Peter Antall, MD, chief medical officer for Amwell, talks about Virtual Primary Care (VPC) and why health plans and employers should be thinking about it.
Question: There are many definitions of and approaches to Virtual Primary Care (VPC). What is VPC from your perspective?
Peter Antall: VPC is part of the evolution of home-based telehealth. Its emergence stems from the recognition that traditional primary care does not exist for many people across the country. In fact, research shows that 25% of Americans don’t have a primary care provider (PCP). Access to care remains a major issue for many patients, due to geographical constraints and a growing shortage of PCPs, which has only been exacerbated by the pandemic. Further, even when PCPs are available many patients do not utilize traditional primary care for their healthcare needs.
As a starting point, VPC is a reinvention of primary care aimed at eliminating these barriers to allow patients to better utilize preventive or primary care. In our vision, VPC takes the best of what traditional primary care has to offer, adds disease management techniques and data integration, and then presents the patient with a user-friendly experience and journey. Inclusive of this program is ease of access, appointment-based continuity with the same provider, labs, testing and referrals that are in network, care coordination, and asynchronous secure messaging. We also offer 24/7 same day (urgent care) visits.
Q: Can you talk about how Amwell is addressing VPC and its offerings in this area?
PA: Right now, in the market, there is a wide spectrum of what’s considered VPC, from simple screenings/wellness visits all the way up to very complex multimorbid patient care that is heavy on care and disease management. At Amwell, we believe the greatest value for VPC falls in being able to care for most, if not all, of these patients, but our primarily focus is on the middle of this spectrum, where most patients are, and where we believe the most value can be delivered. We see VPC as an example of an emerging hybrid care model that will redefine healthcare delivery in the years to come.
We recognize that different clients have different priorities. We have therefore created a core program that can flex to the different needs and capabilities of clients, and of patient populations as required. Examples of this include integrations with health plan databases to enable in-network referrals and care coordination as well as to help address patient gaps in care. More broadly, we see an opportunity to integrate deeply with health plans and/or employer specific programs (like diabetes prevention, smoking cessation or weight management) in order to offer a seamless and wholistic care experience. We are also focused on ensuring an optimal patient experience, inclusive of easy navigation and reminders to improve compliance, and to encourage appropriate proactive utilization.
Ultimately, VPC can be a critical touchstone for patients across the healthcare continuum, from those who may need a yearly physical exam but seem otherwise healthy to those who may require a supplement to in-person care for disease management.
Q: What are the benefits for health plans and employers, and why should they be thinking about implementing a VPC solution?
PA: Health plans and employers should be thinking about the triple aim - improving the care experience, improving the health of populations, and reducing the cost of health care. VPC can help tick all of these boxes. Our VPC program provides a seamless and easy to use patient experience, including for those who are not already participating in preventive or proactive healthcare. It can improve access and is built to improve patient compliance and outcomes.
For patients/members/employees, VPC presents a convenient option which provides quality care for a range of health needs including continuous and preventive care, as well as a starting point from which to navigate the healthcare system. Health plans and employers will benefit from being able to give their members more choices while helping them find the best, most affordable care, ultimately creating a better care experience and helping to close gaps in care.
From a cost perspective, VPC can help drive patients towards in-network care, in network labs, and on-formulary medications, all of which are associated with cost savings and improved coordination for health plans and employers. VPC can also help patients avoid costly urgent care and ER visits and can help mitigate the negative effects of the fragmentation of care associated with that model. Ultimately, with integrations, hybrid models, data use and collaboration, we believe that VPC will lead to improved outcomes and help drive cost of care savings.
Q: Are there any downsides to VPC?
PA: VPC is not for everyone nor is it appropriate for all care interactions. Some patients will still prefer the in-office healthcare experience. Some patients already have a solid PCP relationship and a good medical home. Occasionally a patient using VPC will need in-person evaluation, a procedure or an escalation, however this is less common than one might think as there is so much that can be done virtually today. To date, patient satisfaction in our VPC program has been high, feedback is favorable and repeat visits and engagement are commonplace. Amwell has a track record of creating best-in-class patient experiences and our VPC solution is no different.
Q: As you mention, some people may have concerns over the quality of seeing a primary care provider virtually vs. in person. How are you ensuring the highest level of quality?
PA: This is a valid concern, however at Amwell, our North Star has always been providing evidence-based, high quality care. While care models differ a bit between brick-and-mortar visits and telehealth visits, we have policies and guidelines that help the providers adhere to evidence-based safe standards and know when to refer the patients to other care settings as needed.
Amwell works with the Amwell Medical Group (AMG) to provide clinical services on a national basis. A curated group of these providers are specially trained and provisioned for VPC. All of the AMG providers are U.S. based, board certified, credentialed to NCQA standards, and have an average of 10 to 15 years of experience in a relevant specialty. All providers are trained and certified to practice on an Amwell platform, and all are subject to a full quality oversight process.
Q: How does VPC fit into the healthcare experience of the future? If this is where the industry is going, what’s next?
PA: VPC is the next phase in the evolution of home-based healthcare. This phase is an acknowledgment of the success of existing telehealth programs and represents stakeholders asking for more expanded programs. This phase will be defined as the period in which telehealth addresses chronic disease and continuity-based care.
I believe we’ve only just begun to scratch the surface of what’s possible with VPC and how it contributes to the continued transformation of healthcare. I predict that in the future we will see coordination of care, both between teams of telehealth practitioners, and between telehealth practitioners and those in brick-and-mortar facilities. We will see increased use of data and better data handling, so that providers and patients are presented with actionable data and alerts, in real time. I also predict that VPC will empower increased integration of devices across the care continuum.
The realization of what can be done via telehealth has exploded over the past year and I don’t expect that to slow down in the future. We will likely see home-based testing, home pharmacy delivery and more wearables come into play. Telehealth providers will add asynchronous technologies and nudges, chatbots, and other modes of communication will help providers meet patients where they are when they need care or support. The possibilities are truly endless.