What Are the New Front Doors to Healthcare?

Our soon-to-be-released report, The Evolving Front Door to Care, reviews some of the changing ways that patients are entering and engaging with the primary care system. It looks at how Retail Health & Urgent Care, Telehealth, Virtual & Remote Care Platforms, and AI chat tools including Virtual Assistants, Symptom Checkers, and Chatbots ease barriers, supplement the current system, or aim to replace it entirely.

Key Takeaways

  • Patients want lower cost and convenience in primary care.
  • No single technology solves all problems and many solutions use a variety of technologies to provide value to users.
  • Many options threaten traditional primary care, especially if organizations can’t integrate them quickly for patient use.
  • On March 27th we will host a Healthcare Meetup, centered around a panel discussion on this topic. (UPDATE: Now you can watch a recording of that evening’s discussion).

Retail Health and Urgent Care

Increasing numbers of patients seek care at the roughly 8,700 urgent care and retail care centers across the United States. Patients value the shorter wait times and convenient hours. These sites also boast convenient locations at established health care service locations and at retail locations like Walgreens, CVS, Target, or Walmart. Clinics offer same-day reliable appointment slots online or via an app.

Chatbots or AI-driven symptom checkers enable pre-appointment triage or service locations recommendations. The broad set of non-emergent services on offer include diagnostic screenings, injections, and prescriptions. Customers can get physicals for immigration, school, or employment purposes. Urgent and retail care centers do not offer long-term primary care.

Chilmark has written extensively on recent retail health news, including partnerships between CVS and AetnaWalgreens and Microsoft, and Walgreens and Humana aimed specifically at providing care to Medicare Advantage members.


Telehealth appointments, real-time interactions between patient and provider, resemble traditional primary care encounters. Of all the new options for accessing care, they best leverage one of the greatest strengths of the primary care system: the relationship between patient and provider. Telehealth encounters can be enhanced with materials provided by the patient or remote patient monitoring (RPM) data.

CMS proposed new telehealth and remote monitoring rules late in 2018. Medicare telehealth reimbursement had been limited to rural services and specific use-cases, but CMS proposed removing geographic restrictions on both patients and providers by 2020. In 2019, providers can bill for remote image evaluation and ‘check-in appointments,’ time-limited triage or evaluation contacts.

Virtual and Remote Care Platforms

Asynchronous communication between patients and providers, virtual care and remote care platforms offer patient monitoring for chronic conditions and preventative health maintenance. They utilize a combination of vitals monitoring through wearable or home health technology, and a patient behavior regimen, either self-reported or through the completion of patient tasks. Most platforms include secure messaging or chat for patient/provider contact.

These are supplementary to a provider rather than a replacement for primary care, offering opportunities to replace the tasks and appointments that only aggregate patient data or check in on well-being. Time-savings, reduced travel, and more convenience for both patients and providers result in better adherence to regimens and better outcomes. Specialized platforms can address chronic conditions, including mental and behavioral health conditions, which are outside the expertise of a primary care provider, but which have substantial co-morbidities and increased utilization when unaddressed. Others are targeted at patients in specific risk tiers, using the remote platform to direct activities and monitor conditions that can result in increased utilization or readmissions.

With more patient care occurring in outpatient settings, retaining visibility on patients either post-discharge or between visits is a struggle for health systems. Patients with chronic or pre-chronic conditions are difficult to monitor without significant resources. Regimen adherence is essential to patient well-being but subject to enormous pressures. These platforms offer valuable tools to retain visibility on these patients, support their care plans, and more frequent opportunities to revise care plans as needed.

AI Assistants, Chatbots, & Symptom Checkers

The value of AI assistant, chatbots and symptom checkers is ease of use and convenience for the patient, and less work for providers and office staff. Symptom checkers are a growing component for urgent care and retail centers. AI patient engagement tools are emerging in the scheduling and communication fields. Remote care platforms are offering integration with virtual assistant tools for several home care uses.

Unlike ‘Web MD’ self-triage, symptom checkers offer vetted, automated recommendations to patients. They promise better usability that can drive higher engagement levels for patients and more efficient utilization of capacity for providers. The smoother experience of an AI chat leads to more willingness to engage with a platform or system, especially when they can be integrated into something already in place in a home.


The primary care system can better serve patient needs, but it will have to evolve. Integrating new technologies into primary care and its alternatives will require providers and payers to rethink their ideas about primary care in light of patient/member expectations.

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Did You Know?

MEDITECH Look Ahead: Building on Steady Progress

Key Takeaways from MEDITECH’s Physician and CIO Forum 2018:
  • MEDITECH is moving its customer base to Expanse, the latest iteration of their EHR
  • Expanse has significant inducements for hospitals seeking to support value-based care and be more interoperable

Photo: Courtesy of MEDITECH

Last week, we had a chance to attend MEDITECH’s Physician and CIO Forum, an event the company uses to give its customer executives a look forward.

The more concrete developments described over the course of this two-day event include:

Voice Support

A lot of attendees were talking about a new capability planned for Expanse called the Virtual Assistant. The idea is to voice-enable aspects of the physician’s workflow. Even as MEDITECH, and all the other major EHR vendors, slowly improve the interface design of their EHRs, users still want fewer clicks and swipes and less data entry. MEDITECH, seeing the rapid adoption of voice in consumer markets, wants its users to be able to retrieve results or review charts hands-free. It indicated that it is experimenting with this Nuance-sourced technology at a customer site with a phased roll-out planned once it gains more experience. Sometime next year it will begin work on using voice in physician documentation as well.

Interoperability and FHIR

MEDITECH came out strongly in support of FHIR. It has three live customers who have implemented FHIR servers that support REST-style access. MEDITECH facilities will soon be able to offer FHIR-based access on the CommonWell network. It is also looking at more complex transactions from Project Argonaut to support patient questionnaires and scheduling that will rely on write access to MEDITECH EHRs. You can read our full analysis of their support for API access in the MEDITECH profile in our App Store report.

Mobile developers will soon have access to a new capability called MEDITECH Greenfield to develop patient- or clinician-facing apps. It will serve up a set of APIs based on MU’s common clinical dataset with plans to add other data types down the road.

Clinical Decision Support

MEDITECH will rely on CDS Hooks to offer Stanson Health’s content for a variety of purposes. It will be used to push some of the most common care gap alerts. It will also push recommendations to physicians based on the Choosing Wisely campaign.

MEDITECH’s approach to introducing new functionality allows its customer to keep the lights on and support the onrushing changes to U.S. healthcare.

Population Health Management

MEDITECH’s PHM story is a little clearer than it was this time last year. The company’s collaboration with Arcadia.io means that its customers will soon have access to an aggregated patient record of MEDITECH and non-MEDITECH EHRs married to paid claims. Customers will get access to a new suite of dashboards and reports that provide risk scores, care gaps, attribution, utilization, and costs on a per patient or per cohort basis. The company plans to roll this out to early adopters before the middle of next year.

Patient Engagement

The company talked a lot about its new downloadable app for patients: MHealth. This app will permit patients to manage a lot of administrative and payment tasks in connections with office visits. It also will offer questionnaires that will help with reconciling meds and allergies to the clinical record in the EHR.


MEDITECH hospitals are under the same pressures to adapt to value-based care that the rest of the industry continues to struggle with. Many of the company’s actions over the next year will help them in different ways. MEDITECH’s approach to introducing new functionality allows its customers to keep the lights on and broadly support the onrushing changes to U.S. healthcare.