Hospitals

Primary Care Is at the Center of a Health Revolution

By KEVIN WANG, MD

If our urgent-care-as-healthcare culture isn’t killing us, it’s certainly wasting our time and resources. 

Consider these facts highlighted by Advanced Medical Reviews, based on various studies: 

  • U.S. physicians report that more than 20 percent of overall medical care is not needed.
  • The Congressional Budget Office recently estimated that up to 30 percent of the costs of medical care delivered in the U.S. pay for tests, procedures, doctor visits, hospital stays, and other services that may not actually improve patient health.
  • Unnecessary medical treatment impacts the healthcare industry through decreased physician productivity, increased cost of medical care, and additional work for front office staff and other healthcare professionals.

Most of today’s primary care is, in retail terms, a loss leader — a well-oiled doorway to the wildly expensive sick care system. For decades, practitioners have been forced into production factories, seeing as many patients, ordering as many tests, and sending as many referrals as possible to specialists. Patients, likewise, have avoided going in for regular visits for fear of the price tag attached, often waiting until they’re in such bad shape that urgent (and much more expensive) care is necessary.

The system as it stands isn’t delivering primary care in a way that serves patients, providers, employers, or insurers as well as it could. To improve health at individual and population levels, the system needs to be disrupted. Primary care needs to play a much larger role in healthcare, and it needs to be delivered in a way that doesn’t make patients feel isolated, neglected, or dismissed. 

Luckily, primary care is making a comeback — the kind that doesn’t just treat symptoms, but sees trust, engagement, and behavior change as a path to health.  

Healthcare the way it should be

When primary care is done right, it’s affordable, accessible, and most importantly, loaded with valuable patient-provider time. How many of us have spent hours driving, parking, waiting, and filling out paperwork, only to watch our doctor burst into the room, shake our hands, listen to our brief (and desperate) description of what feels bad, write a prescription, and leave? 

Primary care visits, on average, last only long enough for two people to talk for about 13-16 minutes, according to the Medscape Physician Compensation Report published April 1, 2016. How is that enough time to fully understand a patient’s symptoms, much less solve the problem? 

True primary care makes room for questions, dialogue, and empathetic listening. It’s the only way to get to the root issues of our health. When patients feel heard, they’re more likely to trust their provider and to continue coming in with their concerns rather than waiting for a costly trip to the emergency room. This further allows them to take responsibility for their own health and changing their behavior. 

When done right, primary care is the hub for managing and coordinating a patient’s entire health journey — knowing their current information, test results, medications, and any gaps in care. From start to finish, primary care providers are the only ones who are equipped to effectively drive the necessary referrals, prevent dropped balls in patient care, and bring everything together.

Primary care is simply a more effective way to deliver healthcare without the pitfalls of the current system. That’s not to mention cutting out the excess waste and unnecessary expenditures.

Advanced primary care: true primary care, made better

We’ve been discussing primary care in general terms, but there’s one more term you need to know: advanced primary care.

Advanced primary care (APC) is a data-driven methodology that emphasizes a higher quality of care, increased patient engagement and satisfaction, and improved population health management. The result is better health, which in turn means fewer claims and reduced cost to the patient and the entire system due to appropriate utilization and provider effectiveness.

Many of the features we’ve already discussed are hallmarks of true primary care — time-rich appointments, stronger patient-provider relationships, and empathetic listening.

But the engine behind the “advanced” in advanced primary care is the combination of true primary care plus care coordination, value-based referrals, a powerful informatics platform, and embedded health coaching to guide patients through stages of change. At the population level, claims data analysis gives more insight into community risk factors so providers can better identify, engage, and help those most vulnerable to certain conditions and illnesses. At the level of individual patients, longer appointments and more frequent and hands-on team interactions result in more nuanced information for better diagnosis and treatment plans.

When patients are being sent around to different doctors or facilities, it’s easy to see how vital information can slip through the cracks. That loss of data and context for patient care means valuable time and resources are wasted, potentially endangering the patient’s health in the process.

