Issue link: https://beckershealthcare.uberflip.com/i/267523
43 Executive Briefing: Primary Care The following content is sponsored by Health System Advisors and written with Zipnosis The Virtual Primary Healthcare Revolution: What Health Systems Need To Know By Kate Lovrien, Principal, Health System Advisors, Luke C. Peterson, Principal, Health System Advisors, and Jonathan Pearce, CEO, Zipnosis A growing market segment is demanding unscheduled ac- cess to primary healthcare services without consideration of health system or pre-existing clinician relationship. This population segment has given rise to a new set of "on-demand" primary healthcare delivery channels. These on-demand delivery channels have strong growth projections (ranging from 6.5 to 34 percent annually) over the next several years creating an oppor- tunity or threat for the traditional primary care providers and the health systems. There are numerous reasons for the growth of on-demand delivery channels. Chief among these reasons are the rising importance of convenience, access outside the 8:00 am to 4:30 pm typical work hours and the empowerment of the consumer in directing his or her own health. Consider, for instance, people under 40 years old are almost 50 percent more likely to not have an established primary care physician relationship and instead access primary healthcare through urgent care, retail and virtual providers. Health systems that want to remain relevant and care for this growing population segment must understand this group's demands and embrace innovations in primary healthcare delivery. To date, health systems have been slow to respond. While health systems have gone on a primary care employment binge, they only operate 28 percent of the urgent care centers, 1 are only recently actively partnering with the major retail operators 2 and have almost no presence in virtual primary healthcare delivery. This void in serving the on-demand care is rapidly being filled by technology companies, health insurers, venture capital and other non-traditional healthcare providers. Given the rapid growth rates and importance of the demographic, health systems must understand how they will participate in each of these on-demand delivery models. While each on-demand delivery model is important for health sys- tems, this article focuses on the lessons learned in the asynchro- nous virtual primary healthcare delivery model including experi- ences from Zipnosis, a leading virtual primary healthcare delivery provider. Virtual primary healthcare Virtual primary healthcare is the use of electronic mediums to deliver primary care including: education, prevention, diagnosis, treatment and disease management There are two major models of virtual care: • Synchronous: models that connect people and providers in real-time • Asynchronous: models that deliver care to people without requiring real-time interaction Synchronous care uses technology like phone, video or chat to connect patients and providers (and sometimes clinician-to-cli- nician) in real-time for a wide-range of medical conditions. Syn- chronous virtual care, while a novel application of technology, im- proves clinical efficiency only to the extent it reduces travel for the clinician or patient. In rural areas with large distances, traditional synchronous telemedicine adoption is widespread; however in the urban areas where most of the population lives, there is less efficiency to be gained and the increased transaction costs have outweighed the benefits. Asynchronous care solutions create efficiency in an entirely dif- ferent way. Asynchronous care focuses the clinician's interaction to the most essential elements, allowing batching of the clinician's time to capture scale economies. Starting in the form of secure email, asynchronous primary care models made a major jump in the 2000's as technology took the unstructured email and in- corporated evidenced-based protocols and linked the patient's medical history in a highly structured manner. This transition al- lowed asynchronous virtual care to use sophisticated computer algorithms (and in some cases consumer devices) to collect all the necessary information and organize it efficiently without di- rect patient-clinician interaction. Today, clinicians still review the information and make a diagnosis and treatment, but their role is limited to clinician decision-making, not documentation or admin- istrative tasks. The shift from synchronous to asynchronous has major advantag- es for virtual primary healthcare. For the patient, asynchronous models provide high quality, efficient and convenient access to primary care anytime and anywhere they have an internet con- nection. For the clinician, diagnosis and treatment time can be compressed by a factor of 10 or more. Lessons learned in virtual primary healthcare Zipnosis is a leader in the virtual primary healthcare delivery revo- lution. Founded in 2009, Zipnosis charges $25 to patients to diag- nose and treat common primary healthcare conditions without a face-to-face encounter. In place of a typical scheduled physician office visit or trip to urgent care, Zipnosis uses an adaptive, auto- mated online interview to collect the patient's medical history and summarize the data for clinicians who then review the evidenced- based diagnosis and treatment recommendations and make final clinical decisions.