By: Munir Khatri, SVP, Population Health – Emcara Health
Recent estimates from the Association of American Medical Colleges (AAMC) project a primary care shortage that could approach 50,000 clinicians in just over a decade. If you project adequate support for underserved populations, the U.S. will be short more than 180,000 physicians in this time frame, including primary care and major specialties. In a nutshell, we don’t have enough physicians to support a population that is aging and declining in health.
The primary care physicians we do have today are feeling the weight of this shortage. Research from George Mason University estimates that 1/3 of primary care physicians are experiencing burnout. This study was conducted before COVID-19. It’s safe to say burnout rates have only increased during the pandemic.
Primary care physicians are under immense pressure. In addition to delivering high-quality care to patients, they are faced with numerous regulatory and payer requirements, adoption of new technologies and transitions to new models such as patient-centered medical homes and accountable care organizations.
Specifically when it comes to caring for patients who are medically complex, clinicians are struggling to keep up. A recent study suggests that primary care physicians are unlikely to meet the needs of these patients, not without additional assistance. In this instance, complex patients were defined as having two or more chronic conditions. A lack of time, suboptimal communication channels with specialists, fragmented care and an absence of adequate reimbursement were the most often cited barriers to supporting these patients.
More importantly, the number of complex patients is increasing. Adults over 65 years of age will account for 20 percent of the U.S. population by 2030, and these older adults have more health issues and almost four times the rate of hospitalization than their younger cohorts.
It’s not just complex patients who are reeling from the lack of appropriate primary care support. Rural patients are also at risk. About 14 percent of Americans live in rural communities. These areas represent nearly 75 percent of primary care health professional shortage areas in the country. Rural patients experience higher rates of heart and respiratory disease, cancer, stroke and other illnesses.
How do we better support community-based physicians while extending their impact beyond the four walls of their exam rooms?
Further adoption of telemedicine and other digital health innovations is a good place to start. But technology only goes so far, especially when you are dealing with frail, vulnerable, medically complex and underserved populations. Payers and providers must work together to bring care to the individual. Many of these patients are homebound, living in a facility or experiencing limited mobility. In addition to a long list of medical issues, they are typically grappling with SDOH needs as well.
Asking overburdened physicians to add house calls to their schedule is obviously a non-starter. But progressive health plans are sponsoring the deployment of multi-disciplinary, field-based teams that serve as an extension of provider practices by bringing care into the homes of vulnerable and underserved populations. In this scenario, home is loosely defined as wherever a patient can be effectively engaged. The cost of this effort is easily offset by the value created.
This version of a house is more than a provider visiting a patient’s home. Instead, an entire care team is working together to best understand patient needs from the medical, functional, behavioral and social dimension. The team collaborates with the patient, and the patient’s physician, to support the patient’s goals.
This approach accomplishes several goals that are mutually beneficial for payer and office provider. It eases the strain on current physicians and their office staffs. It reduces unnecessary ER utilization for primary care issues. It increases prevention and health maintenance efforts by patients to limit the number of complications and the rate of disease progression. It extends access to patients who were previously not getting the attention they needed from the system, and as a result helps prevent them from experiencing costly, adverse health events.
Clinicians can practice at the top of their license, reduce burnout and deliver better care to their patient panel. Payers can lower the overall cost of care and improve member satisfaction. Meanwhile, countless individuals and their families experience a higher quality of life. It is win, win for everyone – patient, office provider and the payer.
Given the realities we are facing in primary care, we need innovative new models to ensure that providers, payers and patients all get what they need to thrive. This includes leveraging additional care team resources to physically bring care to the “homes” of vulnerable and underserved patients. Interested in learning more about how your plan or health system can better support community based physicians to bring health to the home? Contact us today for a 1:1 consultation.