The changing face of primary care

By Caroline Watson | September 13, 2022


When an undergraduate student at the University of Wisconsin thought he broke his hand last year, he didn’t visit the nearby hospital. Instead, his family reached out to Pivotal Health, a Wisconsin-based company offering clinician house calls for urgent and primary care, to schedule a same-day appointment at his apartment. The clinician from Pivotal Health arrived with a mobile X-ray machine and confirmed the patient’s hand was broken, but the visit didn’t end there.

“Because of how we operate, our provider was able to spend more time with the patient and figure out that he was going through a bunch of mental health-related things that triggered his anger to punch the wall,” said CEO Sal Braico. “Normally, providers don’t have a lot of time to tease that out and figure out what the real issue is.”

With their technology-enabled home health model that integrates mental health triage, Pivotal Health is among a growing number of providers reimagining primary care. From remote patient monitoring to ultra-convenient modalities, providers around the country are adopting innovative models to address traditional challenges head-on.

Remote, yet more connected than ever

Chip Fillingane, M.D., and his team at Continuum Family Care in Missouri are demonstrating another way that primary care can expand beyond the walls of the clinic, with a remote patient monitoring (RPM) program for chronic care management. “We know that patients’ vitals in the office are generally not accurate,” Fillingane explained. “It’s been really impressive how many times we’ve had to change patients’ medicine based on what we saw when they’re home.”

Through integration with Accuhealth, an athenahealth Marketplace partner, RPM is enabling more proactive care: weight monitoring for heart failure patients, adjusting medications between visits, and fall prevention and management, to name a few. Fillingane says his team even noticed a patient having a heart attack and helped him get to the hospital. “Now we can see any issues way before a patient’s next visit and react to it in real-time. Patients feel like it’s an element of care.”

Reflecting on how remote monitoring enables him to take better care of patients, Fillingane says he believes this is the way medicine should be. “People don’t want to have to constantly think about their healthcare, and there’s no reason that scales can’t talk through the internet to notify us that we need to check on a patient,” said Fillingane. “Our doorbells tell us when somebody is at our front door now. So why can't our scales and blood pressure cuffs tell our doctors that something's not going OK?”

An Amazon-like consumer experience

The Good Clinic, an operator of primary care clinics that combine technology with relationship-driven, personalized healthcare services, is focused on consumer preference and convenience. “As an industry, we’ve been talking about the patient as a consumer for a few years now, but recognizing it is different than actually acting that way,” said Bradley Case, president at The Good Clinic.

Responding to consumer preference to visit a clinic in a convenient location, The Good Clinic’s locations are conveniently positioned in densely populated areas. All appointments are same-day or next-day availability, “so we have the ability to see people for the small stuff that comes up,” said Case. And his model takes a more integrated, relationship-driven approach, comprehensively incorporating everything from behavioral health to wellness planning, according to what patients need.

Similarly, Pivotal Health was also founded on the idea of being consumer-friendly, yet with a different approach. Braico says the idea of house calls partly came out of the desire to save patients commuting time, as appointments take place where and when the patient chooses. In their quest to be as consumer-friendly as possible, Braico and his team take inspiration from giants like Amazon. “When I look at what we’re trying to do, I don’t look at other healthcare companies,” said Braico. “The consumer experience that we’re trying to copy is how easy it is to order something from Amazon.”

Technology opens doors

One challenge that’s seemingly on everyone’s mind? Clinicians want to spend more time with patients, building the relationships that ultimately lead to better health outcomes. But existing models have made that nearly impossible — 68% of physicians feel rushed on a weekly basis and like they don’t have enough time to spend with patients. The Good Clinic is trying to change that with appointments that last at least 30 minutes — nearly double the nationwide average of 18 minutes per primary care visit.

Allowing clinicians to form relationships with patients is also central to Pivotal Health’s model, Braico said. Clinicians see fewer patients with longer appointments, and technology tools are also key. “We selected athena because it had the most robust API set out of anything we looked at,” said Braico. “We’re leveraging tech to automate everything around the visit to maintain that patient-clinician time.”

Continuum Family Care takes a similar approach, automating or outsourcing tasks that aren’t clinical. They rely on athenahealth’s revenue cycle management solutions, Marketplace partners, and medical device integration with athenaOne to take work off their plate. Fillingane says the setup allows the clinical team to spend more time with patients, and as a result, it’s the “most fun” he’s ever had in practice.

“There’s a moral injury to not being able to do the best you can do, but sometimes that’s limited by your time,” Fillingane explained. “We get so much done in a visit now, and the ability to buy that time back through technology gives me the ability to provide a higher level of care.”

Pivotal Health and Continuum Family Care both participate in athenahealth’s Client Advocacy Program. To learn more about the program, please visit Pivotal Health and Continuum Family Care were not compensated for participating in this content.

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