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How virtual primary care can help alleviate ED pressure

May 18, 2017

    This is the second blog in a series about primary care, where we look at ways in which hospitals can work with primary care to accelerate its transformation. In this post, we explore the advantage of virtual care options.

    Flooded emergency departments are the new normal. However, data shows that 30 to 50% of ED presentations are unnecessary and could be dealt with in primary or community care. With patients getting sicker and expecting more convenience from providers, it's no surprise that they bypass primary care for an easily accessible, one-stop-shop option like the ED.

    But this is not sustainable. The primary care model has to fundamentally change to better manage patients outside the hospital.

    One way to transform the model is to increase access points. Around the world, start-ups are launching virtual primary care services to meet patient demand and circumvent system limitations. Here, we highlight three options from the UK, Canada, and Australia.

    A smarter triage

    askmyGP equips GPs in the UK with an online survey tool to increase primary care access and free up capacity by better triaging patients.

    Patients first briefly describe their issues, and then the tool takes over. Its algorithm is built on thousands of past patient survey responses. It uses this database to ask a targeted follow-up question, and then adapts based on each subsequent response. GPs read each survey and either triage the case to their nurse or pharmacist, or calls the patient to provide a phone consult. They can also set up a same- or next-day visit if needed.

    The downstream effects are substantial. GP workload becomes more manageable, since practices are able to treat up to 60% of cases remotely. Wait times drop dramatically once patients are educated on the tool, which increases patient satisfaction.

    askmyGP now works with over 100 practices in England, and just expanded to Northern Ireland.

    Canada's 'Uber of health care'

    Maple, a 24/7 virtual GP consult service in Ontario, was launched by a group of ED doctors who saw patients with non-urgent needs come to the ED because they couldn't get a GP appointment.

    Though effective, virtual primary care is not reimbursable in Ontario. These ED doctors sought to build a platform that provided virtual consults, thereby privatising what the government didn't cover, much as is the case with dental or eye care. With the tool, patients with non-urgent concerns receive a convenient, virtual consult.

    Now, Maple has 55 doctors providing consults, and receives daily requests from others who want to be involved. Doctors—like Uber drivers—create their own schedules, and patients can sort out their concerns whenever and wherever they want for as little as $49 CAD. They can even get a prescription delivered to their home.

    Maple is in its early stages, but it hopes to show that the service improves outcomes, and eventually push for telehealth reform to make virtual care more ubiquitous. To date, Maple has seen over 2,000 patients—100% of whom have rated it either four or five out of five stars.

    Specialists at your fingertips

    GP2U is Australia's only dedicated online medical practice. It operates as a completely virtual 'clinic' from 7am to 7pm every day, providing consultations to patients anywhere in the country. Like Maple, GP visits are paid out-of-pocket—AUS $69 for 15 minutes and AUS $90 for 30 minutes. If you receive a prescription, it can either be mailed to you or filled at a participating pharmacy immediately after your consult.

    The service also employs specialists—such as psychiatrists or dermatologists—that patients can be referred to. Alternatively, patients can sit with GPs in person and use the app to consult a specialist, which is covered under Australia's Medicare.

    GP2U has seen over 30,000 patients since its launch and just received another AUS $1,500,000 investment from one of Australia's largest private insurers, HCF.

    A win-win-win situation

    It's important to note that while these services directly help primary care, hospitals have a role to play here too. With expanded primary care access, patients will increasingly manage their non-urgent needs in the community and not in your ED. Hospitals should consider using their scale and scope to promote virtual options, or even help fund their adoption in nearby GP clinics. This creates a situation where everyone wins—hospitals see truly acute cases, GP volumes become more manageable, and patients receive the timely and convenient care they desire.

    Stay tuned for our next blog in this series, where we will further discuss how hospitals can partner with primary care to accelerate its transformation.

    GPs are in crisis—and it's affecting your hospital

    The current primary care model is at a breaking point as the result of several factors, including increasingly complex patients and evolving patient expectations.

    GPs are beginning to transform how they provide care in response to these pressures, but they can't do it alone. Read our blog post, the first in our series about primary care, to learn how this presents an opportunity for hospitals, health systems, and payers to consider how they can partner with GPs in the transformation of primary care.

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