The Place of the Home in the Center of Primary Care

Healthcare today requires innovative, high-quality solutions. Spiraling costs and systemic inefficiencies have stretched doctors and patients past the breaking point. While a UN and WHO Sustainable Development Goal calls for universal, affordable, accessible health coverage for all, over 400 million people worldwide lack access to the most basic, essential health services.

Four in ten US adults have delayed or gone without medical care in the past year due to cost, disproportionately impacting minorities, women, and lower-income individuals. Addressing the challenges requires giant leaps of progress, rather than incremental steps. 

Solutions that are intended to alleviate the issues that face primary care, including cost, efficiency, staff shortages, access to care, and competition are struggling to make an impact. Telehealth’s potential remains largely unfulfilled and unable to deliver on its promise with current telehealth solutions failing to address the clinical needs of healthcare delivery - the ability to diagnose remotely and build trust with clinicians. Underserved populations remain less likely to access traditional telehealth, further widening the care gap. Other solutions, such as home visits from clinicians, are impractical - with the shortage of clinicians and particularly nurses currently faced by the US, home visit solutions will not be able to scale to meet the needs of families across the country, particularly in rural areas with long travel distances.

The epicenter of our daily lives is disconnected from healthcare

The above factors combined lead to what we call the Home Health Delivery Gap, in which the epicenter of daily life remains disconnected from healthcare. 

The Home Health Delivery Gap impacts everyone, from patients to providers to health plans:

• Families experience poor access to primary care, which leads to greater care gaps, worsening chronic issues, and reliance on costly, inefficient solutions such as the ED. 
• Health plans face a higher total cost of care (TCC) due to the overuse of EDs, laboratory tests, and prescriptions. They see the poor quality of care and poorer health outcomes for members. They also experience lower member satisfaction rates, leading to disenrollment and lower acquisition. 
• Value-based health systems experience higher TCC. Their staff shortage issues are not alleviated. They face lower revenues, lower acquisition, and poorer retention rates. 
• Fee-for-service health systems face lower revenues, lower acquisition, and lower retention, as primary care continues to be neglected and underfunded.

A fundamental shift in primary care delivery

These are big challenges, and the healthcare industry must take equally considerable steps to address them. During COVID, we saw healthcare systems and insurers willing to move fast and collaborate to address the pandemic. By continuing that momentum and collaboration, the healthcare industry can address the Home Healthcare Delivery Gap and ensure that families have access to quality primary care, no matter where they are. 

In his book Care After COVID: What the Pandemic Revealed Is Broken in Healthcare and How to Reinvent It, Shantanu Nundy emphasizes three shifts that must take place to reinvent healthcare. It must be distributed, meaning that care will shift from where doctors are to where patients are; digitally enabled, as it is reinforced by data and technology; and decentralized, as care decisions shift from governments and insurers to communities, families, and patients. 

This is a recipe for primary care from home - or a Home Smart Clinic, as we call it. 

Home - offering access to care at the center of people’s lives. 

Smart - because once technology is involved, healthcare can often be smarter than face-to-face visits.

Clinic - bringing the clinic to where people are, instead of making them travel to access care.

Key changes to ensure transformation

Chris Jennings, policy consultant and former healthcare advisor to the Obama and Clinton administrations, said about care during COVID-19: “People are now seeing this model, which we thought would take years and years to develop. And it’s probably been accelerated by a decade.” Gartner’s September 2022 report ‘The gathering storm in US healthcare: How leaders can respond and thrive,’ discusses how care delivery is shifting to be more personalized and supported by technology. It also mentions how increased reliance on technology can support the shift towards value-based care: “Moreover, $250 billion of US healthcare spending could potentially shift to virtual or virtually-enabled care, which may support two primary objectives of value-based care: lowering cost of care and improving outcomes.”

As this shift continues, key changes are needed to ensure the transformation to primary care at home is successful. We need technology that supports families and clinicians, and behavioral change from all stakeholders. 

Technology that empowers families at home

Many of us have seen the same clinician for the last 20 years, and our default is sitting opposite them in their office, asking questions and getting face-to-face answers. A phone call, or even a video call, will never replicate or replace that experience. 

We need to leverage technology to build trust and accuracy in remote care. For families to use their home as their first point of care for seeing a clinician, they need an easy-to-use solution that they can trust, and that actually provides them with data-based diagnoses. They must be able to speak with their own clinician remotely - not a doctor in the cloud. Their clinician must be able to examine them remotely so they can make a diagnosis and issue a prescription. 

The technology must also support clinicians. The Association of American Medical Colleges estimates the U.S. could see a shortage of 54,100 to 139,000 physicians by 2033. The right technology should save clinicians time, freeing them up to treat more patients. AI, paired with remote diagnostics, can asynchronously flag symptoms or conditions as they worsen, so clinicians don’t have to spend time on an exam once they connect with the patient. Monitoring chronic conditions, such as asthma, can be made much more effortless. 

Getting families to actually use remote care

In April 2020, telehealth usage experienced a huge surge, with uptake 78 times higher than it had been just two months prior and accounting for nearly one in three office and outpatient consultations. Remote primary care utilization has since dropped as patients revert to their default behavior of in-clinic care. Patients are still used to going out to receive medical care, whether at their primary care physician if they have one or to the ER for emergency care. 

Population engagement is central to virtual healthcare’s success. Improving the utilization of virtual care demands lasting behavioral change by all stakeholders that builds trust across the spectrum. 

• Patients must be ready to change their healthcare consumption habits, adjusting default behaviors they’ve done for years such as going to an ED or urgent care clinic, under adverse circumstances (when they aren’t feeling well). 
• Health plans need to apply different marketing strategies to build and promote nontraditional plans.
• Providers must adopt new healthcare delivery approaches and methodologies. 

Ensuring this shift requires behavioral science-based approaches, built into every step of the virtual primary care journey. Engagement blueprints that are tailored to the relevant population and use case must be put in place to encourage families to use the home as their first stop for primary care. Comprehensive training, support, and messaging must be given to clinicians to help them understand the benefits of primary care from home and to enable them to encourage their patients to use it. Health plans must continue to support remote primary care and market it to their members as the best option to start their care journey. 

In the new age of primary care, remote care can make the home the place for efficient, convenient, high-quality care, with no compromises.