The medical office manager has always worn multiple hats. From administrative oversight of payroll, talent acquisition, performance reviews, finance and human resource management to providing guidance to leadership regarding employee benefits—the office manager looks after it all. This briefing will address one of those topics—how to support and encourage employees to build even better relationships with primary care providers.
Primary care has always been the gateway into the healthcare system. Internists, general and family practice, pediatrics and, in some cases, gynecology have been a patient/consumer’s first stop if they have an illness, medical concern, or the presence of physical or mental health symptoms that need attention. The primary care physician 1) shares co-responsibility for her/his patient’s health, and 2) is highly skilled at providing the first and most important medical diagnosis of an illness before providing a referral to the appropriate specialist. It’s important to remember that 70% of all healthcare is either driven by or overseen by a primary care physician.
American primary care physicians are, unfortunately, overworked and, in a growing number of communities, in short supply. Healthscape Advisor research predicts that 60,000 primary care physicians will be retiring over the next decade making access to primary care even more difficult.
For many reasons, Americans are “dainty users of primary care” compared to other developed countries, according to Dr. Uwe Reinhardt, former Professor of Political Economy at Princeton. There are plenty of reasons for that, such as patient out-of-pocket costs, long appointment wait times, short office visits, distracted and overworked physicians, and an increasing number of closed practices. It’s not surprising that more than 25% of American adults do not have a primary care physician. That statistic is even higher for under-represented racial and ethnic groups. And, anecdotally, many patients who actually know their physician’s name have not developed a meaningful, regular, and personal health dialogue with their physician.
The COVID-19 virus has put even more pressure on access to primary care leading many Americans to seek care from hospital emergency rooms, urgent care facilities, or from medical specialists. Those with COVID-19 symptoms or fears who lack a primary care relationship have suffered from added confusion and anxiety as their symptoms, in some cases, became serious.
What does research tell us about the value of a strong primary care relationship?
First, from a healthcare cost perspective, persons with a primary care relationship have lower medical costs. The Journal of the American Medical Association research study (2020) found that for every $1 spent on primary care, $13 was saved by the payer (employer and the employee). Why? Fewer unnecessary emergency room and urgent care visits, correct use of generic medications and avoidance of over-medication, and fewer duplicative and unnecessary imaging orders. Secondly, (and most importantly) the COVID-19 pandemic has created prevailing concerns and worries that a trusted primary care relationship can often alleviate. Longitudinal studies of patients which compared those with and without a primary care relationship have shown that patients with an ongoing primary care relationship had healthcare costs 4%–6% lower than those without such a relationship. (Chernow et. al., “Would Having Primary Care Doctors Cut Health Spending Growth?” Health Affairs, 2009.)
Finally, what are some ideas to increase the visibility and use of primary care?
1) Encourage employees and their insured dependents to search for a primary care physician for each family member. This will mean that they will need to use their insurance company’s website to locate local physicians (in-network) and determine if they are accepting new patients. As difficult and time consuming as this may be, the patient must be willing to switch a primary care relationship if the physician is not attentive or a good fit.
2) Encourage employees to ask if their physician offers virtual office visits for patients. Telemedicine has become more common as physicians and patients get comfortable with a phone and video relationship. Telemedicine is not appropriate for all medical discussions but certainly improves communication and relationship building. Finally, telemedicine must be with one’s own physician to be effective long term.
3) Investigate the availability of local, stand-alone primary care clinics (called Direct Primary Care) in geographies where employees live. Organizations like Euphora Health, Everside Health, OneMedical and Vera Whole Health provide primary care (independent from medical insurance) for an annual subscription (plus copays). These models provide 24/7 access to doctors, longer appointment times, walk-in appointments, weekend and evening hours and personal attention that is very difficult in the current healthcare insurance-driven environment.
4) Healthcare providers like SHIFT Life and Mayo Clinic provide comprehensive, annual primary care medical evaluations for executives/partners. These elite health programs can raise executive awareness and support for primary care for employees and associates.
