IS IT TIME TO RETHINK THE PRIMARY CARE DELIVERY MODEL?

To more effectively understand the moving pieces in this topic, let’s use the Situation-Complication-Resolution (SCR) framework to discuss our primary care conundrum.

SITUATION:

There’s a reason we talk about primary care as being important. Here are the facts:

• US adults who access primary care regularly have 33% lower healthcare costs and 19% lower odds of dying prematurely than those who only see a specialist.
• A JAMA study indicated that 10 additional primary care clinicians per 100K people results in an increased life expectancy of 51.5 days.
• Addressing basic patient problems in the ER costs up to 12 times what it would in a primary care setting.
• Every $1 increase in primary care spending produces $13 in healthcare savings.

Primary care clinicians should optimally be the first line of defense or offense depending on whether it is a sickness or wellness conversation. There is universal acknowledgement across the healthcare industry, the government, and active investors that making primary care more available, accessible, and cost-effective is a high priority.

The outcomes however are not commensurate to the time and money that are being invested in the “let’s reinvigorate primary care” effort. From an investment standpoint, there continues to be a land grab for primary care offices in the traditional brick and mortar sense. Investments in telehealth continue at elevated levels. Yet, most KPIs seems to indicate that these two modalities, traditional (brick and mortar) and virtual (telemedicine), by themselves are not moving the needle sufficiently enough. There are a fundamental set of challenges with both modalities that are resulting in suboptimal KPIs.

COMPLICATION – Traditional (T) and Virtual (V) care models have inherent challenges

• T - We (in the US) will be short by 86K physicians, by 2036.
• T - Roughly 2 in 3 doctors experienced burnout during the pandemic.
• T - Nearly 50% of practicing physicians are over 55 and closer to retirement.
• T - Large % of physicians are reducing hours or contemplating leaving the profession.
• T - 25% of rural hospitals are at risk of closure.
• V - 50% of users encounter barriers that make it difficult to access telehealth.
• V - 42M Americans lack access to broadband.
• V - The absence of scans, biometrics, etc. in tandem with the psychological comfort of "going somewhere for care" makes a telehealth visit an incomplete and suboptimal primary or urgent care experience.
• BOTH - Share of total US healthcare spending devoted to primary care stayed under 6% from 2012 to 2021.

COMPLICATION – Resulting KPIs showcase a worsening situation

• 80% of US counties and 83M Americans don’t have sufficient access to primary care.
• 30% of Americans lack a primary care clinician.
• 1 in 10 Americans live in a care desert.
• 75% of ER cases are for non-emergent reasons.
• There’s been a 36% jump in the share of U.S. children without a usual source of care over the last decade and a 21% increase among adults.

COMPLICATION – AT A MACRO LEVEL

• Medicaid enrollment grew to 93.8 million, an increase of 23.1 million or 32.5%, between February 2020 and March 2023. Medicaid is now the fastest growing component of most state budgets. CMS gives states the option to charge Medicaid patients up to $8 if they visit an ER without a true emergency. As of a couple of years ago, only 14 states had enforced this provision, making the ER more accessible for non-emergent cases...and inherently less accessible for those with true emergencies.  
• The National Institutes of Health (NIH) estimates that the number of people 50 or older with at least one chronic disease will increase by 99.5%, from 72 million in 2020 to 143 million by 2050.

Demand for primary care will only increase with time. As these numbers continue to increase at such a staggering pace, it is going to be imperative that we have a solid first line of defense.

RESOLUTION

“Insanity is doing the same thing over and over and expecting different results.” – Albert Einstein

It is clear that expanding primary care access is critical to the long-term viability of the US healthcare system. The more obvious solutions have been incrementally effective but not sufficient to make a major dent in the problem. We also don’t have an impactful national strategy to address the issue. Based on the complications discussed above, neither traditional (clinics, etc.) nor virtual (telemedicine) care by itself is going to move the needle. The physician shortage in the first and the suboptimal care experience in the latter will continue to permeate a mindset of incrementalism...unless we try something different. We need to think differently and move quickly another direction, while not abandoning any efforts to address our physician shortage and improve the telehealth experience.

The answer, or one of the answers, is doubling down on tech-enabled hybrid care as a “best of both worlds” model, that blends the best of traditional and virtual care, while also addressing head-on the headwinds that both those models are facing.

 A tech-enabled hybrid care model done right looks like this:

• It is scalable, portable, easy-to-deploy, provides the psychological comfort that a patient gets when they physically visit a doctor’s office, while also giving them the convenience of the best that healthcare tech has to offer.
• Includes the scans, biometrics, etc. that make a visit to a traditional clinic comprehensive and personal, in tandem with the rapid scalability offered by telehealth.
• Requires a relatively small footprint ensuring ease of deployment, while also directly tackling the complications we’ve discussed.
• Could be essentially deployed anywhere there is a shortage of access to effective primary care, because the scalability, comprehensiveness, and ease-of-install makes it inherently resilient to the headwinds discussed above.

We are a country that prides itself on thinking outside the box. We can’t keep going on with only these current modalities and expect to improve access to effective care in America. The numbers that I’ve discussed above aren’t going to magically head in the right direction by doubling down on what we’ve already tried. The time to think and act differently is NOW.