Reimagining primary care through relationship-based technology

Recent private health insurance news has diminished what health security many employees across the U.S. had left: 29% of people with employer-sponsored coverage were underinsured, 25% didn’t fill a prescription for a chronic condition because they couldn’t afford to and 40% said they had to skip or delay health care due to the costs. It’s not just employees feeling the crunch as employers face nearly 20% increases in health plan costs at a time when a recession looms, combined with a tight market for employee retention.

And while there are several factors to blame for the impetus of the unaffordable health care crisis here in the states, there’s one simple route that’s been overlooked that can alleviate a massive burden for employers and employers: Re-emphasizing and strengthening the role of primary care in today’s health care system.

The scope of the problem

The problem is something that may be easier to picture, via a too-common experience that we’ve all been through: Sitting in a provider’s office, trying to quickly explain your health and prescription history to a new doctor who knows absolutely nothing about you. Hoping the doctor can treat the root cause of your illness today since you took it off from work, but you know it’s unlikely since they only have 15 minutes to assess you. So you’ll endure many more appointments before finally resolving your concern.

Today’s fee-for-service model is too reactive, partly because people are generally too busy to deal with the grueling process and partly because the model isn’t set up to support the patient/doctor relationships that lead to better outcomes.

The consequences are cyclical. The doctor is forced to spend an obscene amount of time coding visits to ensure insurance regulations are met and the patient’s visit is covered, and the patient is left feeling unheard and rushed – ultimately ignoring the onset of future symptoms until it progresses to disease.

This leads to patients seeking care through the misuse of emergency and urgent care centers. Of employer-sponsored emergency department visits, a whopping 70% are for non-emergency conditions a primary care physician could have addressed. And while a patient may seek care at an emergency department, they are unlikely to receive follow-up care that ensures the concern has indeed been resolved, often leading to re-emergence of the original symptom.

Too often we blame doctors for not paying enough attention to patients and requiring multiple, time-consuming and life-disrupting appointments to receive adequate treatment – or worse, missing important symptoms that lead to disease exacerbation – but those physicians are simply responding to the incentives the fee-for-service system has presented them. Conversely, we may blame patients for going to urgent care instead of setting up a regular appointment which leads to poor outcomes, but those patients are also simply responding to the current system’s structure.

Reimagining the relationship between patient and doctor

Imagine instead that you had a doctor in the family – someone like your mom or best friend, only with extensive medical expertise – who knows your history. You’d likely pick up the phone at the onset of a symptom and be more inclined to manage your health proactively.

It seems intuitively obvious that you’d likely stay healthier, save money, and live longer — and the statistics back this up. Patients who regularly see a primary care physician tend to both save money (spending about 33% less per year) and live longer.

A more active and regular relationship with your doctor also builds more trust, which increases proactive care. As this NY Times article points out, that reduces disease progression and total health care costs. Why? It’s because doctors spending more time with their patients actually saves money; patients who regularly see a primary care physician are less likely to be hospitalized or visit an emergency room, and these are among the most expensive portions of today’s care, quickly adding up to tens or even hundreds of thousands of dollars in costs.

This study found that utilizing primary care as a first course of action could save up to $67 billion annually. Account for inflation and the number is astronomical. Primary care works best when it’s implemented as part of an ongoing, continuous relationship with a primary care physician and when it’s combined with whole-person care. A health care system oriented more to primary care would result in a healthier population with more consistent access to primary care and a more equitable distribution of health care.

Unfortunately, recent studies demonstrate that the portion of total health care expenses devoted to primary care in the United States is at or below that of most other countries and appears to be declining. Even more unfortunate, the rising cost of care has caused over a 25% decrease in consumers’ visits to primary care physicians since 2008. At only four visits per capita per year, Americans visit the doctor at about half the rate of those in some European countries.

We need to get back to our roots and reincorporate the family doctor approach into modern health care and we can elevate technology to do so.

Leveraging technology to reimagine primary care

The recent advancement of telehealth platforms has helped in strides to make health care more convenient for those with busy schedules, such as employees and those with families to take care of, and for those who live in health care deserts.

However, the vast majority of telehealth platforms are really just a more convenient way to access urgent care at a cheaper cost. As illustrated above, these models of care can sometimes be effective at the moment for presenting symptoms, but they do not support the development of relationship-based care that leads to long-term positive outcomes for patients.

The cycling of patients in a fee-for-service model continues. It’s quite comparable to a ride share’s model of service: You need immediate care at a specific time that fits your schedule, you use technology to conveniently schedule that appointment, someone you don’t know – and who doesn’t know you – provides that service and your relationship ends there. There’s no follow-up, you won’t see that doctor again, and there’s certainly no development of an ongoing relationship with a provider that can wholly treat a patient to prevent disease.

This is where we need to reconceptualize primary care and incorporate traditional, ongoing engagement into current models of digital health care. We can use technology to end this cycle and build better, more convenient access to care — and we can use this to increase the trust between doctor and patient.

Forward-looking companies are beginning to not only offer a comprehensive set of benefits that treat the whole person — primary care, mental health, nutrition counseling, and easy navigation to find specialists — but also to deliver those benefits flexibly and quickly via multiple platforms (video, phone, in-person, chat, etc.). It’s a smart move for employers as these benefits create healthier, happier and more productive employees, and ultimately reduce costs for both employers and employees.

Related: New tools help direct primary care grow — with Mark Nolan

When we use technology to rebuild the doctor-patient relationship and bring care to patients in a much quicker, more flexible and more affordable fashion, we’ll realize the dramatic effects this can have on people finding the willpower to take charge of their health.

People trust their physicians; they don’t trust the health care system. In the world of automation and fast service, we’ve accelerated the loss of the personal relationship people have with their physicians. Bringing that back, and nurturing it, is key to getting good patient outcomes.

Dr. Viral Patel is the founder and CEO of Radish Health, an employer health benefit that removes barriers to health care, reduces costs and improves employee wellbeing.