The Future of Primary Care Lessons Learned from COVID-19
Disclosure Dr. Fields has disclosed that neither he nor members of his immediate family have any actual or potential conflict of interest. All information in this deck is confidential – property of VillageMD Page 2
The Future of Primary Care 1. Where We Were Primary care is that care provided by physicians specifically trained for and 2. What Happened skilled in comprehensive first contact 3. Where are We Now and continuing care for persons with any undiagnosed sign, symptom, or health concern (the "undifferentiated" patient) not limited by problem origin (biological, behavioral, or social), organ system, or diagnosis. | All information in this deck is confidential – property of VillageMD 3
Primary Care: Aspiration and Reality Primary Care: Aspiration and Reality Comprehensiveness is limited by healthcare design: Carve out behavioral health Continuity is restricted by Coordination is not uniformly lack of interoperability and respected Data siloes Specialty referrals result in a communication to the referring physician less than 40% of the time | All information in this deck is confidential – property of VillageMD 4
Where We Were The Move to Value • Economic model aligns with Outside of employers’ choices, enhanced communication and structural barriers still remain coordination • Delay in payment • Pace of change remains slow • Lack of data transparency with employers still buying on • Focus on sickness not health unit price and not the total • Specialty and procedural cost care oriented | All information in this deck is confidential – property of VillageMD 5
The Value of Primary Care Primary Care remains the foundation of our system • 500 million PCPC visits a year, more than 50% of all physician visits annually • Only 30% of the healthcare workforce • 7% of the healthcare dollar Family Physicians are uniquely positioned to deliver comprehensive care to patients and communities. The ability to care foe all age groups across health conditions in multiple settings is unmatched. “We are asked to cover for everyone in the clinic, but no one seems capable of covering for us. Maybe that should tell us something” Margot Savoy, MD, MPH | All information in this deck is confidential – property of VillageMD 6
| All information in this deck is confidential – property of VillageMD 8
The Agility of Primary Care COVID showed the “plasticity” of Primary Care, maximizing its capabilities in response to patient and community needs Not unique to COVID • Responses to natural disasters • Meeting the needs of the underserved and rural populations • Responding to a public health crisis | All information in this deck is confidential – property of VillageMD 9
Primary Care Goals 1. Protection of the vulnerable High Risk Patient 2. Treatment and support of the affected Engagement 3. Continuity of healthcare for the entire patient panel Development 4. Protection of primary care providers and staff of a COVID frailty Index 5. Recognition that specialty and mental health care would be moved to the primary care provider Increased need for Specialty and Behavioral Care | All information in this deck is confidential – property of VillageMD 10
Delivering On the Promise of Primary Care Our clinical values, coordinated/continuous/comprehensive, would now be applied to our clinical operation • Colleagues • Covid and non‐Covid • Clinical protocols presentations • Team‐based • Technology implementation • 24/7 THV • Top‐down • Proactive • Consistent Care Management • Staff and provider safety | All information in this deck is confidential – property of VillageMD 11
Decrease in In‐Person Visits Pivot to telehealth will, in retrospect, be seen as one of the most dramatic accelerations of technology in healthcare history Acceleration in use Cases 1. Urgent care 2. Chronic illness 3. Prevention 4. Education 5. Care management 6. RPM | All information in this deck is confidential – property of VillageMD 12
Telehealth: CMS Led the Way! Regulatory Relief The pivot to Telehealth was done without a clear understanding of the cost or compensation associated with the service. CMS was Quick to Lead The Future of Telehealth 1. Telehealth coverage expansion • Not going away 2. AWV inclusion • Commercial plans slower to respond a. Waiver on VSS • Lack of transparency in future 3. Inclusion of THV diagnosis for risk acuity • A current infrastructure mismatched to the delivery platform | All information in this deck is confidential – property of VillageMD 13
