Primary Care Practices Can Engage Patients in Virtual Care

June 6th, 2020
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During the most challenging phases of the COVID-19 pandemic, one opportunity for the health care delivery system has been the rapid adoption of telehealth and virtual care by both primary care practices and patients. The Pacific Business Group on Health’s California Quality Collaborative (CQC) has hosted webinars to support and spread successful practices in virtual care for independent primary care practices and IPAs as they rapidly implemented telehealth technology and workflows.

Nationally, the trends reflect widespread virtual care adoption.  By one May 2020 analysis, telehealth visits in the US increased 300-fold in March and April 2020 compared to the same time period in 2019 (Epic Health Research Network).  Providers have been pleased with their telehealth experience, and patients have too: 88% of patients new to telehealth said they would like to use it again (PwC Health Research Institute).  The health system is eager to build on the implementation gains around virtual care made during the public health emergency, especially its ability to improve access to care and reduce costs.

Patient engagement in virtual care

Yet today, more than ever, it’s essential for health care clinicians and care teams to ensure that virtual care being provided is as patient-centered as possible. This topic was the focus of a May 6 webinar hosted by CQC, which highlighted presentations from a number of experts including Dr. Courtney Lyles, Associate Professor, Center for Vulnerable Populations at UCSF; Libby Hoy, Founder & CEO, PFCC partners; and Dr. Fiona Wilson, former Teladoc provider and current Supervising Clinician Specialist, Workers Compensation Division, Department of Human Resources, City & County of San Francisco.

Dr. Lyles shared examples from decades-long research done around patient portals, telephone visits and tactics that help bridge the “digital divide,” even in regions of strong technology adoption, such as the Bay Area. Her advice was not to make any assumptions about what patients do or do not have access to, and establish ongoing trainings, where patients can be assured to get continuous support for the virtual care they are seeking.

Libby Hoy of PFCC partners shared lessons from her organization’s history building patient advisory capacity. She cautioned that the work, especially at this time, is messy, but reminded care teams and providers that involving patients in the design process of the workflows results in more effective care.

Dr. Wilson shared her experience as a telehealth provider during COVID-19 for Teladoc, an organization that provides virtual care for patients all over the United States. Her advice for clinicians was to be an empathetic and engaged listener to patients when they are sharing their health issues, and make sure to ask about non-medical needs that may be even more present today, such as social isolation and economic hardship.

What providers can do now

Today, primary care practices are regrouping after shelter-in-place restrictions lift, adapting to a hybrid of virtual and in-person care, and working to address any care needs of their patients that were deferred during the height of epidemic. Yet even in this time of transition, CQC’s expert panelists shared the following steps practices can take to focus on patient needs:

Access CQC’s May 29 webinar recording and summary here.

The Stakes for Primary Care – Impact of COVID-19 and the Urgent Need for Action

May 1st, 2020
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The COVID-19 pandemic has infected nearly 1 million people in the United States, killed tens of thousands, and is having an unprecedented negative effect on the country’s economy. It has also strained primary care providers to near the breaking point. Nearly half of independent primary care practices report that they are in danger of closing in the coming months due to a collapse in revenue. Primary care practice closures threaten patients’ access to health care during this pandemic and afterward.

On April 30, PBGH teamed up with the American Academy of Family Physicians (AAFP) and the Partnership to Empower Physician Led Care (PEPC) to host a virtual Capitol Hill briefing attended by more than 100 congressional staff and interested stakeholders. The briefing was opened by the co-chairs of the bipartisan Congressional Primary Care Caucus, Reps. Joe Courtney (D-CT) and David Rouzer (R-NC), and featured expert speakers, including PBGH’s President and CEO, Elizabeth Mitchell, and the AAFP’s incoming CEO, Shawn Martin.

Primary Care Doctors Share Their Story

The highlight of the event was a panel discussion featuring three front line primary care clinicians, who discussed their own personal challenges in delivering care and keeping the doors open in the era of COVID-19.

These physicians all described the financial hole they find themselves in as office visits abruptly fell off, and the frightening prospect of going out of business and leaving their patients with nowhere else to turn. They talked about the 20-hour workdays for themselves and their staff as they work to manage the concerns and health conditions of thousands of people who entrust them with their medical needs — all while abruptly shifting to deliver care via phone or video chat.

The move to telehealth has been both welcomed and challenging. Through a fuzzy online connection, one doctor talked about the poor broadband access in her small, rural town, and how the financial strain of COVID-19 on her practice required her to choose between upgrading her 15-year old audio visual equipment to improve visibility for online patient visits, or to provide her staff with needed personal protective equipment (PPE).

Another physician described his frustration with insurers who have largely failed to step forward to provide primary care doctors with the support needed to stay afloat and available to millions of patients nationwide.

“We’ve saved our country and insurance companies millions of dollars, and I’m sitting here dying,” he told participants of the briefing. He was recently forced to furlough 75 members of his staff and shared that he and his fellow physicians were now working unpaid.

Taking Action — NOW

As the panel demonstrated, absent an aggressive federal response, the country’s primary care delivery system is on the verge of collapse. PBGH, AAFP, and PEPC delivered clear recommendations to Congress for immediate legislative action in five major policy areas:

The event’s slide deck, including detailed policy recommendations, and a full recording of the briefing are available online.