Issue link: https://beckershealthcare.uberflip.com/i/267523
45 Executive Briefing: Primary Care After five years leading the revolution, Zipnosis offers six insights about this primary care delivery channel and why health systems should be interested in integrating some form of virtual care in their delivery platform. Learning 1: Unique population segments Zipnosis users are a rapidly growing population segment seeking to address their primary healthcare needs in very different ways than the traditional healthcare industry has allowed. For most of the patients that use virtual primary healthcare, convenience and time- savings dictated the decisions. This is a population that does not use the traditional scheduled primary care office model for their care. In fact, more than 60 percent do not have a primary care physician. Moreover only 30 percent of the patients would have sought care in a primary care clinic, had a virtual care option not been available. This mentality is not just a phenomenon of the millennials; the typi- cal Zipnosis user is a 37 year old female who is the healthcare de- cision-maker for her family. Zipnosis experience shows the virtual primary healthcare users are not just the tech-savvy, but those that are used to virtually accessing services from other industries like banking, travel and retail. Additionally, the patients attracted by a virtual primary healthcare delivery model are often new patients for the Zipnosis' system partners. More than half of all Zipnosis patients referred for further diagnosis or treatment to a partner system are new to that sys- tem. 4 This new patient percentage is an important consideration for health systems that want to grow into new markets or popu- lation segments. With a virtual access point, the health system can provide 24-7 access to populations both in and outside its traditional markets. Learning 2: Direct downstream health system value Virtual primary healthcare does not treat all primary healthcare conditions. About two-thirds of all patients that seek care through Zipnosis must be referred to another form of care, typically an ER, urgent care or primary care office. While this percentage is de- clining as the number of conditions treated by Zipnosis expands, there will continue to be downstream referrals from Zipnosis. Re- ferrals from simple laboratory diagnostics to complex imaging di- agnostics to acute events means the traditional components of Zipnosis health system partners benefit from the growth of Zipno- sis. Depending on the relationship with the health system, these referrals can be very sticky with the ability to schedule appoint- ments and transition the demographic and patient history directly through Zipnosis. Unlike the other primary healthcare delivery channels, virtual has the unique potential to provide immediate access to its health system partner's scheduling system for refer- rals, follow-up, diagnostics or other services. Measuring the im- mediate downstream economic value (in the form of contribution margin) of a typical virtual primary healthcare patient ranged from $14 to $26, depending on the setting. 5 6 Learning 3: Increased clinician productivity Asynchronous virtual primary healthcare delivery models are highly clinician efficient. Zipnosis' experience has demonstrated a 10 to 20 times increase in clinical capacity for primary health- care visits. This 10- to 20-fold efficiency gain is created by using an adaptive interview to create a full history, description of the symptoms, document 90 percent of the medical record, and using complex evidenced-based algorithms, recommend best practice treatment choices to the clinician. For each visit, the clinician is presented with a series of easy-to-select choices based on the latest evidenced-based treatment guidelines. Because the clini- cians are used only for making clinical choices, not administrative tasks like documentation or calling in a prescription, a clinician requires only an average of 2.5 minutes per patient encounter. In addition to this dramatic efficiency increase, the asynchronous nature means these 2.5 minute clinician time blocks can be fit into any existing open time that clinicians have during the day. Unlike synchronous visit models that demand dedicated staffing and high start-up costs, Zipnosis has demonstrated asynchronous virtual primary healthcare start-up and scaling costs are minimal. One of their health system partners was able to diagnose and treat over 8,000 patients without hiring a single FTE. Instead, they used marginal clinical capacity in existing employed primary care clinics and urgent care. Moreover, a virtual primary healthcare model can be integrated into a health system's market in less than 90 days. Contrast this with a health system's option of a two-year, $2 million- plus development plan for extending an EMR 7 or building a similar solution from scratch without a proven record demonstrates how far ahead the leaders in virtual care are today. Learning 4: Improved quality and satisfaction Algorithms used in Zipnosis' diagnostic and treatment process are based only on nationally accepted, evidenced-based protocols. While each diagnosis and treatment plan is individually reviewed and receives sign-off by a clinician, the software system is de- signed to restrict clinician choices to only those that are clinically appropriate per guidelines and the latest evidence. Moving off protocol must then become a conscious choice rather than an unconscious error. As a result, the Zipnosis adherence to clinical guidelines is 93 percent for the most common conditions, which is two times the adherence of a typical primary care practice set- ting. 8 Moreover, adherence reporting is integrated into every treatment, making it possible to take immediate corrective action rather than wait for a manual chart review that may occur only annually. In an environment of population health and increased quality trans- parency, encouraging patients to use models that adhere more closely to evidenced-based diagnostic and treatment plans is valuable. Additionally, patient satisfaction is far higher than other models. Virtual primary healthcare is experiencing tremendous growth be- cause it fundamentally meets a need in the market for quick, easy and immediately convenient access to primary care. For Zipnosis this has translated into a 95 percent satisfaction rating. More tell- ingly, 91 percent of patients surveyed recommended Zipnosis to three or more friends. In the age of social media, this level of word-of-mouth advertising is unbeatable. Learning 5: Increased scope of care One of the biggest hurdles for asynchronous virtual primary healthcare models has been the scope of care covered. The ini- tial scope of care included the most common health problems like sinus and bladder infections, but these still only represented a small fraction of the total primary healthcare delivered through other channels. However, as more and more objective clinical data flows through mobile phones, remote sensors and wearable computing, Zipnosis and other computer-assisted service models are integrating that data into their digital backbone and increasing the care capabilities. Zipnosis scope of care has steadily grown. From 2010-2012, Zip- nosis treated nine simple conditions for patients over 13 years old. In 2013 it added 40 more conditions — including the ability