Primary care providers face new challenges, new competitors

Primary care providers during the pandemic are facing an increased number of challenges that are opening opportunities for competitors. But experts say patients need to be wary of what those competitors offer.

The pandemic led the way for virtual care to become more mainstream in the U.S. and that threatened primary care providers who practice in smaller facilities and were buffeted by closures in 2020. Smaller practices did not make the transition to telehealth prior to the pandemic and therefore did not have the infrastructure to provide virtual care.

A 2020 survey by Primary Care Collaborative and the Larry A. Green Center found that 6% of primary care physicians said their practices had closed and 35% said they had furloughed staff as a result of excess expenses, lower patient volume and a surge of non-traditional providers of primary care. Nearly 80% of respondents reported fewer patient visits during the pandemic compared to before.

Even prior to the pandemic, data showed that patients preferred the convenience of virtual care. A survey by patient experience research group SPH Analytics showed 70% of patients preferred virtual visits over an in-person appointment to save time in early March 2020.

Enter virtual primary care platforms like HealthTap.

“Our solutions focus on longitudinal ongoing care,” said Sean Mehra, HealthTap co-founder and chief operating officer. “This ability to choose a doctor and establish a relationship with them … and have a conversation about topics beyond your one-time acute issues. We’re trying to make that experience more affordable and more accessible than the alternatives.”

While HealthTap’s services are virtual, Mehra said members can receive referrals for in-person care through HealthTap and schedule appointments at walk-in clinics, including thousands of CVS MinuteClinic locations nationwide. There, they can pay the clinic’s rates for an in-person appointment.

Ari Gottlieb, principal at A2 Strategy, said prices for virtual primary care visits can span anywhere from $30 to $70 on average.

Ellis said these rates are “significantly different” than the cost of going to an in-person appointment, which ranges based on one’s insurance plan and geographic location.

Sabrina Corlette, a research professor with Center on Health Insurance Reforms at Georgetown University McCourt School of Public Policy, said some traditional primary care providers see the rise of telehealth companies offering virtual services as a threat to their business model.

“What I’ve seen in recent years is a trend of major health insurance companies acquiring or entering into partnerships with virtual-only service providers,” Corlette said. “That suggests to me that these carriers are seeing potential cost savings with this model.”

Bradley Ellis, senior director of North American Insurance Ratings at Fitch Ratings, said health insurers are interested in telehealth services for the lower cost utilization and the fact that they can prevent patients from using a higher level of care than is necessary.

“If someone is having symptoms that can be treated with a prescription and diagnosed through a video call, it’s much better than letting it fester and ending up in the ER because it’s grown out of control,” Ellis said.

Corlette said despite the potential for cost saving, she is wary of telehealth and virtual care companies marketing themselves to uninsured people as real coverage rather than a supplement to insurance if they only offer primary care services and not coverage for hospitalization, pharmaceuticals, medical emergencies and chronic diseases.

“I’m a big fan of telehealth, but I’m a fan of it integrated with the broader [coverage] package,” Corlette said.

Dale Owen, CEO of Tryon Medical Partners, said he does not see virtual care providers as competition because the practice is patient-centric and worked on being able to offer care in any format.

He said throughout the pandemic, Tryon Medical Partners were able to see 90% of patients in person and 10% online, while other practices saw up to 70% of patients virtually.

“A virtual platform is only as good as the technology that it’s using and the manpower that it has,” Owen said. “Be wary—who’s being opportunistic, versus who’s really providing value?”

Gottlieb said although virtual care services are perfect for managing one’s behavioral health and chronic conditions, they can never fully replace in person visits for diagnosis and treatment.

“While [telehealth is] a wonderful tool, there are some populations either because of economic or racial disparities, or different social determinants of health, who’ve not been able to take advantage of it,” said Frank Ghinassi, president and CEO of Rutgers University Behavioral Health Care.

While HealthTap’s services are virtual, Mehra said members can receive referrals for in-person care through HealthTap and schedule appointments at walk-in clinics, including thousands of CVS MinuteClinic locations nationwide. There, they can pay the clinic’s rates for an in-person appointment.

Mehra said HealthTap’s goal is to normalize virtual care and make it easier for one to find a primary care provider from the comfort of their home.

“There’s a role that a primary care provider plays that is sometimes underappreciated in holistic care,” Mehra said. “They’re literally your advocate. They do so many roles in helping to navigate healthcare proactively, preventatively and reactively. “