Upstream sites like primary care are feeling the effects of the country's Covid-19 epidemic, with practices reporting low reimbursable volumes, challenges with telehealth adoption, and increasingly dire financial constraints.
How Covid-19 is impacting non-hospital sites of care
But as many traditional practices flounder, new market competitors like ChenMed, Oak Street Health, and VillageMD have demonstrated surprising agility in developing new care protocols to meet patient needs amid the crisis. As a result, they are poised to become even greater disruptive threats to traditional primary care providers (PCPs).
Below we outline three key areas where new competitors have differentiated their approach to primary care—and tactics traditional practices can employ to bolster their own network.
1. Equip patients with information and tools to comfortably transition to virtual visits.
New market entrants already had a robust telehealth infrastructure. This has enabled them to quickly convert in-person volumes to virtual volumes, but also to properly address access limitations and equip their patients with the support needed to use telehealth effectively.
For instance, VillageMD shifted 100% of appointments across its 2,500 affiliated physicians and eight markets to virtual care. While some of its offices do remain open, those visits are reserved for patients whose care needs could not otherwise be managed via telehealth.
Meanwhile, organizations like ChenMed and Oak Street Health, which focus on older adult populations, have shifted more than 90% of their volumes from in-person appointments to virtual visits. Their key enablers were proactively ensuring patients had the technology they needed at home, adapting the technology to make it more user-friendly, and offering alternatives for patients who wanted or needed them.
For example, ChenMed delivered iPads to patients' homes, while Oak Street Health partnered with a vendor to offer video visits in a simple, easy-to-navigate user interface. Oak Street Health also scaled their telephone visit capacity to accommodate more appointments for patients who are not comfortable using video visits.
What this means for traditional PCPs: Telehealth has enabled many PCPs to salvage appointments and meet patients' most pressing needs. However, many smaller practices have struggled to roll out the technology and adapt to new processes on a rapid timeline—even with temporarily loosened government restrictions. To keep pace, traditional PCPs should:
- Invest now in long-term telehealth infrastructure;
- Anticipate and proactively address challenges patients may face in accessing telehealth; and
- Educate both patients and providers on telehealth availability and best practices.
How innovative players are reshaping primary care delivery
2. Find creative ways to provide safe, in-person care.
New competitors have found ways to meet patients' diverse care needs virtually while also offering high-touch, in-person support for polychronic patients. This focus helps patients safely receive necessary care now, instead of deferring and risking downstream health consequences.
To meet patients' care needs while minimizing exposure risk, competitors like Oak Street Health are:
- Reserving in-person appointment blocks for the top 10% highest-risk patients;
- Offering shuttle service for patients to and from appointments, helping to limit public contact—especially for seniors who can't drive and use public transit; and
- Adjusting clinician workflows so that only one staff member interacts with a patient during their entire visit and staff does not interact with each other between shifts. This reduces cross-contamination risk and preserves PPE.
VillageMD also reserves in-office visits for its highest-need patients, and has ramped up preventive care management to help non-Covid patients avoid the emergency department. For patients who require labs, EKGs, or other tests, ChenMed's clinical staff conducts home visits to administer those tests in a minimized-risk environment.
Some competitors, like Forward Health, have even launched new temporary home care programs. Through the organization's "Forward At Home" program, providers send patients kits to record their biometric data such as EKGs, blood pressure, and pulse oximetry at home. Staff also conduct home visits to collect lab samples, further helping patients adhere to self-isolation guidelines.
What this means for traditional PCPs: Many traditional providers have dramatically scaled back the preventive care and chronic disease management services they offer because of temporary practice closures and reduced staffing. To keep pace with competitors, traditional PCPs should:
- Reserve in-person appointments for highest-risk patients who require in-person care;
- Isolate patients from each other during in-person appointments (e.g., using curbside check-ins, waiting in their cars to be called, limiting access to the clinic outside of their exam rooms);
- Keep staff sequestered or have one clinician run a visit from start to finish to preserve PPE and minimize infection risk; and
- Consider home visits for high-risk patients who require labs, tests, or other in-person care but cannot safely visit a clinic.
3. Address social determinants to ensure holistic care management and promote social distancing.
New primary care competitors are also offering services to support patients' health needs more holistically. The most commonly offered services include delivery of essential items, social interaction check-ins, and behavioral health support.
For example, Oak Street Health is helping seniors with the pickup and delivery of groceries, prescriptions, and household items. They are also coordinating with food banks to ensure access to food for those who cannot afford it.
ChenMed is sending daily video texts to stay in contact with their patients, for both care management and any questions or concerns they may have. Clinicians also conduct "happiness calls" to check in on patients and help address social isolation and give support.
Other competitors, like Livongo Health, are expanding services to offer behavioral health support and coaching as part of their chronic condition management platform.
What this means for traditional PCPs: Holistic care management is a new but growing part of traditional primary care, but the influx of competitors offering these services on flexible platforms means PCPs have no time to waste. To keep pace, traditional PCPs should:
- Scale up non-clinical support staffing or form partnerships to help patients with non-clinical care needs, such as prescription delivery, food access, or housing services;
- Communicate with patients on a regular basis to provide care management support and minimize feelings of isolation; and
- Extend behavioral health support—in-house or through partnerships.
How Covid-19 is impacting non-hospital sites of care
While Covid-19 has placed a spotlight on hospitals, the pandemic has also had devastating impacts on the rest of the health care ecosystem. Primary care practices, urgent care clinics, retail clinics, and ambulatory surgery centers have all experienced significant changes in workflow and volumes.
Through a series of briefings, we are cataloging the immediate impact of Covid-19 on volumes and operations at various non-hospital sites of care and presenting projections for the future. Explore our takes for each site of care.