Building Back Better:

Re-imagining Primary Care by Leveraging Technology

More than any time in recent history, the COVID-19 pandemic has highlighted the challenges associated with the lack of access and inclusivity of healthcare. In communities across the United States, the pandemic has resulted in widening economic and social inequities threatening healthy lives and well-being at all ages. This calls for a new paradigm and reconfiguration in re-thinking healthcare and access for all with sustainability as a core focus. Realizing that the COVID-19 pandemic has called for a more inclusive and accessible healthcare system around the globe, it is essential to direct strategic and policy-specific focuses to primary care. Enabling a connection between primary care practices and multi-specialty telemedicine platforms immediately creates access that transcends borders, boundaries, and
physical barriers. It is against this backdrop and within the 2021 High-Level Political Forum on Sustainable Development (HLPF) framework that American Telephysicians is tasked with convening a parallel event focused on Re-imagining the gateway to the healthcare system, the primary care model. The panel titled “Building Back Better: Re-imagining Primary Care by Leveraging Technology” presented on July 14th was part of a series of American Telephysicans’ stakeholder engagements at the United Nations. This stakeholder forum was convened in partnership with Blue Ridge Impact Consulting, to expand the United Nations HLPF 2021 theme of “Sustainable and resilient recovery from the COVID-19 pandemic”. The event’s objectives included discussing current and emerging opportunities for leveraging technology to create better access to quality healthcare, and demonstrating the value of multi-stakeholder ecosystem partnerships in re-imagined access to healthcare for all, among others.

Hosted by Waqas Ahmed MD FACP, Founder & CEO of American TelePhysicians and an International Speaker on Digital Health, and Ameena Zia Ph.D., CEO of Blue Ridge Consulting, the event brought together several expert panelists: Michael Wohlfeiler MD, Chief Medical Officer at AIDS Healthcare Foundation; Monique Mrazek, Senior Investment Officer, International Finance Corporation (IFC), World Bank Group; Douglas Farrago MD, Founder of Direct Primary Care (DPC) News; Mazin Gadir Ph.D.,
Director of Strategic Partnerships at IQVIA; Julia Skapik MD, Medical Director at National Association of Community Health Centers; Sherri Johnson, JD, MBA, VP Communications for American TelePhysicians.

Dr. Michael Wohlfeiler, a chief medical officer leading one of the largest primary care organizations for HIV patients, spoke about a unique model of providing primary care for patients with a specific disease. While drawing attention to the usual isolated approach for HIV treatment, he advocated for an alternative, primary care module. Using this module allows AIDS Healthcare Foundation to treat several comorbidities of HIV from the beginning, engaging new patients within the first 72 hours. A barrier to providing care for any HIV-positive patient, including the unfunded, is tackled at AHF with the help of benefit counselors, case managers, social workers, and resources from the federal 340B Drug Pricing Program. Care about patients without insurance was also a central topic for Dr. Julia Skapik, a national director representing NACHC, constituting the healthcare safety net. To name a few distinct qualities, the centers build partnerships with community organizations in different areas, bridges to specialists, whose services are normally unavailable for patients without insurance or help with technical literacy. Dr. Skapik pointed out that a significant proportion of patients still lack access to insurance, either because they fall into the income gap or because they are undocumented immigrants and their state does not offer Medicaid
services to them. Sometimes, in their cases, telemedicine plays a significant role.

Dr. Douglas Farrago, Founder of DPC News, opposing American industrialized medicine, offered an approach of direct primary care, leaving out all intermediaries. This concept was built on the grounds of spending time with the patients, building relationships, and helping the patients, for daily care purposes, find and get the cheapest MRI and the cheapest medications. Monique Mrazek, Senior Investment Officer representing IFC and the World Bank Group, gave an overview of the global investment initiatives in healthcare. In accordance with other speakers, she mentioned that in the private sector, there is not always the culture of primary care, especially in regions
where patients pay out of pocket for specialty care. The World Bank Group is trying to help institutionally re-engage the focus on primary care rather than just catastrophic care. At the same time, one of the main priorities remains digitalization in economies. In the context of digital technologies, Dr. Mazin Gadir presented projects of IQVIA, one of the leading organizations in using healthcare data analytics and AI. Beyond the insurance claims platform, different reimbursement models, and mobility solutions, the
organization’s drive towards health information exchange in the region touches specifically on primary care. Some of their envisioned outcomes are value-based care and personalized medicine in a complete ecosystem of technology – the internet of medical things. At the end of the event, Dr. Waqas Ahmed presented an all-encompassing model of smart connected healthcare, a platform interconnecting data analytics, family engagement, remote patient monitoring, online clinics modules, and more, creating one digital healthcare ecosystem.

This event examined potential collaborations between stakeholders in re-configuring access to the healthcare ecosystem while improving the understanding of the primary care model in healthcare. Secondly, it renewed commitment to the adoption of technology-driven approaches for sustainable healthcare development and implementation. A set of recommendations drawn from the event can be found below:

Recommendations:

1. Where retention and adherence to medication is crucial or where patients tend to call off their appointments, telehealth can significantly help maintain a connection with patients.
2. Via telehealth, we can build a relationship with a patient, choosing platforms for the most direct contact.
3. Healthcare centers (especially those offering care to patients without health insurance) can extend their help to other essential areas. In aiding more complex services, health centers can build partnerships, provide information on and access to food programs, employment, education programs, or sign-ups for social services.
4. Hand in hand with telehealth, putting forward education tackling low technical literacy is key.
5. Text messaging can be used in multiple useful ways, from checking in with patients through questionnaires to follow-ups and monitoring of COVID-19 patients needing assistance. It is also the most inclusive way of using digital technology.
6. Healthcare should turn from transactions to relationships and focus on the patient.
7. It is a revolutionary thought to eliminate third parties affecting how we care for patients, one being the insurance company.
8. Technology and messaging help to acquire a complete picture of the patient and can check if medications work. At the same time, the physicians have information as to where the cheapest reliable medications are sold, and where the most affordable specialized procedures are provided should serve as advocates for the patients.
9. New concepts in primary care can also emerge from B2B solutions.
10. We need to grow, strengthen and sustain the culture of primary care.
11. Telehealth can enable healthcare workers to have skilled assets in essential locations and underserved areas.
12. Regulatory aspects of telehealth need to become clearer.
13. Ideally, patients should be informed of all the services that can be delivered at home (online physicians, home diagnostics, remote patient monitoring, treatment at home – psychotherapy, physiotherapy, and others). Home unavailable services will be done at the clinics or hospitals, where convenient scheduling of outpatient services with price transparency and value-based care will take place.
14. Interesting concepts applied are the healthcare marketplace and multi-specialty clinics with teleservices in more formats – on-site teleservices, follow-up teleconsultations direct to patients, and physicians to physicians format. The specialty care online can involve mental health, psychiatry, and related behavioral telehealth services.