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How to Leverage Technology to Revive Primary Care
In an era where primary care faces unprecedented challenges, a pivotal aspect demanding attention is the fee model. According to a recent VOX article, the issues confronting primary care have persisted for decades. As far back as the mid-1990s, there were concerns about young adult men who possessed health insurance but failed to establish relationships with primary care physicians. This issue was also highlighted in The Washington Post earlier this year.
The predicament is poised to escalate as a decreasing number of medical trainees opt for primary care, and more family physicians approach retirement. Currently, as reported by the Milbank Memorial Fund, only one in three US doctors practices primary care, but among young doctors with two years of experience, this figure dwindles to just one in five. Projections by the Association of American Medical Colleges suggest that by 2034, the United States could grapple with a shortfall of up to 48,000 primary care physicians.
One contributing factor to the deterioration of primary care has been the conventional fee-for-service model. In this system, doctors are compensated based on the volume of appointments and tests they administer. Consequently, physicians have been incentivized to see as many patients as possible each day, diminishing the emphasis on establishing close patient-doctor relationships. The adoption of “value-based payments” by insurers and health systems, which would reward primary care’s contributions to long-term patient health, has been sluggish.
This prevailing healthcare model has been dubbed “industrial” or “transactional” by doctors. What was once a relationship-based exchange between a doctor and patient is today a multi-stakeholder event which includes performance evaluation teams monitoring patients’ chronic conditions, billing teams determining service codes, and insurers requiring extensive documentation for coverage of drugs and tests.
In the face of diminishing intimacy with patients, doctors are increasingly turning to technology for solutions. Doctors can leverage payer data to optimize market participation, or reach patients remotely through telemedicine. Telemedicine especially is appealing, as these models enable doctors to no longer entirely dependent on the number of services they provide. This new model empowers physicians to deliver care in a contemporary manner, adapting to changing patient preferences.
Technology, aimed at bridging the gap between patient convenience and sustaining long-term relationships with a single practice, offer hope for arresting the decline of primary care. Meeting patients where they are and enticing them back with the kind of convenience tha tled them to explore alternative healthcare options (or opt out altogether) may be a paradigm shift in primary care.
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