Mind the Gap: How can we make virtual care fill the mission-critical shoes of primary care for those that need it the most?

While an apple a day may not keep the doctor away, primary care often serves as the first line of defense against “sick” care. By providing patients with a holistic view of their health and wellbeing, primary care is intended to help alleviate more serious health concerns down the road and takes on much of the care navigation responsibility to ensure patients get the right care by the right clinician.

Over the last year, the financial stress of the pandemic has led to thousands of primary care practices shutting down, raising understandable concern over the long-term impact of delayed preventive care and chronic disease management. With patients no longer able to see their family doctor, many turned to telemedicine and virtual care.

Yet early virtual care services better reflected urgent care centers rather than primary care clinics with a streamlined care navigation system, and rightfully so considering this was the predominant use of telehealth pre-pandemic. While the digital front door may be wide open today, we haven’t yet figured out how to efficiently help patients as they need to move from room to room. For example, if a patient needs a birth control prescription but may be experiencing depression, the burden is most often on the patient to figure out where to go next

Virtual care is taking on a growing responsibility to remind patients they need a doctor for more than when they’re sick. To help fill the gaps of the traditional primary care model, there are a few realizations to address and a handful of potential missteps to avoid:

Pre-pandemic primary care worked for some but not all
There’s little reason to reflect nostalgically when recognizing that 80 million Americans live in primary care health deserts and more than half of Americans are living with at least one chronic disease. The true promise of virtual care is democratizing access at scale, ensuring millions of patients get the right care from the right clinician. By streamlining care navigation and delivery in real-time — rather than expecting patients to spend an hour on the bus after waiting several weeks to see a specialist — virtual care can help ensure patients are no longer left out in the cold.

Virtual care is a complement, rather than a replacement. Even with advancements in remote patient monitoring, there will always be the need for a routine physical exam. Digital health advocates need to be mindful of where it’s appropriate for clinicians to treat patients remotely, and traditional providers must be willing to explore more efficient ways of delivering care. Getting outside of the “either-or” fallacy will help to build care models that amplify strong suits on either side without sacrificing clinical quality.

Bringing the broken system online is not innovation. Telemedicine is not new, yet has been underutilized and underinvested in for several years. It’s important to acknowledge the digital health industry is still in the early stages with a lot more work, maturation, and opportunity to come. When primary care practices quickly pivoted to replace the traditional doctor visit with a Zoom call, this did little to address the inefficiencies of traditional in-person care. While telemedicine accounted for the biggest chunk of the $14.5 billion raised in digital health last year, clinicians are scarce, tech is challenging and expensive to build, and regulations are complicated. 2020 gave us the accelerator to explore, iterate, and test avenues for new care models, digital experiences, and enabling technologies.

Take care of the people who take care of us
We’re facing a growing shortage of more than 120,000 primary care physicians by the next decade and the current system isn’t working for them, either. While virtual care offers the opportunity to close the gap, deliver care at scale, and introduce flexibility to a historically inflexible profession, we need to prepare clinicians for this next stage of healthcare delivery. It’s incumbent on those training the next generation of clinicians to adopt virtual care best practices into their medical school curriculum. A recent study found family physicians are not provided adequate telehealth training in their residency programs. We need to ensure specific training and education on how to treat patients behind a screen and develop their “webside manner” chops.

Broadband access is more than an urban vs rural issue
It’s both an infrastructure and affordability issue. I grew up in a rural part of Texas with limited medical resources, ultimately leading to an autoimmune condition going undiagnosed for 15 years. While this motivated me to get into virtual care, I also recognize the digital divide in my current hometown of Austin, where those without internet access are more likely to be lower-income residents. Virtual care’s impact can only go so far if we’re failing to recognize how to reach all of the 30 million Americans without internet access.

Overhaul patient data sharing
HIPAA is a landmark piece of legislation that was first signed into law over two decades ago to protect patients and their sensitive health information. Unfortunately, lawmakers have struggled to address the unintended side effect of regulatory overhead and administrative burden, which has been a challenge for both traditional and virtual care providers. HIPAA has also been notoriously slow in keeping up with innovation in the health tech space. For example, health data generated from wearables and smartwatches are not protected under HIPAA the same way as health records. Accordingly, we are just now addressing possible changes that broaden disclosure of patient data from “minimum necessary” to what’s needed to support care coordination.

For virtual primary care to effectively act as a guide and gatekeeper for millions of patients, a compromise needs to be reached where HIPAA keeps up with the evolving digital health landscape without sacrificing protection of private health information.

Put our money where our mouth is
The digital health industry is overdue to invest in research, data, and insights that back up many of the claims made in recent years. Above all else, we need to track outcomes, measure quality of care, and demonstrate cost savings with higher utilization rates. A potential outcome of the recent wave of digital health SPACs and IPOs could be a more targeted approach to help shift both the mindset and regulation towards digital health’s favor.

Virtual care offers the promise of a more efficient and streamlined care navigation system, driving down costs and improving patient outcomes, all the while moving quickly to meet patient demand without sacrificing clinical excellence. While we’re still in the beta phase, there is massive potential to continue building and stand side by side with primary care as the front line to our healthcare system.

Source: cyano66, Getty Images

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