Recently, Senior Analyst Alex Lennox-Miller was a guest on This Just In, a radio show and podcast with HIT Advisor Justin Barnes. Over two episodes, Alex and Justin discuss the driving forces and strategies behind new healthcare delivery and business models, particularly in primary care as Alex has explores elsewhere as part of his research on new front doors to care.
In Part 1, they address the urgent need for change with a shrinking clinician workforce and an aging population with more chronic care needs. They also cover best practices in patient engagement and the role of payers in innovative primary care adoption, including the new Primary Care First Model from CMS. In Part 2, Justin and Alex move into best practices and recommendations for care providers looking to incorporate these new models of care delivery, including common pitfalls to avoid.
Listen to other episodes of This Just In with Justin Barnes on HealthcareNOW Radio, Apple iTunes, SoundCloud, iHeartRadio, Spreaker, Google Play, TuneIn, and wherever else you find podcasts.
Listen to the full episodes:
Excerpts from Part 1:
Justin Barnes: What innovative primary care models have you seen that increases care quality or increases care access for patients and lower healthcare cost?
Alex Lennox-Miller: The technology has been around for a while but the reimbursement is catching up to it…[Tools like telehealth, remote patient monitoring, AI symptom ceheckers] offer people a lot more access and give more people much more opportunity to get care as they need it. The ability to retain visibility on them to be getting data on them, to be interacting with them from home on an ongoing basis without needing them to come in for an appointment is huge. It’s groundbreaking…that provider relationship is really invaluable. And the more you could maintain that, the more you could have that as a supplemental to your primary care provider as opposed to a replacement, the happier everybody is.
Justin: What’s missing from the modern recommendation of primary care?
Alex: It may be the case that we may not need our current model of primary care, which is basically “one size fits all”… Instead of single primary care model, we need to branch out, say that, “Different people need different styles of care.”
Justin: Very, very true. [When I worked with a health plan in Georgia, with some younger, healthy patients, we didn’t recommend an annual physical. Meanwhile for diabetic patients], with a wrap-around care strategy, you can have an 80% success rate. I mean you’re lowering cost, healthier lifestyle and then a better lifestyle for them. Quality of life for them, lowering the drug prices, drug costs, and it’s just a well-balanced life for these people. When you can achieve that, as a care provider, that puts a big smile in your face.
Justin: What would be a couple best practices that you’d share around patient engagement?
Alex: Shared responsibility, co-production of health, is probably the single most important change that a healthcare system can engage in. The more you can bring people in as part of their healthcare, include them on healthcare team…if they have responsibility as opposed to just being a passive consumer of healthcare, that’s going to make a huge difference in your patient outcomes.
Justin: What are some of the drivers for these new models of care, in primary care as well as hospitals and health systems?
Alex: Reimbursement is going to outcomes and quality of care. It doesn’t matter how many patients we’re churning through, if you’re not helping them, if they’re getting readmitted, if they’re having ED visits, if their health maintenance numbers aren’t where they need to be. That’s the other issue that health systems are struggling with, is that a lot of their models of productivity don’t square with the direction the reimbursement is going.
Justin: What innovations are you seeing in care design?
Alex: The biggest ones are those that give time back to providers in some way, whether it reduces the amount of time that they’re spending on administrative tasks, wor the time that they’re spending during an appointment collecting information that should already exist in the clinical record or collected prior to the appointment. Things like telehealth, telemedicine, remote care, which don’t necessarily make the individual appointment faster but which take away some of those additional obstacles especially for patients.
Justin: Yeah. To that point, we’ve been able to reduce unnecessary visits with telehealth. Every member has access to their primary care physician via a telehealth app and a virtual care app, and they can ask questions, they can do secure messaging, they can do a video chat with their doctor – not a doctor, with their doctor. And that really frees up those appointments to managing the people that need to be in front of that doctor at that time.
Alex: The other thing which is going to make a big difference, which is building applications and platforms that enable asynchronous communication between provider and patient…If you can get people who don’t need to be speaking to someone face-to-face, and who are comfortable to sending a message or getting feedback on a platform, that enables more or less the same level of care. They’re not getting less attention. It’s just adjusting how that time is spent, how their time is being spent, and what the provider has to spend time doing.
Justin: What are some of the concerns or risks that you see in these new models of primary care?
Alex: I worry that a lot of these lower touch, lower patient involvement systems have the potential to not necessarily reduce burden but just redirect it…If you take all the healthy patients away from a doctor’s panel [by offering patients telehealth and other new services] and replace them with half the number of patients but who have significant chronic care issues, significant health issues, you haven’t made their lives easier.
Listen to the full episodes above for Alex’s recommendations for care providers interested in adapting to these new tools and strategies for care delivery and reimbursement.