May 22

Insights on Primary Care Innovation

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The panel discussion at the Innovations in Primary Care Forum on May 9 provided an unusual glimpse into the future of healthcare. Jennifer Gee, a healthcare entrepreneur with a nursing background, organized the panel and moderated a fascinating discussion that held the attention of over 90 people for over an hour. It was a rare opportunity to hear directly from leaders experimenting with new healthcare delivery models in a candid conversation about their challenges and successes. Each of the panelists has been associated with multiple models of payment, support, an care delivery and is an expert in tailoring to the populations they serve.

The panel included:

Jennifer Gee: Moderator

David Kwok, Exec Dir, Hope Central

Scott Shreeve MD CEO Crossover Health

Erika Bliss MD CEO Qliance

Martin Levine MD Medical Mkt Dir, Iora Primary Care

Matthew Thompson MD, DPhil, Vice Chair Research, UW Primary Care Innovations Lab

Jenn started the discussion by asking for a brief overview of each organization, how they started and how they have pivoted to their current models. All started with the intention of transforming the primary care experience with an increased emphasis on building enduring relationships with their patients by seeing them where they are. For example, Iora clinicians see patients in the home and hospital in addition to the clinic setting. Crossover Health works with large employers, offering onsite and nearsite clinics (Apple was an early customer) and now is expanding into specialty care. Qliance emerged from he concierge movement, a response to rushed/pressured aspects of the fee for service world and uses a monthly fee model. Visits are 30-60 minutes with physicians or nurse practitioners. Hope Central, a non-profit serving the Medicaid population in South King County has had to go the other way, starting with two pediatricians and one child psych provider using a subscription model but has now adopted a more traditional fee for service model due to the challenging regulations. UW Medicine has a large delivery system that is moving from fee for service to value-based models.

Jenn then asked the panel to describe the technical innovations they’ve made since starting. The panel covered the integration of mental health into primary care. When opened up to audience Q&A the panel explored such issues as pain management, telehealth, health system consolidation, and their frustrations from current Electronic Health Record (EHR) systems.

The panel discussion and audience Q&A ran overtime, although the audience did not seem to mind. Jenn asked the panelist if they would answer her final questions for publication on the Health innovators website: We are grateful that they took the time to respond. Here are their answers:

Dr. Erika Bliss from Qliance:

How do you see your model evolving over the 5 year period?

Qliance is focused in the near-term on evolving our care model to further expand the capabilities and scope of primary care and population health management for our clients.  To do that, we are offering new models of payment that are an extension of our original monthly-fee model that enable employers to guarantee access to excellent primary care for all of their employees while only paying the full price for those who use it.  They also get population health and convenient urgent care access for everyone from a trusted healthcare partner who can tie everything together and do all the follow up needed.  We expect that this model, as it evolves in response to the needs and feedback of our clients and the market, will set the standard for primary care in the future, much as we have done to date with our pioneering work in the Direct Primary Care model.
Are there opportunities for practice models like yours to collaborate – i.e. group purchasing, shared analytics, software development, shared referral – cost/quality data, even a shared outpatient surgery center?

Most definitely – I think there is a huge opportunity now for like-minded and like-operating organizations to collaborate to deliver premium quality primary care that really makes a difference for clients.  Group purchasing, shared analytics, shared software development, and shared referral information are useful, but I think what is even more powerful is just the ability to work together to offer a broad geographical reach with a variety of practice styles so people have a choice.  The key would then be to partner with either self-insured companies or payers to offer essentially a primary care ACO where the network of high-performing primary care practices like ours reduce overall costs and increase quality by reducing unnecessary referrals, directing people to high-performing specialists (regardless of system they belong to) and eliminating the need for excess utilization of advanced care.  It’s a pretty simple idea, but with the potential for very powerful results, since most of our organizations are seeing roughly a 20% reduction in total cost of care for patients who use our services, and that’s without benefit of any special narrow networks or contracting relationships.
What are the current challenges in your business that entrepreneurs could help you address?

