The Provider Will See, Text, or Hear You Now: Alternative Care Visits in Primary Care

By Stacie Pankow, MS, Scott Shipman, MD, MPH, and Shana Sandberg, PhD

According to the Center for Workforce Studies at the Association of American Medical Colleges, the United States faces a shortage of primary care physicians that will be magnified by the demands of an aging population and the influx of newly insured Americans from the Affordable Care Act. This situation has prompted growing interest in innovative alternatives to care delivery, including group visits, phone-based appointments, email and text communications, and telehealth delivered via video technology.

Alternative care visits have the potential to increase productivity without increasing providers’ hours or the number of providers needed. The growing popularity of telehealth allows for patients with easily diagnosed and treatable conditions to virtually “visit” a provider or other health team member. Other alternatives to the office visit include phone visits, emails, text messages to touch base, and “e-visits.” Providers can schedule multiple phone visits in one block of time, such as at Kaiser Permanente in Colorado and at Presbyterian Health Services where providers can schedule an average of 3 to 4 phone appointments per day. E-visits through HealthPartners’ online program, VirtuWell, allow patients to submit their symptoms, review their health history, and receive a diagnosis (and a prescription if appropriate) from a certified nurse practitioner in minutes for a fixed set of common, straightforward conditions, all for a flat $40 fee.

Group visits offer the face-to-face interaction with a health care provider many patients prefer with an added bonus of social support from other patients experiencing the same condition or issue. Group sizes vary, but typically include more patients than providers would typically see during one-on-one visits over the same amount of time. Some clinics, such as Clinica Family Health Services in Colorado, have embraced group visits widely and offer an extensive selection of approximately 800 groups for acute and chronic conditions. Other clinics offer group visits for a smaller selection of conditions, such as the University of Utah Family Medicine (diabetes and pre-natal), Iora Health’s Culinary Extra Clinic (diabetes), and Providence St. Peter Family Medicine (diabetes and teen pregnancy).

Alternative visits have the benefit of saving time for physicians and patients, maintaining continuity of care, expanding primary care team member roles, and increasing provider productivity. However, despite these benefits, some barriers still exist. Namely, not all insurance plans reimburse for these services, leaving the bill for the patient to pay or for the health system to absorb. However, with increasing governmental support for new care delivery models along with new reimbursement models to support them, the future looks bright for these innovative approaches to serving patients.

— Stacie Pankow, MS is a Research Analyst in the AAMC Center for Workforce Studies. She can be reached at spankow@aamc.org. Scott Shipman, MD, MPH is the Director of Primary Care Affairs and Workforce Analysis in the AAMC Center for Workforce Studies. He can be reached at sshipman@aamc.org. Shana Sandberg, PhD is a Research Writer in the AAMC Center for Workforce Studies. She can be reached at ssandberg@aamc.org

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