will force larger, more well-established medical organizations to think — and act — differently.
Second, large healthcare organizations now have the opportunity to set themselves apart in a way they wouldn’t have had without the pandemic. Having been forced to implement new technology like telemedicine, they can capitalize on that progress by continuing to adopt new technology systems more quickly and nimbly. Sometimes it takes having no choice but to accelerate a process — the selection and adoption of new technology, for example — to realize that process was broken to begin with. Many large organizations who did not change as readily and relied on telephone visits (versus others who adopted video) will face more challenges to moving forward, and will likely be tempted to try and return to normal too quickly.
But that return to “normal” must be slow and methodical, with an eye on the future. Organizations that take their time and find good long-term solutions that put patient and staff safety before profit will do much better in the long term. For instance, enabling complete remote patient examinations through technologies like those provided by Tytocare or Eko Health that allow for remote physical exams, which can – through connected devices and attachments – assess inside the ears, nose, throat and listen to heart, lungs, and abdomen. This ability, coupled with remote patient monitoring for chronic conditions – e.g., digitally-connected scales, blood glucose monitors, and blood pressure cuffs – would allow for near-complete remote exams and assessment. In addition to improving patient outcomes and satisfaction, this would minimize liability and allow for a broader range of conditions to be treated remotely.
Finally, there will ultimately need to be strong central government action taken to support and drive some of these innovations. We need innovative policy that controls costs related to pharmaceuticals; addresses industry fragmentation and lack of interoperability; introduces shared cost savings; incentivizes and prioritizes primary care; and presents coverage solutions that will allow doctors to care for patients rather than push papers, check boxes and jump through administrative hoops.
Primary care in 2021 and beyond
While the primary care model may change over time, the need for primary care physicians will never fade. If anything, they will be needed more than ever, as holistic and continuous care is so critical to a patient’s care journey.
If we are asked to look back on 2020 and COVID-19 and find something positive, I believe it will be the quick adoption of telemedicine across the spectrum of care. Not only did it demonstrate our ability to move quickly when necessary, but delivered the broad availability of virtual visits, which will increase patients’ access to primary care doctors so that they may receive that ever-critical holistic care – safely and conveniently.