During the COVID-19 pandemic, nearly 90% of people diagnosed with COVID-19 will have their symptoms managed without the need for emergency or hospital care. Their care has fallen almost exclusively to primary-care physicians, many of whom have found themselves challenged by regulatory barriers, limited access to technology and an inability to access a patient's entire medical record.
Despite this, we've seen the nation's primary-care base rise to meet the challenge.
The demands of the pandemic have exposed a foundational weakness in our primary-care system, the true front line for COVID-19 care. Without investment in four key areas—primary care; acceleration of outpatient technology; data-sharing; and a move to prospective payment and value-based care models—we will be no more prepared for the next public health crisis than we were for this one. Investment now can reshape our healthcare delivery system, from reactive to proactive, from hospital-centered to community-centered and ultimately from a focus on sickness to wellness.
Greater investment in primary care
Studies consistently show that access to primary care leads to better outcomes at a lower cost. Patients consistently appreciate the care coordination and communication that can only come from a provider with a general and more holistic approach to patient care. This drives down redundant and unnecessary care and optimizes the site of service for needed medical procedures. Our current healthcare system spends approximately 5% of the total healthcare dollar on primary care. A true commitment to wellness and prevention will require a different level of investment.
Technology and telehealth
COVID-19 has prompted an acceleration and acceptance of technology, particularly telehealth and remote patient monitoring. It is hard to imagine a return to a system that requires patients to be seen in person regardless of the condition. Medical clinics will not be replaced by virtual care, but the ability to extend services outside the clinic walls will be demanded by an ever more consumer-centric system. The temporary regulatory relief granted during the pandemic for the expansion of telehealth services must be made permanent and expanded to include a greater number of patients and clinical situations. In combination with remote patient monitoring, telehealth can deliver services and disease management to our most frail populations in the convenience of their homes at a significantly lower cost.
Medicare currently spends almost 85% of the total healthcare budget on managing chronic illness. Telehealth and remote patient monitoring are well-suited to manage those conditions to a better outcome for less.
The continuum of care from a clinic to the home, both in person and virtually, guided by a primary-care provider working in concert with specialists and ancillary facilities is the answer to the increasing healthcare costs of an aging population.
No more data silos
A patient's medical record belongs to a patient. Silos of data, many times economically driven and never in the patient's best interest, must end. Without access to a comprehensive longitudinal record, clinical care is hampered. With a complete dataset, advanced analytics and risk stratification can identify future avoidable healthcare. When a diabetic does not pick up medications or when a heart patient unexpectedly gains weight, these are all triggers to spring into action. Early interventions can eliminate the need for expensive and avoidable care. At VillageMD, we were able to use our comprehensive dataset to develop a frailty index that could identify those patients most at risk for complications of COVID-19. We realized patients' previous disease burdens may not accurately reflect their risk if they were to contract the virus. The frailty index included social determinants of health such as isolation, food insecurity, ability to walk, cognition status and loneliness. With this index to identify at-risk patients and an aggressive outreach with education and support, we were able to reduce our patients' exposure and risk from COVID-19.
The ability to take in and normalize data should be limited only by capability, not by access. Patient care must come first. Many organizations do not want to share information for a variety of reasons. Legislation and regulatory relief will be needed to make this a reality. We need to demand it for the public good.
Prospective payment system
The current fee-for-service model in medicine is failing, and it has been for years. Healthcare costs so much because the more physicians offer treatment, the more they get paid. Can you imagine a mechanic who—every time the repair was made incorrectly—came back and was paid, again and again? That's fee-for-service. A prospective payment system, one that pays providers a fixed fee to manage the health of a population and supports value-based care, shifts the focus from sickness to wellness. Providers are paid to invest time in education and the management of chronic disease instead of receiving revenue for complications that could have been avoided. To accelerate improvements in the healthcare system, pay for what you want—healthy outcomes.
These ideas aren't new. But there is a new sense of urgency. COVID-19 has shown us we don't have time to wait. Payers, large and small employers, federal and state agencies and individual workers have to finally say enough is enough.