Advancing High-Value Primary Care at PRIMARYCARE23

I recently joined a group of primary care leaders to learn, network, and moderate a panel at PRIMARYCARE23, Primary Care For America’s (PCfA) annual conference. Primary care remains the key to solving America’s fractured, underperforming healthcare system. For me, this event put a spotlight on the many ways the industry is working to reinvent primary care delivery models, payment models, technology, and workforce. Whether in community-based independent practices, corporate models, networks, health centers, or integrated delivery systems, it’s clear that momentum is building behind innovation and investment in primary care.  

If you’re not already familiar, PCfA is working to create change by highlighting the value of primary care through thought leaders and policymakers, with the goal of re-establishing and elevating primary care as a foundation for individual and community health and reinforcing continuous patient-primary care relationships to improve health outcomes and reduce costs. 

Events like PRIMARYCARE23 help us explore the evolution of primary care – both the challenges and the opportunities – including the role of digital innovation. 

Digital innovation is a rich topic ripe with opportunity, so I was thrilled to moderate an expert panel discussion on modern technology and what it can—and should—do to support primary care of the future. Here are a few important takeaways from our panel discussion, featuring the voices of Adam Gail, Stellar Health, Subha Airan-Javia, MD, FAMIA, CareAlign, and Edwin Miller, MBA, Google Health.

I invite you to watch the full discussion as well, which can be accessed here. The full discussion starts at the 2:45 mark and lasts about 45 minutes. 

Relevant data is a struggle in primary care and across the healthcare ecosystem, and each of our experts has a unique approach to tackling it.

• Dr. Airan-Javia: “Too often our systems, our processes, our technology, make it hard to do the right thing and so, because of that, we find necessary workarounds…it’s really about what I like to call an information supply chain problem where in medicine it’s really hard to have the right information to the right person at the right time in the right format so that we can make decisions for patients. Our goal is to help make it easier for us to find what we need and work better together around patients.”

• Miller: “The thing we’re working on now is solving some of the sense-making problems where there's so much data, but very little insight. A lot of noise and not much information…and of course the advent of AI and large language models and how that can be applied to healthcare.”

• Gail: “I think primary care is the future…I just feel it's completely underserved from a technology perspective…we’re really trying to help these clinicians and their offices honestly succeed in their evolution to value-based care. It’s very challenging. The contracts are confusing, the incentives are sometimes misaligned, the rewards are way out in the future and sometimes extremely nebulous…so making sure that they are empowered to succeed…that’s where we spend a lot of our time - getting them the right information through technology at the point of care.”

Legacy technology is too encounter-focused; modern technology should support collaborative care across continuums while automating administrative burden to reduce burnout.

• Gail: “At Stellar we have about 7,000 PCPs that are using our tools, so I get to spend a lot of time in their offices. Spending a whole day in there, it’s incredible what you see. The stress, the precision that’s necessary, and the collaboration between everybody. And as more and more is asked of the PCP, there is more and more collaboration between everybody in the office and responsibility that goes to the staff…So where we spend a lot of time with our technology is building something that allows all the people in the office to do the right things for the patient in a timely way to make sure that we are raising the right actions at the right time.”

• Dr. Airan-Javia: “All of our processes and all of our technologies are designed around an encounter-based system…where we act like we have these intermittent static episodic interactions with patients and forget about the in-betweens. Whereas in value-based care, it's really about how do we as a team work together to take care of a patient across an entire continuum…we really don't have the right tools to make that easy to do… what we need to do is leverage technology…specifically designed for these new and emerging workflows…documentation that is iterative…collaborative…structured around ‘what is the work I’ve already done’ without having to write things 2, 3, 4 times.” 

• Miller: “One of the key causes of burnout is actually the moral injury caused by the system…we live in a system that will spend any amount of money to manage the stroke but no money to treat hypertension. We are trying to be more at the top of the waterfall catching patients before they fall down into the bottom of the waterfall where the whole healthcare industry lives and makes money…on the tech side, (the result is that) a lot of the additional data capturing…for quality measures…were envisioned to actually be automated, but they haven't been.”

Primary care technology must serve better payment, compensation, and workforce models focused on value.

