Access, Costs, Engagement: Virtual Primary Care Takes On 3 Industry Issues

Primary care is a member’s front door to the healthcare system. It’s the hub connecting all the spokes in their healthcare journey. The industry’s desire to minimize costs and leverage technology is prompting a shift toward virtual primary care.  

In a recent webinar, Anna Fishbon, Amwell’s digital care lead, and Dr. Cynthia Horner, vice president of Amwell Medical Group, explored three common challenges the industry is confronting and how virtual primary care can be a solution.  

Challenge 1: Access to care  

One in four Americans don’t have a primary care provider to manage the totality of their care. As a result, crucial gaps in care are common. And with a predicted shortage of up to 48,000 primary care providers in the U.S. by 2034, gaps in prevention, critical follow-up and appropriate longitudinal disease management will grow unless the industry offers more primary care options. Access issues are being driven by geographic, social and economic barriers, which virtual primary care can address.     

Challenge 2: Costs  

The U.S. healthcare system spends $32 billion annually on avoidable emergency department (ED) visits. Lacking appropriate medical guidance, many members turn to the ED for low acuity issues that could be addressed -- for far less -- in a primary care setting.  

For example, when managing urinary tract infections, stable COVID, upper respiratory infections, or ongoing conditions such as asthma, diabetes and hypertension, the primary care setting is proven to reduce costs and improve outcomes compared to episodic or fragmented care.     

Challenge 3: Member engagement   

The impact of engagement goes beyond enhancing a member’s experience with the healthcare system or their health plan. When members participate in their health journey, 63 percent will seek in-network care based on their insurance coverage. But when members are disengaged, half will look outside their network for care rather than trying to decipher their plan.  

Care that starts and stops, soaring costs stemming from a lack of medical guidance, and getting members to engage in their health are critical issues the industry is grappling with. Fortunately, with significant challenges come significant opportunities.   

The solution: virtual primary care

Virtual primary care gained widespread use during the pandemic. In 2021, 63 percent of health plans provided some version of the offering, but the experience varied widely. Two years later, virtual primary care has matured into a comprehensive longitudinal relationship between the clinician and the member, focusing on prevention, disease management and addressing social determinants of health and gaps in care.     

This change is drawing more health plans to virtual primary care, especially in rural areas or for unengaged populations. Nearly 70 percent of large employers say they’ll implement a virtual primary care offering in 2024 or 2025.    

The three challenges the industry is working hard to resolve – access to care, soaring costs, and member engagement – are precisely why more payers and employers are offering a virtual primary care option.   

Gaps in care are easier to close when members can access the care they need without leaving their homes. Healthcare costs are one-third less for those who regularly see a primary care clinician than those who don’t. And with 84 percent of virtual primary care users saying they’ll continue to access the care venue in the future, payers are better able to engage members by providing a digital option for primary care.  

Vitals for virtual primary care success 

A successful virtual primary care experience takes more than a secure video link for providers and members to connect. Based on Amwell’s work with some of the world’s top payers and providers, Cynthia shared best practices for a successful virtual primary care experience:  

• Keep virtual primary care at the center of the care team; care coordination starts here – just like it does with an in-office visit  

• Nurture longitudinal relationships between members and providers; virtual primary care isn’t a replacement for urgent care or annual wellness exams, and it’s not an online after-hours option for a brick-and-mortar primary care office   

• Remember that virtual is one way to deliver the same evidence-based standards used in the best of primary care settings and that there are times when the right course of action is in-person treatment; virtual primary care must have built-in protocols to leverage remote patient monitoring devices and coordinate care when in-person exams are needed   

• Embrace a holistic member view that includes behavioral health and chronic care management   

• Confirm data assets are shareable with a member’s virtual care provider    

• Ensure a seamless member follow-up and support the care decisions members make between visits   

A clinical lifeline: Amwell Medical Group   

With staffing shortages making headlines across most specialties, Cynthia shared how Amwell Medical Group (AMG) provides members access to high-performing virtual primary care.  

AMG has thousands of clinicians trained in telehealth and longitudinal care across service lines. Using the Amwell ConvergeTM platform, these experienced providers take a holistic approach to diagnosis and treatment, work with a support team to coordinate follow-up care and ensure members stay in-network for specialist referrals, labs, e-prescriptions, vaccines, and other services. Clinicians also confirm that selected medications align with payer formularies and that referrals align with payer referral networks. The practice has robust and detailed quality oversight, credentialing and regulatory review processes to ensure care meets the highest quality standards and complies with state and federal regulations.  

AMG is a clinical lifeline that connects members to the virtual care they need, helps control costs and keeps members engaged in their health.  

The shift toward virtual primary care  

Like its in-person counterpart, virtual primary care is the hub of a member’s health journey. But as the industry strives to address considerable operational challenges, it’s experiencing a shift toward more comprehensive virtual primary care offerings.  

Watch the full webinar, “How Hybrid Care Can Address Healthcare Challenges,” to learn more about how virtual primary care and Amwell are helping the industry overcome complex problems related to access, increasing costs and member engagement.