By KEVIN WANG, MD
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.
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.
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
primary care: true primary care, made better
discussing primary care in general terms, but there’s one more term you need to
know: advanced primary care.
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
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.
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
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.
health revolution is overdue
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.
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.
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.