If digital health technologies take hold the way many believe they will, the U.S. may no longer have to worry about a pressing shortage of primary care physicians, projected by the Association of American Medical Colleges to reach 65,800 doctors by 2025.
"There are a lot of ways to deliver primary care," explains Greg Caressi, senior vice president for healthcare and life sciences at market analysis firm Frost & Sullivan. A key function of primary care is to screen to determine if a patient needs to see a specialist. Remote technology and midlevel providers are more than adequate for triage and testing, he says.
Caressi noted that Vinod Khosla, co-founder of Sun Microsystems, predicted last year that technology eventually could replace 80 percent of physicians. Accountable care organizations and other payment reforms – as well as changing consumer preferences – are going to force healthcare organizations to reevaluate how they deliver care in the next dozen years or so, according to Caressi.
Caressi shared these ideas at Frost & Sullivan's 18th annual executive exchange on medical devices last month and spoke to MobiHealthNews this week.
"Some of the business aspects really need to change radically," Caressi says. "If hospitals are going to survive, they're going to have to leverage telehealth."
And makers of medical devices are going to have to pay attention, he added. Quite a few device companies are only contemplating incremental changes in care delivery, says Caressi.
"The world has changed and the way people get information has changed," he continues. There is a strong opportunity here for healthcare providers to reach young adults and others in generally good health who might not care about seeing a particular physician as long as they can get care when they need it.
This is like the Kaiser Permanente model, where patients are tied to a clinic rather than a single primary care doctor, Caressi notes.
This notion may seem to conflict with the patient-centered medical home, which stresses care coordination by making sure patients have a "home" for all their healthcare needs, in the form of a primary care physician. "This is almost at odds with that," Caressi says, but he asks an important question: "Is the primary care physician the hub or is primary care the hub?"
In his vision, primary care, not the physician, is the focus, and the most important individual in the entire equation is the patient.
Though he did not say this in his talk last month, Caressi tells MobiHealthNews that electronic health records and interoperability of health data underlie this whole concept because clinicians need accurate information to make informed decisions. Having a complete patient history, medical record, data from remote monitoring devices and clinical decision support makes it easier and safer to care for patients, he explains.
Caressi says clinicians of all levels need to practice to the fullest extent of their licenses, saving physicians for the most difficult tasks. He says hospitals have given lip service to this idea, "but they could do more." This includes beefing up telehealth services and relying more on call centers staffed by nurses to expand access to care and manage larger panels of patients.
"If you want higher touch at lower cost, you need to leverage technology," Caressi says.