Primary care delivery needs an upgrade

Primary care needs and upgrade: ©Crazycloud -stock.adobe.com

We know that access to primary care improves public health outcomes and cuts health care costs, but increasing access to everyday care is much easier said than done. The health care industry and the government are both investing toward this goal, but we’re too focused on care delivery models that aren’t moving the needle.

Demand for primary care is growing as the U.S. population ages, but supply is shrinking, setting up a perfect storm for public health. Clinicians are stretched thin, with a worsening physician shortage causing high levels of burnout, longer wait times for patients, and care deserts. Telehealth solutions exploded during the pandemic, but video chat visits lack the scans, biometrics, and diagnostic capabilities clinicians need to deliver appropriate care. Adoption has continued to dwindle in the last couple of years.

If we don’t make smarter investments to increase access to everyday care now, health equity will suffer for decades to come. Physicians have an opportunity to both increase access and grow their own practices by rethinking the primary care delivery model.

A dire imbalance

The American Medical Association reports that 80% of U.S. counties and 83 million Americans already lack access to primary care due to a long-standing physician shortage. With more medical professionals reducing hours, leaving the profession, or retiring, the U.S. will be short 86,000 physicians by 2036. As the population ages, researchers estimate the number of people 50 or older with at least one chronic disease will double to 143 million by 2050. This demographic shift will cause care demand to completely overwhelm our supply of clinicians.

Additionally, people who would benefit the most from primary care often cannot afford private insurance and instead rely on Medicaid or Medicare. Medicaid enrollment is dropping as pandemic-era protections expire, but there are still 71 million enrollees nationwide who need access to care. Many of these people are clustered in underserved areas, and lower reimbursement rates have made it unprofitable for physicians with smaller practices to treat these communities. Physicians want to help everyone they can, but accepting a high volume of Medicaid patients can strain operations and lead to closures.

For patients, this means fewer care optionsand dangerous treatment delays. As a result, more people turn to emergency rooms for routine care, causing costs to skyrocket while hospitals struggle to devote time and resources to the most critical patient needs. These dynamics create a vicious cycle for underserved communities and the physicians who care for them.

Medical training takes years, so there is no quick fix to this problem. We must find ways to scale the primary care experience with the limited number of clinicians we have today.

Current care delivery models can’t keep up

Government and industry efforts to boost primary care access have focused on opening more traditional brick and mortar clinics or expanding telehealth options, but progress has been slow. Building and running traditional clinics is too expensive to scale, especially in rural areas. Without a convenient place to get care, people in small towns across the country either travel more than an hour to the “nearest” option or they don’t seek care at all.

Hopes were high for virtual care during the pandemic, but that model was a Band-Aid, not a long-term solution. Telehealth solutions are often out of reach for communities with limited internet access, and when patients do have reliable connections, these options are still an incomplete primary care experience. Physicians are limited to what they can see and hear through a video call, with no way to reliably measure patient vitals or handle diagnostic scans.

These care delivery models simply aren’t making enough of a dent in our access problem. To improve health equity and public health, we need to get more creative about meeting underserved communities where they are.

Scaling creative solutions

There are organizations working on these issues at the local level with support at the federal level, but there’s more we can do to scale everyday care.

Sometimes the solution is as simple as coordinating transportation to medical appointments. Rural health organizations in states like Missouri, Minnesota and New Hampshire all offer services that help patients get to and from their appointments at traditional clinics. Ride-sharing companies like Uber and Lyft are increasingly being tapped to provide non-emergency medical transport for patients in rural areas. Physicians who partner with transportation networks to coordinate routes or work with insurers to subsidize costs can reduce the business impact of no-shows while making it easier for patients to stick with follow-up care plans.

There are also new technologies that both individual physicians and larger health systems can use to better serve vulnerable populations. Some clinics now ship medical devices like blood pressure monitors, pulse oximeters, and glucose meters to patients in underserved communities. These tools can make virtual health solutions more effective by adding some of the diagnostic capabilities telehealth lacks on its own.

Mobile clinics are another way to bring a more complete primary care experience to hard-to-reach communities in both rural and urban areas. By partnering with hospital systems, local universities, and nonprofits to meet underserved communities where they are, physicians can serve more patients beyond their backyard without the costs of building and running a satellite office.

Physicians could also consider a hybrid care delivery model that uses technology to combine elements of both in-person and virtual care. Hybrid health care stations sponsored by community partners can be set up in places patients regularly visit like a grocery store, workplace, or school. Each station functions as a private “clinic in a box” that can be located anywhere there’s an outlet. Patients connect with a live on-screen physician in a station equipped with medical instruments that handle the critical diagnostics, scans and vitals needed for effective everyday health care. This model gives patients a more familiar primary care experience closer to home, work, or school, and on-demand. It also empowers physicians to expand the reach of their practices without causing longer wait times for office visits. Physicians using this hybrid model could serve more Medicaid patients with lower overhead costs by tapping into a network of remote clinicians to handle walk-ins or offer extended hours.

The way forward

To close our widening health care access gaps, physicians must think bigger than expensive brick-and-mortar investments and half-measure video chat solutions. With closer coordination between clinicians, local organizations, and the government, we can bring everyday care to the communities with the highest needs.

New care delivery models, support services, and hybrid technologies can help scale the primary care experience for more patients, without putting more stress on physicians. By getting creative and seeking out partners, physicians can grow their practices and make a bigger impact on the communities they serve. With surging demand for everyday care just around the corner, the time to think outside the box is now.

Karthik Ganesh is the CEO of OnMed, a tech-enabled hybrid-care delivery company focused on healthcare access for underserved communities and care-challenged settings. His experience spans healthcare leadership roles across health-tech, care delivery, health plan, pharmacy services, TPA, and value-based care companies.