In the APC model, patient records are kept more complete and up-to-date because more care is managed out of their primary care office, and care coordination eliminates gaps in information when specialist care is necessary. Care coordination involves the scheduling, follow-up, and integration of the specialty care plan into the overall care plan, so that everything — including important details like a new prescription — is available to the primary care team.

Additional services like embedded health coaching work in tandem with the primary care team by giving patients helpful, practical tools and support for changing their behavior, minimizing the effect of social factors impacting their health, and meeting their personal goals. Health coaches are an integral part of the care team, trained in understanding how to move people through the stages of change. While primary care is still centered on prescriptive medicine, embedded health coaching provides an additional approach to bolster patient confidence in controlling their own health.

Making use of the health coaching benefit showed Rosemary (not her real name), a patient at a Vera Whole Health clinic through a commercial insurance plan, that small, manageable steps could help her lose weight, be more active, and pursue her dream of writing again — even if she was skeptical about the process at first.

“I went and it literally has changed my life,” she says. “I am not the person I was before. I’m physically 100% stronger. I’ve lost about 12 pounds. So, here I am. Extremely healthy with great habits. Not only that, I’m now working on the next step for writing.

“It’s hard to explain how something I didn’t want to do ended up being a game-changer. It’s the accountability, I think. It’s knowing someone else cares. I think that’s what the key is.”

Within the advanced primary care model, the care team has everything they need to serve their patients and communities the way they were trained to. Primary care providers deliver the majority of healthcare services, from regular checkups to more serious diagnoses and treatment for injuries, infections, and chronic and acute disease, keeping the majority of a patient’s treatment in-house. When necessary, a patient can still be referred to a specialist or an outside facility, but coordination of that treatment is managed by the primary clinic so that no gaps in vital information or care are created.

A health revolution is overdue

For too long, we’ve relied on the same ancient delivery models. At a time when our healthcare system has never been more in need of change, what was once considered a failure is our best hope to truly deliver cost-effective, high-quality managed care. 

Innovation in healthcare is the next step. Placing primary care at the center of the healthcare system is the only way to do it well. 

You can look at incredible organizations like Seattle Children’s, who have benefited by expanding their primary care options as a way to better serve their organization’s health and drive down costs.

After noticing that only 50% of their employees had identified a primary care physician, Seattle Children’s started to see the correlation between the out-of-control costs they were experiencing and the number of incidents of high cholesterol, blood pressure, and weight-related illnesses. 

They radically shifted their model, put primary care as the center of their healthcare system, and were amazed to find that ailments that had sent their employees to urgent care clinics and emergency rooms previously could now be controlled through effective primary care at their employer-funded, near-site clinic. Today, they have healthier employees and a better bottom line.  

This is the power of primary care done right. Not symptom control, but a vehicle that can pave the way to better health — through trust, stronger relationships, and behavior change. 

Dr. Kevin Wang, CMO of Vera Whole Health, leads Vera’s advanced primary care initiative which improves experience and health outcomes, drives down cost, and boosts provider satisfaction.

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Kevin Wang, M.D.LeoHolmMD Recent comment authors
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LeoHolmMD
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LeoHolmMD

All good points, but I have been seeing very similar posts for the last decade and a half. Various titles for the venture: ACO, PCMH, CPC, etc. They all seem to degenerate into the same care model we have now: little time with patients, lots of referrals, not seeing enough patients, not ordering enough tests, declining reimbursement. The only exception has been DPC, which has actually made good on it’s promise despite the up front costs and lack of acknowledgement. The rest have been total failures, especially the PCMH which sang almost the exact same song as in this post.… Read more »

Kevin Wang, M.D.
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Kevin Wang, M.D.

Thanks for your reply. You touch on many of the areas that are well known to us: in our assessment the “tiresome pattern” you describe largely happens whenever there is a misalignment between services provided and how those services are paid. The most vicious being FFS models (even in some FFS ACOs) that incentivize fast touches, higher RVUs, productivity, etc. to secure all-too-often declining reimbursement rates. Whereas the article didn’t get into the Vera secret sauce, I can tell you our advanced primary care model is absolutely and entirely value-based. Meaning, our model is more DPC-like in payment (think cap-like),… Read more »