The Future of Primary Care Lessons Learned from COVID-19 - - PowerPoint PPT Presentation

The Future of Primary Care

Lessons Learned from COVID-19

Page 2 All information in this deck is confidential – property of VillageMD

• Dr. Fields has disclosed that neither he nor

members of his immediate family have any actual or potential conflict of interest.

Disclosure

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• 1. Where We Were
• 2. What Happened
• 3. Where are We Now

The Future of Primary Care

Primary care is that care provided by physicians specifically trained for and skilled in comprehensive first contact and continuing care for persons with any undiagnosed sign, symptom, or health concern (the "undifferentiated" patient) not limited by problem origin (biological, behavioral, or social),

• rgan system, or diagnosis.

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Primary Care: Aspiration and Reality

Continuity is restricted by lack of interoperability and Data siloes Comprehensiveness is limited by healthcare design: Carve out behavioral health Coordination is not uniformly respected Specialty referrals result in a communication to the referring physician less than 40% of the time

Primary Care: Aspiration and Reality

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The Move to Value

• Economic model aligns with

enhanced communication and coordination

• Pace of change remains slow

with employers still buying on unit price and not the total cost care Outside of employers’ choices, structural barriers still remain

• Delay in payment
• Lack of data transparency
• Focus on sickness not health
• Specialty and procedural
• riented

Where We Were

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Primary Care remains the foundation of our system

• 500 million PCPC visits a year, more than 50% of all physician visits annually
• Only 30% of the healthcare workforce
• 7% of the healthcare dollar

Family Physicians are uniquely positioned to deliver comprehensive care to patients and communities. The ability to care foe all age groups across health conditions in multiple settings is unmatched. “We are asked to cover for everyone in the clinic, but no one seems capable of covering for us. Maybe that should tell us something” Margot Savoy, MD, MPH

The Value of Primary Care

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COVID showed the “plasticity” of Primary Care, maximizing its capabilities in response to patient and community needs Not unique to COVID

• Responses to natural disasters
• Meeting the needs of the underserved and rural populations
• Responding to a public health crisis

The Agility of Primary Care

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• 1. Protection of the vulnerable
• 2. Treatment and support of the affected
• 3. Continuity of healthcare for the entire patient

panel

• 4. Protection of primary care providers and staff
• 5. Recognition that specialty and mental health

care would be moved to the primary care provider

High Risk Patient Engagement Development

• f a COVID

frailty Index

Increased need for Specialty and Behavioral Care

Primary Care Goals

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• Colleagues
• Clinical protocols
• Technology implementation
• Proactive
• Staff and provider safety
• Covid and non‐Covid

presentations

• 24/7 THV
• Consistent Care Management
• Team‐based
• Top‐down

Our clinical values, coordinated/continuous/comprehensive, would now be applied to our clinical operation

Delivering On the Promise of Primary Care

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Pivot to telehealth will, in retrospect, be seen as one

• f the most dramatic

accelerations of technology in healthcare history

Acceleration in use Cases 1. Urgent care 2. Chronic illness 3. Prevention 4. Education 5. Care management 6. RPM

Decrease in In‐Person Visits

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Regulatory Relief The pivot to Telehealth was done without a clear understanding of the cost or compensation associated with the service. CMS was Quick to Lead

• 1. Telehealth coverage expansion
• 2. AWV inclusion
• a. Waiver on VSS
• 3. Inclusion of THV diagnosis for risk acuity

The Future of Telehealth

• Not going away
• Commercial plans slower to respond
• Lack of transparency in future
• A current infrastructure mismatched

to the delivery platform

Telehealth: CMS Led the Way!

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Regulatory Relief Timeline

March 14

• PHE Declaration by Secretary Azar
• Telehealth Benefits in Medicare are

a Lifeline for Patients During Coronavirus Outbreak

March 17

• Medicare Telehealth FAQs
• Medicare Telemedicine Health Care Provider Fact

Sheet

• President Trump Expands Telehealth Benefits for

Medicare Beneficiaries During COVID‐19 Outbreak

• HHS OIG Policy Statement on Practitioners That

Reduce, Waive Amounts Owed by Beneficiaries for Telehealth Services During the COVID‐19 Outbreak

• Policy Statement Regarding Physicians and Other

Practitioners that Reduce or Waive Amounts Owed by Federal Health Care Program Beneficiaries for Telehealth Services During the 2019 Novel Coronavirus (COVID‐19) Outbreak

March 18 ‐ 30

• DEA – COVID‐19 Information Page: Telemedicine
• CMS – General and ESRD Provider Telehealth and Telemedicine Tool Kit
• FAQs on Availability and Usage of Telehealth Services through Private Health Insurance

Coverage in Response to Coronavirus Disease 2019 (COVID‐19)

• Long‐Term Care Nursing Homes Telehealth and Telemedicine Tool Kit
• Notification of Enforcement Discretion for Telehealth Remote Communications During the

