How to decrease $4.1 trillion in healthcare expenditure
Solve the primary care maniac
Healthcare Spending in the U.S
The U.S healthcare spend is projected to be at $4.1 trillion in 2020 and is expected to grow at a rate of 5.5% YoY until 2027 — much faster than the projected economic growth of 4.7%. At this rate, within 5–7 years, it will reach $6 trillion, or one-fifth (20%) of the GDP. As per the Statista dataset of 2018, U.S has the highest overall healthcare spend with 17% of GDP followed by Switzerland, Germany, and France while the average spending of OECD member countries on healthcare is 9–10% of their GDP.
As per the health system article, other wealthy nations spend about half as much on health per person than the U.S spends
As we dive deep into the total healthcare spending, the United States spends 5–7% on primary care while other OECD countries spend an average of 14% on primary care. As per the PCPCC Report, the spending on primary care providers declined 6% from 2012 to 2016 while during the same period, spending on specialists increased by 31%.
Focus on primary care could lead to lower overall healthcare expense
There is enormous evidence that greater use of primary care is associated with better health outcomes, a decrease in hospitalizations and emergency department visits, and higher patient satisfaction. A patient without access to timely primary care could possibly end up in with a specialist visit, urgent care, or an expensive Emergency Room. The Commonwealth Fund report suggests that a small investment in primary care could yield a six-fold decrease in medicare services and an overall 2 percent decrease in medicare costs.
Primary care and preventive visits can be seen as very similar to seat belts in cars. As seat belts are mandatory to prevent accidents, primary care visits can cut down long term serious health implications.
Current Challenges with Primary Care
Why can’t we have enough primary care doctors to solve the problem? The problems with primary care are much deeper. Among all the specialists, Primary Care providers are among the least paid in the market. Considering the time it takes to become a doctor and pay the student debt after graduation, the primary care specialty doesn’t provide enough incentives for medical students to pursue it. The market size of the Primary Care Doctors industry is expected to decline -3.3% in 2020 and the paid pages for primary care doctors have increased by only 0.2% between 2015 and 2020.
New effective primary care solutions
So how do we increase access to primary care doctors? There has been a significant venture investment and a number of startups to help deliver effective primary care. Startups providing effective primary care include One Medical, Forward, Aledade, ChenMed, Iora Health, Crossover Health, Oak street health, VillageMD, Privia Health and Heal.
Startups such as One Medical and Forward are offering primary care visits at clinic locations as well as telehealth visits. Aledade created accountability among primary care doctors by creating affordable care organizations. Given effective primary care requires a deeper understanding of the patients, companies such as Heal are trying to get to patient houses and understand the family as a whole which brings an understanding of social determinants of health. And then there are solutions such as K Health which provides primary care and urgent care through text messages.
It can be seen that the value offered varies across these primary care mediums. House calls offer the best type of care as patients get access to doctors at their fingertips, doctors look at a patient’s family history, living situation, and other social determinants of health. The telehealth visits are usually transactional in which the patient calls for the doctor to get a symptom/diagnosis. The chat-based solutions in the market rely on doctors in the background but a lot of basic information is verified by the ChatBot. A visit to the doctor's office is a good interaction since it’s in an external setting and quality preventive care can also be provided during that time.
Are the new solutions enough?
Given the number of primary care, doctors haven’t increased across the country, the startups are moving the existing independent practitioners under their umbrella. They are increasing efficiency by taking care of the administrative overload from the providers so that more patients can be seen by a doctor in a day.
But would that be enough to reach the goal of providing effective primary care to everyone in this country? House calls and telehealth won’t be sufficient to feed the timely primary care needs of all patients.
We need to find better ways to provide quality primary care at the intersection of AI and the human touch while ensuring that quality care is delivered. The solutions could be based on text or voice. There is so much data already collected within a phone about our health that it can act as a good starting point for the primary care doctor.
As Alexa and Google Home reaches everyone’s home, can they do a preventive checkup of the patients?
Delivery of primary care to patients
While we need to ensure that primary care is available for all patients, we must also think about how to drive patients towards such care. Though a lot of health plans are designed to provide free primary care or at low co-pays, in order to enforce the primary care and preventive care behavior in patients, more incentives need to be developed. Employers can link employee bonuses with preventive healthcare visits or make it mandatory for a new employee to get a preventive visit within 90 days as a part of onboarding. Medicare patients have a higher age, so a more effective way for primary care could be through house calls and remote patient monitoring.
There is a lot of disruption in the industry to solve this problem.
Everyone deserves a great primary care doctor that cares about them and checks with them from time to time.
Wait, all we talked about today is Primary Care. What about chronic care? 90% of the total $4.1 trillion healthcare expenditure is on chronic conditions and mental health. Haven’t you heard that 50% of adults suffer from a chronic condition in the U.S?
We will discuss that in the next post.
I wanted to share my thoughts related to primary care with you all. Feel free to share yours in the comments.
Update — July 17th, 2022 — I wrote this article 2 years ago, and never published it. Thinking that I will improve it, get feedback from others and then publish it. Over these 2 years, I have learned a lot and have realized that I am perfectly imperfect. So I am publishing it without an update.
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