In the Vera Whole Health advanced primary care (APC) model, one of the ways to reduce the total cost of care is by providing 80-90% of the care a patient needs in the primary care setting. When specialty care is needed our care teams coordinate care by arranging referrals and integrating follow-up into the patient’s care plan.
We recently sat down with Vera’s Chief Medical Officer Dr. Kevin Wang to discuss Vera’s approach to care coordination and the vital role it plays in the success of APC.
Vera Whole Health (VWH): Why does Vera's approach to care coordination matter?
Dr. Kevin Wang (KW): We know that in real life most adults aren’t getting their appropriate screenings. It’s clear when you see the health of patients at 66, 76, or even 86 years old. Most of these patients have a minimum of three to five comorbid conditions. Before we even begin caring for them they already have, for example, diabetes, depression, high blood pressure, and a whole list of medications as well.
This situation requires strong care coordination. You have to have a model in which primary care is the hub that drives the right referrals when needed but also quarterbacks the patient's care.
In our opinion, the only person equipped to coordinate a patient’s care is the primary care provider and their care team.
With the most clear-cut patients, your 26-year-old healthy patients with no medical conditions, it matters less. That patient just needs to be seen annually for now, and as they age, should access additional age appropriate screening measures.
VWH: How does Vera provide the necessary environment for a care team to effectively manage each patient's care and efficiently coordinate outside care if needed?
KW: There are three different phases that are important to consider: pre-visit, during the visit, and post-visit. At each phase the care team must be equipped to do their work.
For the pre-visit phase, we give the care team as much digestible information as quickly as possible. Our goal is for them to be able to review and understand the patients’ needs, potential care gaps, etc. during their daily huddles when they discuss and plan for the patients who will visit that day.
The intent of this effort is to drive crucial conversations that go something like this: “John Smith is coming in, he is 60 years old. He needs these three preventative screening measures. He also went to the urgent care six weeks ago. We don't know why, but we need to follow up.” These types of conversations prime the care team to provide the best care possible to patients.
During the visit, we consolidate any necessary tests, procedures, or screenings under one roof while we have that patient there. We have to assume this is our one touch for the patient for the year. Hopefully, we can engage them more with follow-up, but that doesn’t always happen.
In the post-visit we follow up with proactive support. If a patient needs health coaching in order to self-activate some healthy habits, for example, then we're going to have our health coach follow up.
This in-depth care model allows us to identify when a patient needs specialist care and ensures they’re well taken care of when they come back to the care center.
VWH: How does a Vera care center improve the effectiveness of a specialist referral while also reducing cost?
KW: We save patients time when a referral is needed. We talk to the specialist ahead of time and give them the patient's background, previous blood work, past tests, and results. Specialists can see how the patient’s medical condition has changed over time and make more informed decisions without having to run a whole new round of tests.
VWH: Can you address the waste that occurs in the system when people go directly to specialty care?
KW: Waste happens in three big areas: appropriateness of care, cost, and time. In terms of appropriateness of care, both primary care providers and specialists want appropriate patients to come into their offices. But there are numerous reasons why that doesn't happen. A primary reason is that patients don’t know how to choose the right level of care. An endocrinologist would not want a diabetic to come in if the disease can be well-managed in primary care. And vice versa, primary care providers don't want a patient with diabetes to go straight to an endocrinologist when primary care can manage it well.
The next area is cost. Without knowledge of the patient’s history from the primary care provider, duplicative testing and procedures take place which wouldn’t have been necessary with proper care coordination.
For example, if a patient goes to a cardiologist and says they have congestive heart failure, they’ll get a number of questions that they may or may not be able to answer. The best patients might have a copy of their most recent EKG and know their ejection fraction, current medication list, and previous weight. But when you start going down the checklist, the patient is more likely to say, "I don't know." At that point the cardiologist will have to run a series of tests to ensure they have a clear picture of the patient's condition.
Finally, the third area is time. Everything I’ve just talked about takes exponentially more time as compared to when the primary care provider is coordinating the specialist visit.