COVID‐19 Nationwide Public Health Emergency

• Chairman PAI Announces Plan for $200 Million COVID‐19 Telehealth Program

April 3 – 30

• Rural Health Care and Medicaid Telehealth Flexibilities, and Guidance Regarding Section 1009 of

the SUPPORT Act, Medicaid Substance Use Disorder Treatment via Telehealth

• Guidance on the COVID‐19 Telehealth Program Application Process
• FCC's COVID‐19 Telehealth Program Application Portal Opens on Monday
• Guidance on the COVID‐19 Telehealth Program Application Process
• FCC Grants Limited, Conditional Waiver to Support Wireless Medical Telemetry Services
• FCC Approves Fourth Set of COVID‐19 Telehealth Program Applications
• FCC Approves Third Set of COVID‐19 Telehealth Program Applications
• Trump Administration releases COVID‐19 Telehealth Toolkit to Accelerate State Use of Telehealth

in Medicaid and CHIP

• HHS launches telehealth homepage
• FCC Approves Second Set of COVID‐19 Telehealth Program Applications
• Enforcement Discretion for Telehealth Remote Communications During the COVID‐19 Nationwide

Public Health Emergency

• FCC Approves First Set of COVID‐19 Telehealth Program Applications
• COVID‐19 Telehealth Program
• FCC's COVID‐19 Telehealth Program Application Portal Opens on Monday

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 Patient-Centered  Primary Care-Driven  Risk-Stratified  Proactive  Team-based  Technology-enabled

COVID Highlighted the Care Model of the Future

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Foundational structure for team‐based care

• Physician
• App
• Care Manager
• Social worker
• Pharmacist
• Data analyst
• In‐clinic
• Virtual visits (audio and

video)

• Remote Patient

Monitoring

• At‐Home
• Evidence based clinical

guidelines

• Disease‐specific

methodologies

• Operational excellence

resources

• Provider training
• EMR optimization
• docOS
• Increased touchpoints

for high risk patients by leveraging our providers and platform

• Frequency determined

by risk stratification

• Performance scorecard
• Regular monitoring and

evaluation

• Culture of learning and

continued improvement

Modalities for care delivery that extend far beyond the four walls of a clinic Resources, education and technology to ensure “Villageway” standard of care Increased touchpoints to deliver more personal care Measurement of success

VillageMD Care Model

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VillageMD Care Model: Providers

Primary Care Physicians (MD, APP, PA)

• Diagnosis
• Disease Management
• Utilization

Management

• Patient Education

Nurse Care Managers

• Care Coordination
• Patient Education and

Counseling

• Caregiver Support

Pharmacists

• Medication Optimization
• Medication Review/

Reconciliation

• Medication Adherence

Counseling Social workers

• Identify and address

barriers

• Behavioral health

support

• Social determinants of health

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IN CLINIC VIRTUAL CARE REMOTE PATIENT MONITORING AT HOME

VillageMD Care Model: Platforms

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• Frequency of contact will be driven by risk stratification
• Our data shows correlation with increased visits and overall IP cost (acute, BH, subacute)

We see some correlation with decreased ER cost and higher correlation with ER to IP visits (more practice visits lead to less ER cost and a lot less IP admissions from the ER). Due to usual establishment of care and coordination on hospital visits?

VillageMD Care Model: Frequency

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While all other elements of the framework remain the same across disease conditions, Content is where we focus on specific needs for each condition. There are 5 pillars within Content

EVIDENCE BASED CLINICAL GUIDELINES

(DISEASE‐SPECIFIC)

OPERATIONAL EXCELLENCE PROVIDER TRAINING EMR OPTIMIZATION docOS

• Clinical Best

Practices

• Disease Strategies
• Tools and

Assessments

• Conditions:
• COPD
• CHF
• Diabetes
• Post Acute Care
• Depression
• ACP/Palliative Care
• Annual Wellness

Visits

• Transitional Care

Management

• Care Management
• Risk Acuity and

Clinical Documentation

• Quality
• Utilization

Management

• Pre‐Visit Planning

METHODOLOGIES + TOOLS PROVIDED FOR ABOVE

• Provider Training

Platform

• Credentialing
• CME’s
• Optimized

experience for providers

• Consistent

documentation of key data

• Consistent
• perational

processes w/ adherence that is captured

• Updated features
• Practice

management

• ptimization
• Data
• Insights

VillageMD Care Model: Content

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• Performance Scorecard
• Regular Monitoring
• Culture of continual learning and

process improvement

Core Capabilities to Drive Effective Value‐Based Clinical Care (“The Quad”) Utilization Management

Engaging patients with the optimal resources to reduce unnecessary utilization

Panel Management

Proactive alignment of PCP workflow to the needs of patient panel based upon clinical diagnoses, risk, etc.

Clinical Documentation

Creating a 360⁰ view of the patient to ensure

• ptimization and comprehensiveness of care

delivery

Quality Measures

Meeting and exceeding clinical performance targets aligned with quality care outcomes Key Metrics

• % of patients with a PCP visit in

last 12 months

• Visit frequency rates by chronic

disease

• Attributed Lives / Provider

Key Metrics

• Inpatient admits per 1,000
• Post‐discharge follow‐up rates
• 30‐day readmission rates
• % of high‐risk patients in active

care management Key Metrics

• HEDIS metrics
• STARS metrics
• Gap in care closure rates

Key Metrics

• AWV completion rates
• Chronic disease recapture rates

VillageMD Care Model: Results

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The Future of Primary Care

• Team based, proactive and risk

stratified

• Technology enabled across existing

and emerging platforms

• Incorporating wellness and prevention

with focus on chronic disease management

• Supported by prospective payment
• Patient centered
• On demand
• Price transparency

The Future of Primary Care: What Will It Look Like?

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• Align with colleagues with

similar clinical goals

• Supporting each
• ther…there is no one

right answer.

• Bringing a bigger stick to

Washington

• Don’t be afraid of change,

embrace it

The Future of Primary Care: How Will We Get There?