Topic: Most companies still allow patients to develop long-term relationships with a primary care physician

While there are plenty of new startups emerging to disrupt primary care, the idea is still pretty new. In fact, many of these companies have been founded in the last 5-10 years, meaning it’s not entirely clear yet how this will all shake out, and what primary care will look like when all is said and done.

For example, with the rise of on-demand care, a la Doctor on Demand, can we really have that traditional doctor-patient relationship when your doctor might not be available at your command?

Today, the primary care doctor, unlike an urgent care doctor or a specialist, typically acts as the gateway: they are the person the patient comes to when they initially want to know what’s wrong with them. That means patients often want to find someone they feel comfortable with, and who they know they can trust; studies have shown that patients are willing to wait longer to see a doctor they are familiar with, as long as the problem is not urgent. Not only that, but they’ve also shown that continuity of care actually improves health outcomes.

(Vator and UCSF Health Hub are teaming up for a virtual event on November 17 called “Primary Care and the New Medical QB,” in which we will be talking to various stakeholders in the healthcare system, including providers, patients, and startups, about this change)

Some might say that such a notion is becoming outdated, and that it seems to matter less and less to each successive generation: while 84% of Boomers have a primary care physician (PCP), that’s true of 67% of Millennials, and only 55% of Gen Zers. Those numbers may not tell the whole story, of course, since the numbers might simply be lower simply due to age; obviously, someone in their 20s doesn’t need to see a doctor anywhere near as often as someone in their 70s. When Gen Z eventually becomes the old generation, it might not be surprising to see the numbers be closer to what they are for the Boomers.

To be sure, more than 70% of Americans had primary care doctors in the early aughts vs 64% in 2015. If there’s no longer a primary care physician needed, who will be the front door to someone’s healthcare journey?

In trying to understand this, we asked many of the emerging telehealth and primary care disruptors offering on-demand access whether they’re recreating the primary care physician or establishing them as the traditional gateway. Turns out, most of them are.

Amwell, for example, strongly encourages its patients to choose a single online primary care provider that they will then follow-up with for ongoing care.

“The fundamental principles undergirding virtual primary care are the same as those in brick-and-mortar practices: namely, patients should be able to access evidence-based, high quality healthcare through an ongoing relationship with a well-trained doctor who knows them,” Dr. Cynthia Horner, Medical Director at Amwell Medical Group, told me.

For the company, providing primary care is actually a more recent development, and really only came about because of the pandemic; prior to 2019, most telehealth visits on Amwell were for urgent care needs, such as colds, sinusitis, allergies, bladder infections, and rashes.

“As the COVID pandemic shuttered brick and mortar practices, many patients sought care for chronic diseases online, and many clinicians pivoted to adding telehealth services to their practices. With endorsements from professional medical societies and regulatory support from CMS both patients and clinicians are pivoting to use telehealth as an efficient and effective way to manage chronic diseases,” Horner explained.

On MDLIVE, meanwhile, patients have the opportunity to select their own provider based on their own preferences: providers can be designated as favorites so the user can easily find them again, or they can search for providers based on availability.

In addition to primary care, MDLIVE also provides urgent care and behavioral health services, and the company has found that provider continuity is more important to patients using telehealth for primary care and behavioral health than it is for urgent care, where most people just see the first available provider. That being said, some do schedule an appointment with a preferred urgent care provider.

One company that provides both in-person and virtual primary care is Parsley Health, though it provides care through a monthly membership fee. Patients are able to choose their doctor and health coach, both of whom they will have an on-going relationship with when they sign up, based on who is accredited in their state. Patients get access to five doctors visits, totaling three hours of patient-doctor time, and five health coach visits per year.

Patients can change their doctor pairing on request, if schedules don’t align, for example, but the model is focused on building those relationships, rather than offering one-off visits.

Maven Clinic, a digital clinic that is focused on women and families, takes a similar approach to Parsley: every Maven member gets a care team comprised of a range of providers who can help meet their needs.

Topic Discussed: Most companies still allow patients to develop long-term relationships with a primary care physician

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