In our recent Provider of Choice Summit, service line experts discussed how Covid-19 and other market forces have accelerated new primary care groups' disruption of referral pathways.
Many of these disruptors, which include population health managers like Chen Med and Oak Street Health, and convenient care providers such as Walmart Health, have grown in both scale and scope over the past year.
Here are our key takeaways from the discussion, informed by both Advisory Board's research and the live cohort discussion and interactive exercises.
What did we learn?
- One-in-five attendees have experienced primary care disruption in their market—but less than half have taken steps to mitigate the impact these groups could have on their specialty care referrals. And 12% said they've heard of primary disruptor groups in their market but aren't in any partnerships, while 8% said they're in partnerships with at least one primary care disruptor.
- There are many front doors to the health system now, and health systems vary widely in how prepared they are to capture specialty volumes from these diversified referral pathways. With specialty patients coming from urgent care, virtual visit platforms, retail clinics, and more, there is no longer a standard referral pathway, and many emerging referral pathways are more complicated. Meanwhile, 18% of said they're feeling somewhat prepared to position themself as a specialty partner of choice, while 19% said they're somewhat concerned about the impact of convenient care on their business.
- One of the biggest drivers of primary care disruption remains patient preferences, specifically convenience and accessibility. But issues such as clinician shortages, provider burnout and long wait were exacerbated by Covid-19, and these are furthering interest in innovative care models and technologies—among patients looking for a care provider, and clinicians looking for new employers. Members reported the landscape of primary care today with words such as "shortage," "long wait-time to appointments," and "huge spectrum of options."
How should service lines think about primary care disruptors moving forward?
The big convenient care retailers have been remarkably persistent in their attempts to break into this market: despite the lackluster success of original retail clinic models, CVS, Walmart, and Walgreens all continue to evolve and expand their clinic models.
And of course, last year drove explosive growth in virtual platforms, with companies like Teledoc and Amwell seeing unprecedented levels of growth. Many of yesterday's start-ups have rapidly become powerful players within the industry. For example, One Medical and Oak Street Health both went public last year and have consistently outperformed Wall Street expectations since then.
These groups are growing in part because they have demonstrated an ability to reduce utilization and control costs. They report that they can reduce hospital admissions, ED visits, and specialist use-which makes them attractive to payers who are looking to control costs.
In response, service lines will increasingly be unable to take a "wait and see" approach and instead will need to make themselves appealing to disruptors to build partnerships with them, or earn their specialty referrals.
This strategy starts by understanding who the disruptors in your market and their specific value propositions to patients and payers are and diagnosing what their top priorities are in looking for specialty partners.
Depending on the outcomes of that analysis, your service line may need to make investments in care navigation to improve cross-stakeholder collaboration, expand access, improve patient satisfaction scores, improve quality metrics (ex. shorten length of stay), minimize care variability, and/or institute triage tactics to help patients navigate between the ED and alternative care options.
Fortunately, many of these efforts to capture volumes from primary care disruptors will help service lines appeal to other patients, referring physicians, payers, and employers, as well.