The future of primary care: multiple check-ins and a team-centric approach

CMOs from Firefly Health, Buoy Health, and UnitedHealthcare at the Invent Health Event

At the Invent Health Virtual Event - Primary Care and the New Medical QB event in November, presented by Vator and UCSF Healthub, we invited a group of chief medical officers from some of the leading companies disrupting primary care to talk about how new models are changing the role of the traditional primary care physician.

The moderators of the panel were Dr. Archana Dubey (CMO Consultant, HP; Chief Clinical Officer, AliveCor), and Bambi Francisco Roizen (Founder and CEO, Vator), while the panelists included Dr. Andy Ellner MD (Founder and CCO, Firefly Health), Dr. Adrienne McFadden, MD, JD (Chief Medical Officer, Buoy Health), and Dr. Donna O’Shea (Chief Medical Officer of Population Health, United Healthcare). 

Dubey kicked it off by asking each member of the panel what they see as the role of primary care from each of their different perspectives. And, while coming at the problem from different angles, all three seemed to agree on one thing: the future of primary care is going to involve multiple touch points, and a team-based approach. 

The first to answer was McFadden from Buoy Health, which is an AI-navigation platform that started as a way for people to find out how best to seek care through its smart symptom checker. The company now also gives patients information about their potential diagnosis to giving them information on where to go to seek care. For example, if someone is sick, they may not know which doctors to go to, or which of them are covered by their insurance plan.

The first thing she said is that we might need to rethink the role of the primary care physician: instead of being the quarterback, they might be the offensive coordinator, while it's actually the patient who's the quarterback.

"I say that because, on average, folks are seeing their primary care physician maybe two to four times a year, if that. And so, the real important piece of that is the in-between the visits and how we're able to maintain, sustain, or regain health in between those visits," she said.

"We do a really good job of information exchange, potentially collaborative care planning with the patient, at those visits, but that integral three, six, nine months, it's really going to be important for the person or the patient to be fully engaged and informed about their own care goals, their care plan, so that they can continue to be a really integral member of actually achieving health."

For that reason, Buoy Health is focused "very focused on the person who oscillates between personhood and patienthood, so to speak," which means that the company can provide information and navigation to them between their primary care visits, when they are sick but even when they aren't. 

Returning to her metaphor about going from a quarterback to the offensive coordinator, McFadden noted that what that really means is creating a team-based approach around care.

"It's almost unfair to the primary care physicians to burden them with all of the responsibility of the coordination for mental and behavioral health, physical health, social health, environmental health, that we all know contributes to the overall health of an individual or their patients," she said.

That means having team members who are able to contribute to that overall care planning and intervention and navigation to the right services, or care, or even just social drivers of health that may be improved in the interval; that can be a mental health counselor, a nurse practitioner, an RN, or even a neighborhood pharmacist.

"And so, the PCP is really becoming more of an offensive coordinator and part of more of a team-based approach," McFadden said. 

Dubey asked her how the company is using its AI-first navigating tool to facilitate that changing role for the PCP, to which she responded that they are doing by enhancing the confidence and the information for the patient themselves, making them into an engaged and well informed patient, which then "creates really fruitful conversations during a visit."

That means having personalized discussions about what's important to that individual patient. 

"Being able to personalize it and customize it to the needs of the patient is really important. But in order to achieve that, the patient has to be informed enough to be able to have a conversation and confident enough to feel like they've been heard and can share their opinion as well as part of that team-based approach."

Ellner from Firefly Health answered next; his company focuses on a care-team approach that helps people achieve their health goals, setting up expectations to go beyond an annual checkup but frequent check-ins to ensure people are on track to meet their goals. Their team approach includes a medical doctor, nurse practitioner, health guide and behavioral health specialist.

As Dubey characertized Firefly as having a "physician-centric approach, or a physician or care team-centric approach," he clarified that the company is still patient-centric, 

"Adrienne referred to a traditional approach to primary care, which says primary care is you have an annual physical and, if you're lucky enough to have a primary care doctor, and remember that you had this visit, then you go once a year. Then, when you get sick, you try to get in and you can't get an appointment. So, you end up going to the emergency room or urgent care. We talked about moving away from the visit-based architecture that is driving a lot of inefficiency of every kind in healthcare," he said. 

What Firefly did instead was replace that one visit with what Ellner called "48 clinical touches a year on average with our members."

"To every one physician, we have three nurse practitioners, three health coaches, two social workers, and a wide array of specialist consultants that we can pull in at any time. And so, what that allows us to do is take care of a vastly larger number of patients per physician with a vastly higher quality of care," he said.

Right now, Firefly's ratio is about 5,000 patients per one physician, which he said will increase over time.

"At the end of the day, what really drives value in healthcare is relationship and trust, and a lot of what we tried to solve for is removing a lot of the administrative barriers and structural barriers that have stood between people and having a real human relationship with a team of providers taking care of them. And what we see then is just extraordinary outcomes," Ellner said.

When Francisco asked him what a few of those touch points are, he said that a majority of interactions on the platform are over chat. 

"We do omni channel, we'll do phone calls, we'll do video visits, but what we found is you can deliver a really high quality of care mostly over chat, and using care plans and increasingly modules of content that provide people information about their conditions, help them make decisions, things like that. It's a very different experience and it allows us to build deeper relationships and deeper trust with people to have those more frequent touches."

Dubey turned to O'Shea next and asked her, after hearing from both companies, if these are approaches that the UnitedHealthcare would care about, to which she said that her company does consider primary care to be really important.

"They really are the backbone of the healthcare system and if we don't make it so that they can do their jobs, then we're really all going to be in trouble," she said.

That's why UnitedHealthcare looks at it in a lot of different ways, including ways to make sure they get paid fairly, and part of the problem there is that primary care need to be team-based.

"I'm not saying the primary care doctor needs to work 24/7, obviously, but it is team-based, and they need to have all the right connections in place, all the right platforms for chats, for urgent care, for whatever it is, and so we need to make it happen and we need to pay differently for that, to support that," said O'Shea.

There's also the reality that not everyone can see their doctor in person, for a variety of reasons, including not being near one and also the patient being unable to go due to disability. 

"As Andy said, there's a lot of touch points that can help people stay healthy and have them stay on the right track and the one annual visit a year probably is not going to keep anybody on track for very long, if you have multiple medical conditions," she said, while also recognizing that there are people who have really good relationships with their doctor, and in those cases, the company wants to make sure that it's helping get those providers on value-based care.

"The other thing was, we need to make it easier for the docs, whether you're in person or virtual; where we are now, it shouldn't matter, in-person or virtual, the care experience can be the same and the virtual provider can decide when you need to go in to have things done in person. And so, there's a lot more we can do now, and a lot more that's acceptable after COVID, of course, because prior to COVID, people were like, ‘oh, you can't do that.’ All of a sudden, now everybody recognizes the value and what you really can do if you put your mind to it."

You can see the entire panel below:

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