Sunday, February 5, 2023

Could hybrid care fix healthcare’s access problem?

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Once a much more niche method of delivering healthcare, telehealth and virtual care use grew during the COVID-19 pandemic as patients and providers tried to distance themselves when possible. But as the pandemic changes shape, more hybrid care options are joining the mix, with its proponents arguing they can improve quality and access to care by connecting with patients both in-person and virtually.

One hybrid player is Carbon Health, which last year made multiple acquisitions and announced a $350 million investment round. CEO and cofounder Eren Bali said the company is trying to fix the multiple “broken handoffs” in the healthcare system when patients have to handle the next steps in their care on their own. 

“When you go to a provider, and then you need to do other things, for example, you might start with a telemedicine visit, but then you need a urine test or a lab test. And then you need to go to another location. There’s a broken handoff there because you just throw the ball back to the patient to figure it out,” he said on a panel at ViVE on Monday. 

Dr. Marijka Grey, system vice president for ambulatory transformation and innovation at national health system CommonSpirit Health, said her role at a more traditional healthcare provider includes keeping the parts of the system people love, like their personal doctors, while fixing those pain points. 

“I think one of the huge challenges is that before our doctors relied on the fact that they had the expertise, that the patient would always come to them. And what we’ve seen with just Amazon entering our life is that our timelines have shortened,” she said. “Now, to wait two days for a package is the minimum, and if Amazon can’t deliver it in 48 hours, you’re upset. Well, what do we think people are going to think for their healthcare?”

Direct-to-consumer virtual care company Hims & Hers initially focused on providing men’s health products for hair loss and erectile dysfunction through the mail. COO Melissa Baird noted those are conditions patients are embarrassed about and maybe wouldn’t want to discuss face-to-face with their doctors. 

But many people also don’t have a primary care doctor to go to: A study published in JAMA Internal Medicine found the percentage of U.S. adults who had a primary care provider fell from 77% in 2002 to 75% in 2015. That drop was even greater for younger patients. In 2002, 71% of Americans in their 30s had primary care, compared with 64% in 2015.

“With the ability to treat a stigmatized condition, suddenly we were trusted to be able to treat for other things. So when COVID came on the scene in 2020, we very quickly stood up primary care services and our mental health services in order to accommodate those people too. And it’s been, to us, that is the digital front door. You come in for one service that you know you need, and then you start to build a relationship over time,” Baird said. 

But when delivering hybrid care, it’s also important to consider a wide variety of patient populations, some who may have an easier time using virtual options than others. At women’s health startup Tia, which announced a $100 million Series B raise last year, CEO and cofounder Carolyn Witte said women aren’t a uniform group and have different care needs. 

That includes training providers on trauma-informed care, so patients who’ve experienced sexual assault can feel more comfortable during sensitive procedures like pelvic exams. 

“It’s really about how do we create healthcare experiences that are both highly individualized, but also can create community, relationships, connection,” Witte said. “We do that by connecting women with other women and women with providers, but also tailoring our experiences in a way that affirms the lived experiences of women in the world.”

CommonSpirit’s Grey noted it’s difficult to use that individualized approach when providers don’t have time to get to know each patient, and it’s impossible to understand a patient’s circumstances just by looking at them. 

“So how do we make sure that we know people for who they are? One of the things is opening up the exam room space, taking off a lot of the administrative burdens from the physicians and the nurse practitioners so that they can actually concentrate on their patients. Because what they tell us is that the EHR, and the technology that we’ve layered in ostensibly to make their lives better, has actually created more of a barrier for communication,” she said. 

“So really [it’s] removing as much of that flotsam and jetsam, so that we can get back to the pure heart of the physician-patient relationship, which is the physician getting to know the patient better.”

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