Connected Primary Care

Background

The modern practice of U.S. primary care has common yet critical pain points with patient access and provider experience that invite innovation:

• Patient access: Since primary care providers (PCPs) keep full schedules serving traditional patient needs, it can be challenging to find additional availability to serve both new patient appointments and time-sensitive care for existing patients. In fact, past studies have shown it can take an average of 18 to 24 days for new patients to schedule appointments with physicians in some of the largest U.S. cities. PCPs also may have limited data and tools to assist their patients in the self-management of their conditions, which could otherwise help patients avoid unnecessary visits.

• Provider experience: Meanwhile, providers may struggle to find the desired time to spend on their highest complexity patient needs. They face an incredibly high volume of electronic health record (EHR)-related documentation work and other paperwork, billing requirements, patient emails and phone messages, and low complexity follow up that might be more readily performed by another qualified colleague.

Idea

To address these challenges, MedStar Health has piloted and expanded a Connected Primary Care (CPC) model aimed at enhancing patient access, provider experience, and practice efficiency through technology, workforce, and workflow innovation. While this work started before the COVID-19 pandemic, it was accelerated by the exponential expansion of telehealth services in response to the crisis.

The CPC model creates and deploys a central connected care team of virtual practitioners and virtual staff members who currently serve four key functions that help address patient access and provider burnout:

• Same day/next day video appointments: Typically, these visits focus on serving quick-turn, acute needs of existing patients and finding availability for new patients.
• Remote patient monitoring (RPM) for chronic disease management: This proactive care keeps patients connected from their home and is currently focused on high blood pressure.
• Prescription refills: Algorithmic software is used to assist PCPs with the completion of their requested prescription refills in a safe manner that reduces the physician workload to those refills that truly require their attention. Automated prescription refills can also help routine needs to be processed for the pharmacy in an average of four hours.
• Urgent lab/diagnostic result follow up: This quality and safety function ensures important long-loop results (e.g., those following mammograms and colonoscopies) reach patients in a timely manner.

MedStar Health central connected care offerings were initially driven by three connected care teams affiliated with Olney, South Baltimore, and Southern Maryland. They each leveraged existing groups of 20-25 providers from those respective areas, as well as one fully-dedicated nurse practitioner (NP) and medical assistant (MA) who only worked remotely. These three connected care teams supported 14 MedStar Health office-based practices in these geographic areas.

The model also leverages the MedStar eVisit workforce, which traditionally provides on-demand urgent care via telehealth, to offer an additional layer of centralized connected care support as needed. This helps ensure a surge in any of these local primary care contexts can have centralized back up, while keeping teams the right size overall. This team consists of emergency medicine, urgent care, and primary care providers who are acute care specialists: physicians, physician assistants, and nurse practitioners. A day in the life of a centralized connected care provider can be diverse. For example, these providers may start the day with general RPM work and escalations, conduct video visits for their assigned primary care practice, return to RPM work, contribute to MedStar eVisit surge management, and then end their day by resolving RPM escalations. In a single shift, they may serve patients via three different care delivery platforms for three different disciplines—showcasing the flexibility and adaptability of this team.