Readers Write: Fixing What Ails Healthcare

Fixing What Ails Healthcare: A Checklist for Building a Modern Primary Care System
By Ray Costantini

Ray Constantini, MD, MBA is founder and CEO of Bright.md of Portland, OR.

For years, the industry has been struggling to find solutions to help fix what’s broken in primary care. There’s been an influx of urgent care centers, retail health clinics, and video telehealth services to address the growing patient load, offer more convenient access to care, and help stem physician burnout. While these alternatives are now commonplace, the state of primary care has actually gotten worse instead of better. 

The healthcare sector is plagued by a shortage of primary care physicians. Existing providers are retiring or leaving practice because of burnout, and there are not enough interested medical students to take their place. Between 1996 and 2007, the number of medical students going into general medicine declined as much as 61%.

Making matters worse is that there are even greater demands on primary care providers’ time. The Affordable Care Act added millions of more insured patients into the mix just as the aging population needed more care. Add to that the burden of exponentially more administrative tasks, which take providers’ time away from seeing patients. 

With primary care resources on the decline and waits for appointments sometimes exceeding 50 days, urgent care centers and retail clinics saw opportunities to jump in to offer supplementary services. The number of urgent care centers exploded during the last decade, reaching more than 8,000 nationwide by 2018, and the number of retail clinics doubled. But even these vast amounts of new options have been unable to ease primary care burdens.

Others have turned to video visits to streamline provision of care and eliminate the need to travel to doctors’ offices. But in reality, video telehealth is equally problematic for providers and patients. In fact, video technology often adds another layer to delivering care. To prepare for a 20-minute “visit,” a provider must go to a location where the patient’s privacy won’t be compromised and then set up the equipment. Plus providers still have the same administrative tasks that accompany an in-person visit. On the flip side, video may not be a viable alternative for patients who lack broadband services or who may not be tech savvy.

Even though they value the convenience of these walk-in clinics and video, a recent survey found that patients still overwhelmingly prefer to receive care from their own provider or any healthcare provider rather than from tech companies or retail centers. 

So what can primary care providers do to ensure their practice is on the right track to deliver 21st century care? Here’s a checklist that will help health systems meet the needs of modern patients, while also reducing their administrative burdens:

• Survey resources. Which resources are being underutilized? Which are overburdened? Where can shifts be made to increase productivity?
• Embrace a care team approach. Staffing each step of the care pathway appropriately allows everyone to practice at top of license. Introducing virtual care team members multiplies that positive impact.
• Use technology where it makes sense and for what it does well. Automate the repetitive tasks to let machines do what they do best and free up humans to practice the art of medicine. With an assist from useful technology, high-quality care can be delivered in less than two minutes for conditions that account for about 60% of primary care visit volume.
• Be open to change. Just because it worked 100 years ago doesn’t mean it works today or that people still want to operate that way. Not everyone is resistant to change. Many are likely clamoring for it.
• Link bricks with clicks. Integrate online offerings with in-person ones. Whether a patient gets care virtually, in a clinic, or in the emergency department, every provider should benefit from access to the most up-to-date and accurate health record.
• Find a partner that can help solve challenges today and in the future. Innovation matters, but the technology must be human-centered and configured to address each practice’s unique issues.

Modern primary care must be on-demand, which means not just when patients want it, but from wherever they are — home, school, work, or even the bus. Technology, such as asynchronous virtual care, already exists to make this possible. Practices now must embrace change and evaluate how they can evolve to be true game-changers in primary care.