Regulatory Relief Timeline March 14 March 18 ‐ 30 • PHE Declaration by Secretary Azar • DEA – COVID‐19 Information Page: Telemedicine • • Telehealth Benefits in Medicare are CMS – General and ESRD Provider Telehealth and Telemedicine Tool Kit • FAQs on Availability and Usage of Telehealth Services through Private Health Insurance a Lifeline for Patients During Coverage in Response to Coronavirus Disease 2019 (COVID‐19) Coronavirus Outbreak • Long‐Term Care Nursing Homes Telehealth and Telemedicine Tool Kit • Notification of Enforcement Discretion for Telehealth Remote Communications During the COVID‐19 Nationwide Public Health Emergency • Chairman PAI Announces Plan for $200 Million COVID‐19 Telehealth Program April 3 – 30 March 17 • Rural Health Care and Medicaid Telehealth Flexibilities, and Guidance Regarding Section 1009 of • Medicare Telehealth FAQs the SUPPORT Act, Medicaid Substance Use Disorder Treatment via Telehealth • Medicare Telemedicine Health Care Provider Fact • Guidance on the COVID‐19 Telehealth Program Application Process Sheet • FCC's COVID‐19 Telehealth Program Application Portal Opens on Monday • President Trump Expands Telehealth Benefits for • Guidance on the COVID‐19 Telehealth Program Application Process Medicare Beneficiaries During COVID‐19 Outbreak • FCC Grants Limited, Conditional Waiver to Support Wireless Medical Telemetry Services • HHS OIG Policy Statement on Practitioners That • FCC Approves Fourth Set of COVID‐19 Telehealth Program Applications Reduce, Waive Amounts Owed by Beneficiaries for • FCC Approves Third Set of COVID‐19 Telehealth Program Applications Telehealth Services During the COVID‐19 Outbreak • Trump Administration releases COVID‐19 Telehealth Toolkit to Accelerate State Use of Telehealth • Policy Statement Regarding Physicians and Other in Medicaid and CHIP Practitioners that Reduce or Waive Amounts Owed • HHS launches telehealth homepage by Federal Health Care Program Beneficiaries for • FCC Approves Second Set of COVID‐19 Telehealth Program Applications Telehealth Services During the 2019 Novel • Enforcement Discretion for Telehealth Remote Communications During the COVID‐19 Nationwide Coronavirus (COVID‐19) Outbreak Public Health Emergency • FCC Approves First Set of COVID‐19 Telehealth Program Applications • COVID‐19 Telehealth Program | All information in this deck is confidential – property of VillageMD 14 • FCC's COVID‐19 Telehealth Program Application Portal Opens on Monday
COVID Highlighted the Care Model of the Future Patient-Centered Primary Care-Driven Risk-Stratified Proactive Team-based Technology-enabled | All information in this deck is confidential – property of VillageMD 15
VillageMD Care Model Resources, education and Foundational structure Modalities for care delivery Increased touchpoints technology to ensure for team‐based care that extend far beyond the to deliver more Measurement of success “Villageway” standard of care four walls of a clinic personal care • Physician • In‐clinic • Evidence based clinical • Increased touchpoints • Performance scorecard • App • Virtual visits (audio and guidelines • Regular monitoring and • Care Manager for high risk patients by video) • Disease‐specific • Social worker leveraging our providers evaluation • Remote Patient methodologies • Culture of learning and • Pharmacist and platform Monitoring • Operational excellence • Frequency determined • Data analyst continued improvement • At‐Home resources by risk stratification • Provider training • EMR optimization • docOS | All information in this deck is confidential – property of VillageMD 16
VillageMD Care Model: Providers Nurse Care Managers Primary Care Physicians (MD, APP, PA) • Care Coordination • Patient Education and • Diagnosis Counseling • Disease Management • Caregiver Support • Utilization Management • Patient Education Pharmacists Social workers • Medication Optimization • Identify and address • Medication Review/ barriers Reconciliation • Behavioral health • Medication Adherence support Social determinants of health Counseling • | All information in this deck is confidential – property of VillageMD 17
VillageMD Care Model: Platforms REMOTE PATIENT AT HOME IN CLINIC VIRTUAL CARE MONITORING | All information in this deck is confidential – property of VillageMD 18
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