Primary care is the entry point for people to get care. It comes in a few flavors that fluctuate in popularity over time:
• Dr. Google
• Nurse triage lines
• Retail clinics
• Traditional PCP office visits
• On-site employee clinics
• Urgent Care
• Traditional specialist office visits
• Emergency Rooms
As you see, I define primary care not by who’s delivering the care, but by the entry point chosen be an individual to get care.
To further explain this, a study was just published in JAMA describing trends in acute care for 20.6 million insured people from 2008 to 2015. Here’s what it found (stats listed below are from 2015 data):
• The need for acute care is rising as wait times for traditional PCPs have skyrocketed.
• ER usage has declined (57 per 1,000) in favor of rising urgent care visits (103 visits per 1,000)
• Retail clinics have marginally increased (22 visits per 1,000).
• Telemedicine usage is negligible (7 visits per 1,000).
Another study by the Healthcare Cost Institute showed an increase in specialist visits (“specialists as primary care”) and a decrease in traditional PCP office visits.
Since primary care as we knew it has broken down, every company needs a primary care (entry point) strategy. And if “primary care” is the entry point, a company has three realistic options for a primary care strategy that can scale to all employees.
Status quo: do nothing and let employees increasingly use random doctors at urgent care for primary care
While urgent care is definitely less expensive than the ER, it’s overkill for 95% of everyday primary care issues. It’s ideal for issues that require a simple procedure or imaging to diagnose and have some sort of time sensitivity. Other than that, urgent care only exists because you can’t get in to see your PCP in a timely fashion and because ERs are overly expensive. If an employer chooses the status quo primary care strategy, they can expect the same results from their health spend.
Onsite Employee Clinics
These will work fine for very, very large corporate campuses. Roughly 40% of employees won’t need care enough to visit a doctor in a given year and ~20% of people want to use their own personal doctor. So let’s do the math:
One full-time doctor or nurse practitioner/physician assistant seeing patients via office visits needs 1,500 to 1,800 patients to stay busy. They also need a nurse and office admin for logistical support. So, three professionals, at minimum, costing ~$500k per year in salary and benefits plus the cost of building the clinic and maintaining operations. If doctors/NPs/PAs are not at capacity, which takes at least 18 months to get to, there’s a ton of wasted time and money. At minimum, you must have ~4,000 employees in one campus, and 18 months of patience until capacity is reached, to justify the cost of operating an employee clinic that can offer timely access to employees.
Virtual Primary Care
Since 80-90% of people need only typical primary care for all of their health issues in a given year, and Virtual Primary Care Physicians can diagnose and treat 95% of everyday primary care issues (~1,500 conditions) for all employees anywhere, the combination of Virtual Primary Care + traditional Urgent Care (for time sensitive issues that need basic imaging or basic primary care procedures) + strategically-used traditional fee-for-service specialists is the only realistic primary care strategy to tackle the wide spectrum of health issues employees will face.
Also, it can be implemented in 24 hours and employers only pay on a per Episode of Care basis. So there’s no massive up-front investment and the cost only scales as usage and value increase. And, more importantly, the effects of “benefit-aware” primary care doctors increases as usage increases.