A common story about the impact of the Covid-19 pandemic on the healthcare sector is that of emergency rooms and hospitals, which remain overwhelmed and understaffed. Health providers in these care settings are traumatized by wave after wave of patients—and despite the best medicines and the most heroic interventions money can buy, many lives are often unsaved. Deeper in the narrative of the pandemic is the story of primary care physicians who have been fighting on the front lines of the same war but face different battles.
Growing number of primary care physicians More people lose to Covid-19 than any other medical profession. PCP has been struggling to meet the new demands of virtual care delivery, chronic Covid syndrome, vaccine hesitancy, science denial, patient anxiety, financial stress, overflow from crowded emergency rooms and many other challenges.
Despite these enormous pressures, primary care has shown extraordinary resilience, always striving to serve our communities, many of which have been hit hard by their own financial crisis. As a practicing primary care physician, I want to help readers understand the future of primary care this year, a discipline unlike any other medical specialty, and why primary care needs to lead the way in 2022.
The pandemic is a coercive feature that has led to the explosion of telehealth. In my own practice, I now have patients I have never met, but we have a strong therapeutic relationship: the foundation of high-quality primary care.
A whole new area of the industry is booming — built on telehealth platforms — and technology is nimble enough to keep pace. This includes the rush to deploy an integrated HIPAA-compliant telehealth solution powered by Zoom at the start of the pandemic. For primary care, this new “channel” of patient communication has become a fundamental part of the care delivery system. It reduces overhead, expands access, and is so convenient for patients that they no longer have to take time off, find a babysitter, fight traffic, or sit in a waiting room with other potentially infectious patients.
In fact, virtual primary care as a new component of integrated primary care practice (not to be confused with virtual urgent care) is one of the things we can’t take back. It’s here to stay, and our reimbursement policies need to reflect its value, considering its impact on patient experience, access to care, and overall healthcare costs.
If the past few years are any indication, we can also expect 2022 to bring more innovation in healthcare payment models, with a focus on “value,” or better health outcomes at lower per capita costs.Primary care is the only medical specialty the more the better. In this context, alternative payment models aimed at adding value often involve changing how (and what) primary care is paid for.
A new payment model innovation for 2022 is the Centers for Medicare and Medicaid Services’ Direct Contract Entity (DCE) program. This essentially replicates the Medicare Advantage model, where traditional Medicare beneficiaries contract with private for-profit companies that agree to manage the total cost of care for a specific population, taking both upside and downside risk.
In these contracts, the DCE has complete flexibility in determining how the PCP is paid—capital, pay-for-performance, shared savings—with all options on the table. Whether the plan will produce similar outcomes to Medicare Advantage plans (increasing costs for CMS with little improvement in health outcomes), or potentially benefiting from private sector hacking, will be closely watched.
Another development to watch in 2022 is the rapid expansion of direct primary care (DPC) models. In the DPC model, the primary care physician opts entirely to get rid of insurance billing and reimbursement, and instead puts the patient in control of the money. Patients pay a monthly or annual subscription fee to the clinic in exchange for longer appointments, unlimited and enhanced PCP access, and most of the clinic’s services and procedures covered by this single fee.
Previously thought to be affordable only by the wealthy, patients, doctors and employers are finding new and creative ways to fund this model so it doesn’t increase patient out-of-pocket costs. What is lacking is the reporting of results on the DPC model to validate that this approach does indeed create more value for patients and the healthcare system.
Technology that supports healthcare has become a very Big businessThe challenge is the physician’s user experience, where the murmur of systems, platforms, and login credentials can lead to fragmented patient information, unnecessarily complex workflows, and increased overhead.
In 2022, I will be looking for professional organizations such as American Academy of Family Physicians Help define the best digital ecosystem for family medicine (and other primary care specialties). Interoperability for a seamless user experience will be a cornerstone of such efforts, along with comprehensive data integration to create “whole person” clinical images, reduced documentation burden (without compromising information quality), smart populations with predictive analytics Management tools, and low hassle reimbursement support to maximize practice revenue.
Primary care physicians have important work to do to help our nation recover from the many aftermaths associated with this devastating pandemic. Stress-related illnesses, hidden mental health symptoms, long-term Covid syndrome and a variety of other health consequences will find their way into the loving hands of primary care physicians in the years to come. I hope that governments, healthcare systems and industry will collaborate to empower primary care physicians to serve their communities in a way that only they can, supported by the right technology, policies and payment models to do this critically well important work.
Photo: aldomurillo, Getty Images