• Gail: Innovation “starts with ‘here’s a problem we need to solve, so let’s solve this problem and let’s do it in a way that we can drive better patient outcomes’ - that’s the premise of bringing the solution to market. Next is ‘how do we get it paid for?’...You put that whole package together and then it’s ‘how do we get the doctors to use it?’ And half of the innovation is asking that question…well you should have started there. That’s what excites me about what we’ve been doing at Stellar…You should start with the person that spends the most time with that technology, and they should get the most benefit from it.”

• Miller: “I think we gotta blow up the (legacy) EHRs…You have to be LHR first, meaning longitudinal health record, which means being very greedy about getting data from all the other places, and that’s happening. The first step in EHRs was replacing paper charts…Now we start to have national networks, HIEs, things like that where we can pull data and share data better. But it is still hard to make sense of that data. So there’s an LHR which is ‘bring the data in.’ And then there’s a normalization, sense-making layer that has to happen, at scale…once you have that, then you can start to build workflow tools on top of that. So I’ve already described probably 10 start ups, and you probably don’t want it all in one place…it’s more about how the platforms merge, and we’ve just not done that as an industry.”

• Dr. Airan-Javia: “When I think about the HIMSS exhibit floor, where there’s football fields-worth of new things, everyone wants this shiny new object to be this patch to fix this one tiny piece of a problem. You need to be able to go to the root cause of an issue and address the underlying problems or the underlying cause of so many multiple problems.” For example, “there is such an overload of messaging everywhere. I’ve probably heard 10 different people in just the last week say ‘AI’s gonna fix your messaging problem’. How about we change why we have so many messages in the first place? So many of our messages are actually tasks…there’s no concept of a..project management solution in medicine.” CareAlign already works to “have a shared view of, for any given patient, who needs to do what, when, where…it’s not enough for it to be buried in 50 different progress notes.”

The influx of market point solutions add to a fractured, patchwork digital landscape that distracts from patient care.

• Dr. Airan-Javia: “If you take a moment and think about your phone, your phone has like 50 (if not more) different pieces of technology on it, which all work seamlessly together. We all probably use 10 of them every day between our calendar and email and text and WhatsApp and at least five other things. Our experience is that it's seamless and we don't even think of it as having to go into all these different applications because they just work. (Primary care) technology should be able to do that for us…I so often hear ‘how do we get doctors to use it?’...I have news for everybody: doctors love technology, we love gadgets…as long as they work well and they help us take care of patients.”

• Miller: “One of the big jobs of AI is taking unstructured data and turning it into structure with a machine. One of the most powerful uses of this will be summarization and bringing the right information to bear.”

• Gail: “I think it behooves us as an industry to involve the primary care physicians more in the design of some of these tools and more in the decision making on whether they should be implemented by these larger…value-based organizations.”

More work is needed to improve collaboration between the primary care and health technology communities.

• Gail: “The last few organizations I’ve worked for have served primary care. The best innovation that we’ve brought to them was because we had a primary care clinician in the room when we were designing it.”

• Miller: “Creating awareness with the IT community around the role of primary care and its growing influence…they’re not caught up. I think there’s an awareness problem.”

• Dr Airan-Javia: “Ideally having a financial incentive to actually improve primary care and have them drive decisions would help a lot.”

A call to action: If you could ask policymakers and policy influencers to do something, what would you say? 

• Dr. Airan-Javia: “Make it easier for people to try new technology…HIPAA policies really hinder a lot of new technology usage and experimentation.”

• Gail: “I'd ask them to spend a day in a primary care office. It was life-changing for me.” 

• Miller: “I think the policy things are happening, they're just happening too slowly.”

Primary care physicians are the connective tissue holding together the health system of America. They organize health system chaos and neutralize health threats from all angles by prioritizing patient-centered, high-value care over profit-focused priorities. In this context, value-aligned payment models, workforce support and new innovations, including technology, are absolutely critical to our ability to succeed in delivering care that is convenient, accessible, comprehensive, and coordinated to protect the sanctity of the relationship between a patient and their PCP. When given the resources and the support, primary care is poised to make enormous gains in advancing America’s well-being. After two days spent with colleagues and peers, I am reinvigorated by the focus of PCfA and its members to make this a reality.