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May 16, 2022

The crisis in primary care: Technology’s role in today’s value-based care models

Is primary care simply “tumbling,” or has the system failed us all together? That was the initial question panelists grappled with at the final session of the American Telemedicine Association’s (ATA) 2022 Annual Conference & Expo, How Do We Fix Our Broken Primary and Specialty Care Delivery?

Speakers included Archana Dubey, Chief Clinical Officer at AliveCor, Anand Iyer, Chief Strategy Officer at Welldoc, Nate Murray, Founder at Crossover Health, Rushika Fernandopulle, CIO at One Medical, and Heather Hagg, Senior VP, Clinical Operations at Parsley Health, who walked the audience through the problem with today’s primary care structure, how technology can make an impact, and what needs to be in place in order for that to happen.

Deciphering the problem with primary care

According to Dubey, primary care is on a slow decline and needs to be bolstered, since it holds the initial trust of the patient. “We need to fuel primary care with the right tools and funding so we can build a care delivery model centered on the patient and the trust between them and the provider,” she said.

A fee-for-service system doesn’t help this cause, Dubey continued, since it positions the physician often as a gatekeeper for a value-based system, breaking that trust. “Either that or [they see it as] a funnel for specialist care,” she said. “We need to flip the system.”

Healthcare as relational—first and foremost—spurred discussion around technology as an extension of a care plan. ”And [technology] shouldn’t waste time; these things have to work into clinical workflows,” said Anand. “Overworked, under-paid primary care doctors don’t want one more thing to do in addition to what they have on their plates, no matter how shiny or glamorous it is.”

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Technology can have the impact we need it to have though, said Murray, but in order for that to happen, it needs to elevate the provider and occur—ultimately—outside of a fee-for-service model. Instead, individual primary care should employ a spectrum of physicians, nutritionists, mental health professionals, and so on.

Although people want changes to happen within primary care desperately, he continued, ultimately the system is fundamentally at fault for being fee-for-service. “We can dress it up and call it ‘value-based care,’ but when thinking about changing primary care and how we do it, what will have the deepest impact is shifting away from reimbursement models that affect our behavior.”

Technology’s potential for delivering on value

When it comes to playing ball within the current fee-for-service model, Anand said it’s critical for technical ‘integrability’ to occur at the workflow level, the systems level, and at the model level for it to be successful. Technology should help illuminate and guide the provider while also providing longitudinal support to the patient. “All of it, though, has to work into the provider’s workflow,” he said. Technology needs to integrate into an EMR and be flexible enough to adapt to what a clinician wants to see and how they want to see it–which is at the core of Bright.md’s asynchronous telehealth solution.

“It’s an art versus a science,” he said. “No two clinicians take the same formulaic approach, which is part of how they garner trust.”

“It’s eye opening, when you look up and see a point of light in the sky,” Anand continued. “At first it [looks like a] star, but no, it’s a planet. WIth Hubble, for instance, you see a whole galaxy, and what Hubble is to an astronomer is what digital care can be to the provider—it helps illuminate what’s happening under the surface. If we do that, we can get ourselves out of this conundrum.”

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What today’s primary care doctors need from their technology

Whether you’re seeing 30 patients or 10, today’s primary care physicians are often tasked with responsibility over their patients’ wellbeing, said Dubey. However, whenever the patient is away from their doctor, information sharing becomes a “black box.”

“Technology needs to be omnichannel and needs to lean into data that’s insightful,” said Dubey. “[Clinicians] need data, but not a data dump—they need data that makes insightful decisions happen in the moments that matter, either through rule-based algorithms, AI-based or clinician-based; it just needs to scale a provider beyond the four walls of brick and mortar.”

And from a solutions perspective, clinicians need tools that exist within a limited system or platform. Multiple apps with multiple log-ins run the risk of the clinician being “an even higher-paid typist” than what they already are, said Fernandopulle. “Where you can add support holistically, where it makes sense, is an opportunity to support primary care.”

“Today’s employer-created digital health maps have 100 different solutions and look like a dog’s breakfast—it’s a mess and it’s chaotic,” said Murray in closing. “You stare at it and decide to go to the ER because it’s more simple. But in the end, [these health maps] are so fragmented and difficult to understand, and no one uses them. We have to organize and curate better for everyone, so we can deliver more effective care.”

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