Newer health care delivery models have evolved over the past decade. Today, physicians are adapting to the changing ecosystem of health care digitization. In fields like neurology and radiology, physicians have explored new roles and collaborated with newer telehealth models to broaden their market footprint. The services provided by a tele-stroke unit in the ER to guide treatment options are immense.
As we have noticed in other service-focused industries, patients want convenience and health care at their fingertips. The pursuits to perfect health care from a patient standpoint favor a consumer-centric model, with the patient asking questions like:
1. Is the location convenient?
2. Are caregiver arrangements required for a doctor’s appointment?
3. What is the commute to the doctor's office? Does my work need to be rescheduled?
4. Which doctor has the shortest wait-time?
5. Can the doctor provide care to all members of my family?
These consumer needs are rooted in convenient lifestyles and have poised primary care for a makeover. There is a shift in primary care outreach, as the home is the nexus for health care delivery. Primary care is adapting and recasting its business model by collaborating with digital technology and telemedicine.
What is Virtual Primary Care (VPC)?
VPC is an emerging field in telemedicine that encompasses primary care. The primary care physician uses virtual visits for chronic conditions vs. traditional telemedicine that targets urgent and non-recurrent disease conditions. VPC is the newest entrant to the health care continuum that offers convenient quality health care, from home. In the VPC model, additional services like laboratory tests and follow-up visits are made available on the same-day or at-home in the future. This progressive primary care model embraces the needs of busy health enthusiasts while maintaining a “Hi-Touch with Hi-Tech” model.
During a recent telemedicine encounter, a patient asked me to order him Tamiflu because he had flu-like symptoms. When I asked him if he had tested positive for the flu, he said, “I am 65. If I go to the doctor or the lab, there will be so many sick patients, I will catch the flu.”
This encounter got me thinking, as the patient had made a very valid point. I started thinking of how I wished I was able to order a test without having the patient exposed to sick contacts. I realized that teleconsults could evaluate non-emergent and non-chronic health conditions. However, the patient still required physical examination and lab work. Although telemedicine fills the gap in triage and utilization by an appropriation of resources, it has a limited scope, as it does not address chronic disease in primary care or ensure continuity of care. During teleconsults, I recommend that patients follow up with their primary care physicians for physical examinations, further lab work, and referrals to specialists. Traditional telemedicine lacks a smart referral system and access to network physicians, or patients' insurance-network-approved health care providers. However, the VPC model equips VPC physicians with more tools.
The virtual care team, comprising of physicians, physician extenders, and in-network services, adds value to existing teleconsults. The virtual care team can order tests, set follow-up visits, refer to specialists, and have access to medical records and thereby offer continuity of care. The VPC model streamlines further access to care by using a direct referral from a teleconsult. The patients will have diagnostic telemedicine kits that will allow for smart integration into virtual EMR platforms, and patient data points will be available to the physician at the televisit. Diagnostic kits will include a digital stethoscope that can collect and transmit sounds locally and remotely to enable telemedicine. To put this service in perspective, the virtual care team can order a test, follow up on the test, and order appropriate medications.
Of 883.7 million physician office visits, 54.5% percent of the visits were made to primary care physicians. About 28% of adult men and 17% of adult women do not have a primary health care provider, according to a government survey. Telemedicine bridges this gap in health care access. Massachusetts General Hospital has enabled virtual video visits without compromising on the quality of care.
VPC has advantages over traditional telemedicine and reins in medical costs. The integrated VPC model is technology-driven and marks a new era of exponential enhancements in digital health care, as it can improve the quality of primary care access and continuity of care in urban and remote areas. Because care is received at home, virtual visits save on direct medical costs and exposure of high-risk patients to sick contacts.
The VPC model is a digital makeover for traditional primary care practice.
Nita K. Thingalaya, MD, BCMAS Dipl ABOM, is a Board-certified Internist, who specializes in Medical Affairs and Obesity Medicine. She practices telehealth and hospital medicine. She is currently the Medical Director in Healthcare Utilization. Her diverse experience in clinical research, utilization, and informatics make her a leader in Medical Affairs. The article is independent of her affiliations past or present. Dr. Thingalaya is a 2019-2020 Doximity Fellow.
Illustration by Jennifer Bogartz