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Why new coordinated, mobile primary care models could work

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- As each new health tech incubator, hackathon, and innovation conference claims that the next “healthcare fix” is just a single start-up idea away, many physicians simply roll their eyes.

For years, physicians have heard empty promises from big pharma, device companies, and political figures that a better healthcare delivery system was just beyond the bend. Ultimately, they know, when it comes to changing American healthcare, new frameworks (or products) must both demonstrate clinical improvement as well as align with the bottom-lines of multiple parties in a complex dynamic to gain traction or approval.

But primary care in the United States may just be there. A perfect storm of changing payment models, physician workload demands, and patient expectations have aligned the stars that make a single, simple change quite powerful.

Physicians (will) want the change

In healthcare, status quo isn’t just the norm — it’s a way of life, and so breaking away from traditions and professional expectations in an attempt to change culture is a monumental task. However, many primary care physicians are feeling overworked and undervalued.

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Nearly every day another report appears which discusses the equivalence of healthcare outcomes of patients who see physician extenders (e.g., physician assistants, nurse practitioners) and board-certified internists and family practitioners. Physicians are beginning to understand that care is a team activity and that coordinating is time-consuming, largely unreimbursed, and doesn’t require seven years of post-graduate education.

Mid-level providers typically don’t rely on fee-for-service (or fee-for-value) models, but rather they are salaried or operate per diem. And there is a growing incentive to hire them. By providing these mid-level providers with mobile tools that simplify remote data collection and the coordination of care between high-cost specialties, healthcare networks can reduce overall per-patient costs while also reducing unnecessary or repeated testing, treatments, and diagnostics.

Given ongoing high-demand for in-person primary care, physicians will be able to offload these types of reimbursed activities while maintaining volume and focusing more on relevant aspects of care.

Payers want cost-reduction

Long-term healthcare strategists continue to speak about the value of the measurement. If it can be measured, it will ultimately be valued. Already, payers are aligning payments with mortality rates, hospital readmissions, and other measures of population health.

As our tools for data collection continue to spread outside of the hospital and the physical office visit, it should be expected that those measurements will be tallied, compared, and valued. While unlikely to be measured directly, care coordination can be leveraged to reduce the cost of care for nearly all specialties.

With a guiding document for mobile tools in place, payers will begin to require the use of remote and mobile data collection to reduce the consumption of in-person services. With these data available, payers will then be able to create benchmarks for specialty driven care.

For example, well-controlled diabetic patients whose A1Cs are consistently less than seven percent may not require endocrinology consultation for ongoing therapy. For high-risk and uncontrolled patients, more frequent home, reminder, and specialty care can be delivered.

Patients have to pay

For many Americans, logging onto healthcare.gov or their state exchange is first time they’ve been asked to put a dollar sign next to healthcare services prior to receiving them. As the cost of healthcare services (and not just plans) becomes more transparent and proactive, patients will have to consider both quality and cost prior to receiving care.

The era of willful ignorance until the bill arrives in the mail is beginning to see its final days, and as we know, American consumers are cost-sensitive. Plans and physicians who are able to leverage mobile technology to reduce the costliest types of care will often be the best value proposition for patients.

These three aspects of the current and changing healthcare climate combined with a worsening shortage of primary care physicians will encourage continued adoption of mobile tools that ease the burden of in-person primary care and reduce consumption of high-cost emergency and inpatient care.

While this may have been true for quite some-time, anyone in the healthcare industry knows that without the grassroots desire for change from physicians on the front line, even the best ideas are likely to fail. However, now more than ever market forces and physicians expectations are beginning to align incentives for continued adoption of EHR and health IT systems, particularly those that are mobile, with a focus on enabling team-based care.


Zachary Landman, MD, is the Chief Medical Officer for Doctorbase, a leading developer of scalable mobile health solutions, patient portals and patient engagement software. He earned his medical degree from UCSF School of Medicine and as a resident surgeon at Harvard Orthopaedics, he covered Massachusetts General Hospital, Brigham and Women’s Hospital and Beth Israel Deaconess Medical Center. He is a frequent author and speaker on the topics of patient engagement, mobile health, and patient portals. 


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