Traditional patient care patterns have been radically altered by the COVID-19 pandemic. And after more than a year of disruption, it’s doubtful that everyone will revert to those patterns after the pandemic.
New habits have been formed, and consumers are more willing to pursue the path of least resistance in obtaining care, such as opting for quick and easy telemedicine appointments. Both patients and clinicians have identified benefits from virtual care approaches.
However, this and other easier approaches to care carry the risk of jeopardizing the care coordination required under new care approaches, such as value-based care reimbursement and the patient-centered medical home.
Initiatives such as the medical home put the patients at the forefront of care decisions, with the intent to build better relationships between patients and clinical care teams, with the intent of improving care quality and the patient experience. However, the coordinated team-based approach that supports medical home initiatives can be disrupted by care episodes that occur outside of the team and are not sufficiently included in patient records that form the basis for coordinated care.
Traditional care encounters were set aside quickly last spring, as COVID cases spiked and lockdown orders and restrictions on in-person meetings were quickly put in place. Providers were at the tip of the spear, with care capacity dedicated to patients with serious health issues related to the coronavirus, and out of caution to limit the transmission of the disease between patients, clinicians and other provider staff.
Providers reduced patient loads to limit potential contact between patients and staff. Consumers then shifted to seek care at urgent care centers or via telemedicine. These alternatives sometimes were offered by the health systems, which were able to offer them to their patients via their internal systems, thus ensuring that it could keep track of encounters and retain records to ensure continuity of care.
But not always. During the turmoil caused by COVID, consumers were just as likely to seek their own care options when they faced challenges in seeing their own primary care physicians. For some, urgent care centers became their primary source of care, as they stopped calling their PCPs. Others opted for an array of freestanding telemedicine choices, especially as they understood that payers would cover these virtual services during the pandemic.
The willingness of consumers to choose telemedicine also promoted diversification of services in the space. Specialty telehealth services emerged for treating patients with one condition, and specialists emerged – enabled by technology and consumer demand – to treat issues that had not been handled by telemedicine before, such as dermatological concerns.
The fragmentation and lack of contact resulting from the COVID pandemic could set back efforts to widely implement patient-centered medical homes and thus improve continuity and effectiveness of care. Physician practices are most likely to be negatively impacted – and despite that, they are also the most likely to resist change, even as consumers gravitate to new care options.
The reluctance of physician practices to change is understandable. Many believe that post-pandemic, that things will return to “normal,” and they’ll be able to go back to pre-pandemic practices. However, that doesn’t take into account the growing trend toward patient empowerment, nor does it factor in consumers’ increasing comfortability with new, easier ways of accessing care.
Instead, physician practices can embrace ways in which emerging alternative modes of care can be incorporated and how technology can enable new forms of care to support patient-centered medical home initiatives. Technologies such as telehealth enable practices to become more efficient – for example, easing the concerns of parents of a toddler with a minor laceration, or enabling quick diagnosis of a teenage boy with abdominal pain who could have appendicitis. Virtual technologies can be powerful tools in the hands of clinicians who know patients’ histories and conditions.
The lesson for physician practices is that telehealth services offer a chance to improve the furtherance of the patient-centered medical home. However, adoption won’t happen without change and adaptation.
Technology can enable practices to offer more immediacy in care to patients, such as same-day virtual appointments rather than trying to schedule patients for in-office visits. However, that necessitates changes in internal workflows to manage and create bandwidth to support this shift in services.
Shifts in technology aren’t always greeted warmly by practices. For example, patient portals were initially opposed by physicians who feared that they would result in an uptick in email correspondence from patients. That didn’t pan out, and eventually, portals resulted in other efficiencies, such as less routine phone calls for requests that patients could handle themselves through a portal.
Rather, physician practices need to take a fresh look at the benefits offered by telemedicine, and how this expanded range of services can increase patient engagement and satisfaction with services. The technology can meet the needs of mobile consumers and those who became accustomed to broader access to care as a result of the pandemic. And telemedicine encounters that can be integrated into electronic medical records systems can improve physician practice performance in the building the patient-centered medical home
About Dr. Jeanne Armstrong
Dr. Jeanne Armstrong has been the chief medical information officer for Allscripts TouchWorks® EHR since 2016. Dr. Armstrong has more than 17 years of experience as an active physician and has a proven track record of technology change in medical offices. She has helped successfully install, convert and customize many applications, leading to better patient care and stronger information flow. Currently, she contributes to development of policies, procedures and quality control standards. Dr. Armstrong is board certified in Clinical Informatics and Family Medicine and holds a medical degree from the University of Indiana Medical School.
