The first article in this series focused on the basics of telehealth for primary care. This included definitions, benefits, and examples. If you haven’t read it yet, check it out here! Now, we’re going to dive deeper into telehealth innovations and challenges. I’m excited for the future of telemedicine opportunities, and hope you are too. 

We hear a lot about burnout in healthcare these days. To start a conversation about physician and clinician burnout, I like to think back to what the term means from a mechanical perspective: the reduction of a fuel or substance to zero and/or the failure of an electrical device or component due to overheating. You’re either out of gas or you’ve worked so hard as to blow a circuit and shut down – or both.

Virtual healthcare services use skyrocketed during COVID. It dramatically changed the way the world did work and school and shaped how we practice medicine. 

Previously, encounters were limited to patients coming into the office and being seen. There were quite a bit of phone calls, and some Inbasket electronic messages. Occasionally, someone was doing virtual appointments or had a specialty service dedicated to this. Some hospitals had begun using tele-stroke providers or tele-Intensive Care Unit monitoring. But few primary care practices incorporated it into routine services.

A clinically integrated network (CIN – sometimes pronounced “sin,” which is why I prefer to spell out the letters, “C-I-N”) is a group of healthcare providers that work together to actively assess and modify services to deliver efficient and affordable coordinated care to specific groups of patients. They share pertinent information and data, creating a high degree of interdependence and cooperation among the clinically integrated providers to control costs and ensure quality, usually via an electronic platform.

At the Reimagining Primary Care (RPC) Forum this spring, a prevailing theme about how primary care can and should be done in the future was one of team-based care. Our current paradigm of primary care comes with some mismatches, even conflicts to the notion of care delivered by a team, and this leads to challenges in transforming care.

Medications, both prescribed and over-the-counter (OTC) play an enormous role in American healthcare. According to the Centers for Disease Control, 71.9% of ambulatory office visits involve the prescription of a medication, and about 8% of all healthcare spending involves a prescription medication.

At the Reimagining Primary Care Forum this spring, Joel Brill, MD moderated a panel discussion on how to build the future of primary care. Dr. Brill asked the panel what one thing they would change in primary care if they had a magic wand.

Chronic conditions have rightfully gotten a lot of attention over the past few years. We know the gradual, progressive degradation to a person’s health and well-being that diabetes or heart failure can cause. There are acute issues that can cause serious and rapid setbacks for our patients, though, like a sudden onset of an infectious disease.

Many physicians, providers, and facilities appear to practice medicine from a perspective of isolation. Professional isolation has been named as a contributor to physician burnout and disillusionment, but this goes further. The thought that we are on an island with the patient, solely reliant on what’s in front of us with no contact to the outside world – either where the patient’s been or where they’re going – can cause drastic problems for the patient and those seeking to control medical costs. Redundant care, gaps in services, incorrect clinical judgements, and patient harm all arise from this problem of perspective.

In 2024, The Center for Medicare and Medicaid Services (CMS) implemented a supplemental code, G2211, for primary care providers to add-on to existing Evaluation and Management services. The idea is to give PCPs a financial boost for the ongoing care and relationship with their patients. According to CMS, “G2211 captures the inherent complexity of the visit that’s derived from the longitudinal nature of the practitioner and patient relationship.”

Patient financial responsibility plays a significant role in revenue management. As out-of-pocket expenditure continues to rise, healthcare providers face challenges in collecting payments, leading to increased accounts receivable (A/R) and uncollectible revenue. Understanding the impact of patient responsibility and implementing effective strategies are essential for maintaining financial stability and delivering quality care.

In primary care, the concept of patient engagement has emerged as a key driver of improved patient outcomes. Imagine a scenario where every patient not only leaves the clinic with a treatment plan but also with a clear understanding of their role in their health journey.

As Season 2 of BoPC’s podcast keeps reminding us, relationship is a key component to high value health care. Certainly, frequency of visits aids in building a trusting relationship. But we sometimes forget that helping a patient feel cared for plays an even greater role. Proximity, touch, compassion, and empathy all facilitate this feeling. Sitting at eye level, within a few feet of a person shows them you’re engaged and, in turn, engages them.

The US Centers for Medicare and Medicaid Services, through their Innovation Center (CMMI) announced a new ACO program to go live in 2025 – ACO Primary Care Flex. The hope is to build on the data, experience, and successes they have had with their other models that promote primary care, but with a focus on rural and underserved regions.

J Michael O'Connor, MD (or Mick, for those who’ve met him!) is a Pediatric Emergency physician and VBC advocate and expert. Recently, on his website (cite here), he gave an elegantly simple explanation of some of the alphabet soup associated with value-based care.

I had the honor and pleasure once of sitting in on a broadcasted conversation with Faisel Syed, MD on the Sacred Patient-Physician Relationship. (Faisel and Friends) That discussion got me thinking more about the special rapport needed between the Person we call the Patient and the Healer for healthcare to be effective and to optimally create value.

One of the first and most important challenges an organization faces when moving from strictly fee-for-service (FFS) healthcare delivery to value-based care (VBC) is aligning physician and provider compensation to the new priorities of VBC. If this gets left to be done “later” or not at all, the disconnect between incentives will make VBC success very difficult. 

We have an unfathomable amount of data available to us today in healthcare. Beyond our clinical data, we have multiple discrete fields of other bits and bytes that we can look at to discover better ways to care for our patients. Sometimes, though, in our zeal to find problems or solutions, we get things a bit wrong in putting the data together into useful, actionable insights.

Here’s another article in the medical literature that was needed to verify common sense – an all too frequent occurrence in healthcare, as we seem to often forget it (e.g., handwashing). This one deals with a well-known social risk.

As a follow-up to the VBC Drivers article on Preferred Provider Networks, this article will focus on the importance of at-risk Primary Care Physicians engaging Specialty Physicians in driving Value-Based Care (VBC) outcomes through the development of High Value Networks (HVN) for continued performance improvement in VBC models.