One way that entrepreneurs could help us develop our business would be to become purchasers of Qliance under our new Access to Active™ model and help us understand the needs of their particular sector by using our services.  This is always how we’ve gotten the best information on how to solve for the market’s needs.  To be truly honest, a lot of the technology and tools already exist to make what we do work, we just need partners who are interested in engaging and using our platform of services to help us understand where to expand next.

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Dave Kwok from Hope Central:

How do you see your model evolving over the next 5 years?

We don’t really see our model changing that much, but we do hope to expand to other neighborhoods with mixed socioeconomic demographics. We’d also like to expand into family medicine.

Are there opportunities for practice models like yours to collaborate – i.e. group purchasing, shared analytics, software development, shared referral – cost/quality data, even a shared outpatient surgery center?

What are the current challenges in your business that entrepreneurs could help you address?

Standardized technology platforms for data interchange between healthcare entities. Standardized electronic medical record. Better low-cost EMR’s (interface, reporting, API’s). More flexible insurance plans that allowed greater autonomy in the use of well-care dollars.

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Dr. Matthew Thompson from the UW Primary Care Innovations Lab:

How do you see your lab evolving over the next 5 years?

With the growing need for more efficient, more effective, and more cost effective health care, the primary care field will expand. Added to this is the growing need for ongoing care of people with multiple conditions/chronic disease as well as growing interest in wellness. I see the need for more opportunities for the PCI Lab to engage with companies and technologies that need to be tested, evaluated, implemented in the primary care space growing. Whether this is ways of integrating wearable wellness tools, new ways of providing technology that allows more to be done in single visits, or better ways to engage patients and caregivers in health. In addition, the interfaces in primary care are going to need to improve dramatically, including how data is entered, used, and analysed. Therefore I see more engagement with more companies and innovations, and PCI  Lab being established as the ‘go to’ group for innovations in primary care in the US.
Are there technologies or models you’ve seen deployed in low resource settings that can work in newer practice settings here?

Some low resource settings have been ahead in terms of use of some point of care tests, for example point of care malaria tests have transformed primary care management of fever in many countries, others have adopted handheld ultrasound scanning. Probably the biggest learning point has been the innovation in health care delivery teams, many lower resource settings use health care providers who are not doctors, but provide excellent service for their level of training – this type of model, where the doctor is important but not the sole member of the primary care health care team is needed in high resource settings (and is in fact happening), in order to make best use of all the health care team’s expertize, and not rely so much on doctors.

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Dr. Marty Levine from Iora Primary Care:

How do you see your model evolving over the 5 and 10 year period?

I think our model nationwide will move in two simultaneous directions.  One direction will emphasize convenience care for the majority population and include novel ways to meet care needs with far less office visits with doctors, but there will need to be a part of the practice with more intense care for those with chronic conditions.  The other direction will emphasize expanded chronic care services for populations like those served in Seattle presently (Medicare).

-Are there opportunities for practice models like yours to collaborate – i.e. group purchasing, shared analytics, software development, shared referral – cost/quality data, even a shared outpatient surgery center?

We do lots of collaborating now.  We work with several different innovative organizations.  This is managed through the Boston headquarters.

What are the current challenges in your business that entrepreneurs could help you address?

In Seattle, our growth is dependent upon sales of Humana medicare insurance because we have an exclusive relationship with Humana.  Some insurance sales are done with Humana-employed agents, but most are done by independent agents who sell different insurance plans.  Insurance sales are complicated and most customers do not understand the benefits and costs of plans well when they purchase them and, instead, focus on a key attribute or two (eg, total cost, or choice of doctor).  Even independent insurance agents, pressured to do all sales during the open enrollment period from ~10/15 to 12/7 often have limited understanding of the plans they are selling.  There seems to be a real opportunity for an entrepreneur to figure out how to simplify the sales experience and make the public better consumers than simply looking at total cost or choice of doctor.  Increasingly, people are purchasing insurance by phone or online.

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