Industry Voices—Virtual primary care moves healthcare beyond telemedicine  

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Virtual primary care is taking healthcare beyond telemedicine. (Getty/BrianAJackson)

As the U.S. healthcare debate rages on, we need to turn our focus to primary care. According to a recent Kaiser Health News article, 45% of 18-to-29-year-olds and 28% of 30-to-49-year-olds had no primary care physician. This number is concerning as study after study reveals that continuity of care helps improve patient outcomes and yet the gap between access to primary care services and the need for primary care continues to widen. 

So, how do we bridge this gap so that patients can receive the quality primary care that they need and deserve?

Telemedicine emerged to fill a void caused by primary care physician shortages and the overuse of emergency rooms, urgent care centers and other high-cost care options. It is a model for handling acute, low complexity healthcare issues often resolvable through a single doctor-patient interaction, generally without follow-up care.    

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Hill Ferguson (Doctor on
Demand)

Telemedicine is a cost-effective alternative to urgent care and gives patients the ability to schedule doctor visits at their own convenience. While these services perform an important role in filling gaps in care, they are limited in scope and do not address the chronic care and primary care needs of the population. 

This shortcoming has led to the creation of an entirely new category: virtual primary care. 

Virtual primary care offers the access and convenience of telemedicine, but pairs those aspects with the benefits of traditional and enhanced forms of primary care. It is a holistic care model, focused on the health of the body and the mind, that uses technology to offer continuity of care and builds ongoing relationships between physicians and patients within a virtual care environment. Through virtual primary care, patients receive care from a team that consists of primary care physicians, nurses, psychologists, psychiatrists and other healthcare professionals, all working together in an integrated care setting to provide holistic patient care. Patients interact with virtual care physicians through multiple communication channels, including real-time video, mobile and secure messaging.  

There are three key elements of virtual primary care:

1. Dedicated clinical teams led by a national, employed physician practice that creates a continuous, relationship-centered care environment for patients. This team coordinates care with downstream providers and navigates patients to the highest value settings of care within their health plan’s network, including specialty services

2. A single, integrated telehealth platform that supports connectivity and interoperability across the clinical ecosystem (lab connectivity, device connectivity, record sharing, etc.)

3. Software and machine learning tools that provide clinical and administrative support to physicians and care teams. These tools give patients more control over the management of their own health and enable scalable growth in primary care services nationwide.

As we adopt this new model, it’s important to dispel what virtual primary care is and isn’t. What elements of virtual primary care are similar to telemedicine and what are completely new?

 What virtual primary care is and isn’t

 Virtual primary care is:

  • Holistic, mind-body care 

True virtual primary care provides patients with full mind and body care, inclusive of preventive health, chronic care management, urgent care and integrated behavioral health, as well as continuity of care. Through virtual primary care, patients have one dedicated primary care physician and are able to see that same physician on an ongoing basis. This is only possible when the virtual care provider has a fully employed workforce of physicians, nurse practitioners and care coordinators to provide consistent care across patient needs.

  • A form of primary care that leverages technology 

In practice, virtual primary care gives patients face-to-face time with their physicians across devices. Some telemedicine providers rely heavily on the telephone which has been proven to be an ineffective replacement to in-office visits. In virtual primary care, the patient sees a physician via video technology, enabling both the physician and patient to experience the complete benefit of both verbal and non-verbal communication. This allows the physician to read body language and recognize if their patient is in physical distress or if other forms of physical illness are present on the body. Virtual primary care also equips the physician with the essential tools of any primary care visit including, e-prescribing, labs, referrals, diagnostic radiology and digital health devices such as stethoscopes and blood pressure cuffs. 

  • A model that requires a smart referral system

Virtual primary care requires a smart referral system that ensures all member referrals, lab services, imaging and prescriptions stay in-network and works with existing providers and ecosystem partners to support complete patient health. This is supported by a clinical care team consisting of nurse practitioners, pharmacists, dietitians and care coordinators that deliver quality care. This team is in place to provide seamless, ongoing patient support and to guide patients through the often complex healthcare system.

  • Inclusive of integrated behavioral health

In order to deliver fully mind-body care, virtual primary care includes access to licensed psychologists and psychiatrists. A primary care physician can make recommendations for patients to see a behavioral health professional and any follow-up appointments are included within a patient’s plan.

RELATED: Does healthcare need a virtual medicine specialty? Experts aren’t so sure

  • Available at the patient’s convenience 

One element of traditional telemedicine that is preserved through virtual primary care is the ability for patients to easily schedule an appointment via an app or across mobile devices. Patients can see their physician at home, during their lunch break or on their commute. Physicians are available at times convenient to the patient’s schedule, not vice versa.

 Virtual primary care is not:

  •  Part of the gig economy 

Most telemedicine providers do not fully employ their physicians. What does this mean? The physician in these practices is “moonlighting." In addition to their regular private practice, he or she may pick up telemedicine shifts. This model of care does not allow for patients to receive consistent and continuous care. Virtual PCPs are dedicated, highly rated physicians who make their primary source of income practicing virtually. Continuity of care is established through regularly scheduled visits with a patient’s primary care doctor, reducing fragmented care within the healthcare system. 

RELATED: Primary care using NPs and PAs to reach patients with virtual visits

  • A second-rate substitute 

Virtual primary care physicians are highly trained and highly rated. They work for a virtual care provider’s medical practice, are dedicated to that network and specialize in telemedicine. They undergo a hiring and screening process that is as rigorous, if not more rigorous, than brick-and-mortar healthcare institutions and receive extensive training specific to virtual care. 

  • Telephone and text-based 

With virtual primary care, initial physician visits are conducted via video to establish a physician and patient relationship face-to-face. Follow-up questions may occur on the phone or via asynchronous messaging but the appointment itself is a video visit. This is how a physician can ensure a thorough visit and examination and build a rapport with the patient. 

  • Just urgent care 

While virtual primary care offers on-demand visits to see a doctor immediately, it goes beyond urgent care. Virtual primary care doctors are licensed to prescribe ongoing medication, schedule follow-up visits and make referrals to see specialists.

Telemedicine was the first step in connecting technology to healthcare. Virtual primary care is an evolution of telemedicine and takes a holistic approach to a patient’s health by providing continuity of care, offering a team of providers specifically trained for virtual care, supplying access to virtual care across devices and giving patients the ability to connect with physicians face-to-face. Through virtual primary care, patients receive full mind and body care and experience the access to quality healthcare they deserve.

 Hill Ferguson is CEO of Doctor on Demand, a virtual care provider.

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