There has been lots of coverage about “importing” specialist services to primary care offices via telehealth – Harvard Program Integrates Behavioral Health Into Primary Care Via Embedded Mental Health Staff & Telehealth Consultations and How Can We Deliver A Seamless Primary Care/Behavioral Health Consumer Experience?. So the recent announcement by Stanford Medicine of its new “virtual primary care clinic” caught my attention (see At Stanford Medicine, A Virtual Primary Care Clinic Designed Around The Patient). I have always thought that specialist consultations could be virtual, but primary care?
The Stanford program, called ClickWell, has an interesting model. Primary care is available through a range of tech-enabled options – email, phone, and videoconferencing – as well as traditional face-to-face services. The program is open seven days a week, and offers extended office hours on weekdays – from 7 a.m. to 9 p.m. and weekend days from 9 a.m. to 5 p.m. – and in-person visits are not required to be prerequisites to virtual ones. In addition to primary care, wellness coaching is also available through the ClickWell system.
The statistics for the program were impressive. Seventy-one percent of new visits were in-person, with six percent as video visits and 23% as phone visits. However, among return visits, only 39% were in-person whereas 18% were video visits and 43% were telephone visits. The program reported that labor and supply costs were reduced to two-thirds of the typical costs of a brick-and-mortar clinical practice. The average face-to-face time for a video or phone visit for a new patient was 24 minutes and 21 minutes, respectively. By comparison, the average face-to-face time for an in-person visit for a new patient is 31 minutes.
Interestingly, the Stanford team stated that the reason for creating the program was to serve younger consumers who didn’t select primary care physicians, but were instead using urgent care centers and emergency rooms. (This concern squares with the just-released March 2016 article in Health Affairs, Retail Clinic Visits For Low-Acuity Conditions Increase Utilization And Spending, that found that retail clinic and urgent care utilization was adding to health plan costs.)
This is an example of the growth of “on-demand health care” – a market segment that has been predicted to grow as much as 34% annually over the next few years (see The Virtual Primary Healthcare Revolution: What Health Systems Need To Know). And a quick look around finds more evidence of these “virtual primary care” models gaining traction around the country over the last few years:
- Ohio-based Cleveland Clinic launched MyCare Online in June 2015 – an app-based primary care consultation service that allows consumers to instantly connect with a doctor, nurse, or other health care professional for quick complaints such as colds, flu, rashes, or urinary tract infections (see Cleveland Clinic Launches MyCare Online).
- Tacoma-based MultiCare Health System announced in April 2015 that it will offer “video doctor visits” to patients throughout Washington State in partnership with Doctor on Demand (see MultiCare Offering App-Based Video Doctor Visits For $40 In Washington State).
- Pennsylvania-based University of Pittsburgh Medical Center launched AnywhereCare in September 2014 – a web-based platform that allows consumers to consult with a physician for primary care concerns (see UPMC Offering ‘AnywhereCare’ Telemedicine Service Across Pennsylvania).
- Hampton Roads-based Sentara Health Care introduced MDLive for virtual visits in 2012, allowing consumers to visit with doctors via a virtual consult platform, which also connects to pharmacies to allow for electronic prescriptions (see Sentara Jumps On Telehealth Collaboration Bandwagon).
- Newport News-based Riverside Health System announced in 2015 that it would provide virtual physician visits which included access to board-certified physicians 24/7/365 using a computer or a mobile device (see Riverside Expands Its Telemedicine Services With Access To 24/7 Physician Care).
These emerging virtual primary care models bring two questions to mind. First, can this same “virtual” model work to provide “on demand” targeted case management, peer support, or home health support? What would utilization – and disease management protocol adherence – look like if consumers had round-the-clock multi-modal access? And, as specialist provider organizations look to provide a “seamless” primary care experience, is it better to collaborate with a primary care provider organization with this “virtual” approach to services?
For more, check out, Is Your Organization Ready To Be ‘The’ Care Coordinator? , Integration of Primary Care & Behavioral Health, New Perspectives On Primary Care Service Integration, or New Perspectives On Primary Care Service Integration. For a deeper look into some of the tech-enhanced service models flourishing in the market, check out App Potential. And make sure to mark your calendar for June 8 when my colleague Joseph P. Naughton-Travers will host the townhall session – Why Can’t The Health & Human Service Industry Embrace Innovation? A Town Hall Discussion On Overcoming The Barriers To Change – at The 2016 OPEN MINDS Strategy & Innovation Institute.