#JPM19 - The Race to Innovate In Primary Care

For our inaugural Tech & Health Luncheon at #JPM19, we invited a panel of digital health industry leaders and entrepreneurs reshaping the world of primary care–traditionally the realm of independent or hospital-owned doctor practices. They included Sharon Vitti, senior vice president and executive director at CVS Health/Minute Clinic, Jenni Vargas, chief strategy officer of One Medical, Tony Boselli, president of Caredox and Iyah Romm, CEO of Cityblock.

Although AI, blockchain and precision medicine hogged the spotlight in 2018, we noticed an uptick in the attention primary care is getting among influencers, both online and at physical events like JP Morgan. Driving this interest are media reports that tech giants Amazon and Apple plan to run their own on-site clinics in a bid to lower healthcare costs.

Lisa Suennen, who just started a new position at Manatt, Phelps & Phillips leading the Digital & Technology Group, moderated the panel. Her first question “What is primary care?” generated different interpretations from the panelists.

“There are different primary care offerings for different populations to meet different needs, and I think that’s where we’re going in primary care,” said CVS Health’s Vitti who oversees more than 1,100 Minute Clinics located at CVS pharmacies and Target stores.

“It depends on the context,” added Romm. “We talk to our members; whatever matters to them, matters to us. There’s a set of services underneath primary care that are preventative health on some level–urgent care, diagnostics, behavioral health services.” Cityblock provides personalized care for its members by also taking into account their living conditions and social milieu.

Vargas, who spent 20 years working at payer organizations when primary care providers were the gatekeepers who decided when and if a patient should see a specialist, believes healthcare is moving away from this model. One Medical, which offers concierge medicine, wants to be “the trusted healthcare advisor for your family.”

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CareDox’s goal is to transform healthcare for kids, particularly the underserved Medicaid population, by bringing care into the nation’s K-12 school districts. “We want to be that quarterback,” says Boselli, who played offensive tackle for the Jacksonville Jaguars. “We want to be the hub where we can make sure they’re getting proper care; we want to be that front door and partner with schools.”

Those answers should worry hospitals that could face a reduction in revenue as a result, but instead the panelists see their services as complementary. “We should be a hospital’s best friend,” said Boselli. With the shift from fee-for-service to value-based care, he believes that partnering with CareDox will “drive better outcomes.”

Vargas was emphatic that One Medical was “committed to only providing typically primary care services,” and not specialty medicine, where the big bucks are. Plus, One Medical doctors can prevent unnecessary trips to the emergency room. “We’re not trying to do anything harmful.”

Vitti, a former hospital executive, acknowledged that primary care is “not the business hospitals should be in and they know it. Clinical partnerships with health systems is the right way to go.” Minute Clinic tries to link patients with their main physician to make sure there’s continuity of care, and makes more than 2.5 million referrals a year to primary care providers since 35 percent of its patients don’t have one. That can be done by sharing data through Epic electronic health records and even faxes.

Suennen wanted to know how the panelists can provide comprehensive healthcare to make sure patients are getting all the treatments they need. Technology plays a big role. “Can you build a tool that aggregates the full set of insights for our members? Can you build tools that allow you to extract raw data from a variety of different points?” asked Romm. Yes; Cityblock can draw its data from health information exchanges, Epic and other sources to aggregate information.
Vargas said they provide patient information to their hospital partners through Epic. “We work very hard on interoperability.”

CareDox has also integrated with Epic, but Boselli said that although the company can collect and aggregate information, it needs to focus on ways to reach the Medicaid population to make sure it has access to care. “Why shouldn’t every parent have a record of their kids’ immunizations, and why shouldn’t every parent have access to telehealth?”

All panelists traced “breakdowns” or patients falling through the cracks to lack of access to care, or lack of follow-up and care coordination. “Fully-integrated models shouldn’t have this problem, but they do because one of the challenges is not so much disaggregation than a lack of commitment coming from primary care,” said Vargas. “Primary care is just the low man on the totem pole. We’ve all grown out of this need to make it better.”

For an industry that Suennen alluded is probably akin to cable companies in customer satisfaction, how can the panelists succeed in building a consumer brand? It could be as simple as giving patients what they want, when they want it, said Vargas, who pointed out that half of their business comes from companies, because employees ask for One Medical.

“Just do the right thing,” said Vitti. No appointments are necessary at Minute Clinics, which are open seven days a week and in the evenings. Many patients drop in after hours for services that are relatively affordable.

Panelists believed they’re able to attract clinicians because they can practice in an environment that allows them to focus on the patient. Despite the messiness of working for a startup, “they’re able to have a real conversation with a member and do the right thing,” said Romm. “They don’t have to think about how quickly they bill.” “It’s like Cheers, but it’s medical,” added Vargas. “Clinical service is all that matters.

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Payers such as Humana and UnitedHealth are buying clinics, and Amazon and Apple are getting deeper into healthcare, but panelists were not too worried about the potential threat to their business. Building trust and relationships with their customers are the best defense.  

“We’re partnering with schools; our advantage is we’re leveraging the trust that parents have with the schools,” said Boselli.

All plan to add more services. Minute Clinic wants to “integrate” with providers to offer specialty care and behavioral health.

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One Medical would like to widen its services to include perhaps dentistry. “We’ll innovate in that broader category of things that are important to people, not to insurance companies.”

CareDox expects to have partnerships with 25 percent of public schools in three years, and ultimately would like to reach the entire family. “You can train them how to access care and that’s where you can see change--as soon as you allow people to own their healthcare,” said Boselli.

To hear more from our panel discussion, please see the video below:

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By Rob CroninComment