How Text-Based Solutions Empower Primary Care Access and Affordability

By Robbie Cape

Executive summary: Rising costs and lack of accessibility continue to impede utilization of healthcare benefits. These can cause patients to avoid medical care when they need it, receive care too late or go to the wrong provider, all of which diminish quality. Primary care visits for adults under the age of 65 have declined steadily over the last 10 years. High-cost premiums and claims are making it increasingly difficult for organizations to keep their benefits packages competitive and affordable. Healthcare consumers struggle to find the time to see their doctors, only to endure long wait times when they do. Employers are searching for new innovations that address these issues, but every potential solution comes with a set of trade-offs. This article takes an in-depth look at healthcare’s biggest challenges, the gaps left by traditional solutions and how text-based virtual care offers a new approach. 

When it comes to healthcare, employers understand the strain their workforce feels. While rising healthcare costs affect employees and companies alike, organizations also know that lack of accessibility is not only deterring employees from seeking primary care, it’s impacting the quality of care. To improve utilization and boost employee well-being—in turn reducing sick days and advancing overall productivity—employee-benefits leaders are continually searching for ways to overcome healthcare hurdles around cost and accessibility, while enhancing quality. 

Data from top healthcare systems shows that primary care physicians saw an 18% decline in the number of patients over a recent four-year period. Visits for adults under 65 years old with employer-sponsored insurance has been steadily declining for 10 years. It’s widely known that individuals who receive regular primary care have overall better health outcomes, and an estimated 19% lower odds of premature death than those who only see specialists. Recent research reported that even a small investment in improving primary care could result in a six-fold decrease in Medicare services and a 2% drop in Medicare costs. This type of cost reduction and improved population health at the macro level can trickle down and ultimately reduce the overall cost of healthcare for both employers and individuals. But to date, the innovations that have tried to solve this problem have often come with undesirable trade-offs. 

Traditional telemedicine is one example. Believed to improve accessibility and reduce costs, telemedicine is now offered as part of the benefits packages at many organizations. Between 2015 and 2018, the number of large companies paying for telemedicine increased from 27% to 74%. But we’re still seeing many gaps in this model. Telemedicine represents less than one percent of total outpatient visits, meaning even enrollees who have these services are not using them and it has failed to make a significant impact on addressing key challenges. While implementing traditional video and old-fashioned telephone telemedicine has marginally improved cost and accessibility challenges, it hasn’t done so without sacrificing quality. Inherent trade-offs between improving on cost, accessibility and quality with traditional telemedicine are leaving many organizations feeling like they are stuck in a never-ending game of whack-a-mole, unable to address all three issues without sacrificing another. This opened doors for new innovations and created an opportunity for employers to embrace solutions that can provide their workforce with truly affordable, accessible and effective primary care.   

Enter text-based virtual care. This approach can concurrently address all three major hurdles, giving employees access to a medical source they can trust at a reasonable cost, right from the mobile phone in their pocket. Provided as an employee benefit to supplement conventional benefits packages, text-based virtual care provides patients an app-based interface to communicate with primary care doctors anytime, anywhere.  

As Kellee Amerman, Director of Benefits and Total Rewards at Stonebridge Companies, a hotel development and hospitality management company, recently observed, employees need an affordable and easy option. She said, “Cost and convenience is huge for our associates. When our associates aren’t feeling well, they want to pick up their mobile phone and get legitimate answers from a board-certified physician.”

Cost

While traditional telemedicine does reduce the total cost-of-care by eliminating some brick-and-mortar clinic costs, these reductions are not substantial enough to provide meaningful savings to the end user. Even without the costs associated with a physical clinic, physician time still makes up a significant portion of the cost. Most telemedicine visits cost between $45 and $65 per visit, which is covered by the employer, insurance company, consumer or a combination of those parties. These expenses can easily sneak up on employers, especially when combined with the additional administrative fees (often between $0.50 and $2 per visit) that come with offering and maintaining the service. While a company may be aware of the copay the employee is contributing, they may not have full visibility into the amount being charged back to the employer for each visit via claims, as they are often lumped together with all primary care claims and not separated out as a telemedicine-related expense. This is just one example of how a solution that is aimed at driving down costs can actually add unexpected line items to the overall health plan cost. 

To truly tackle the cost of care, solutions must change the economics. Text-based virtual care can do this by leveraging artificial intelligence and machine learning to augment physician time. This doesn’t mean using AI to make clinical decisions. Rather, it means limiting the amount of time physicians are billing solely to when they’re actually caring for patients. For example, AI can automate and complete administrative tasks and other repetitive workflows like charting and patient follow-up, so doctors become more efficient and are freed up to focus exclusively on diagnosing and treating patients. When doctors are able to spend more time treating patients than doing paperwork, costs come down and quality improves.

Accessibility

Traditional telemedicine touts its ability to provide accessibility to patients anywhere by eliminating the drive to a doctor’s office. This has improved access to primary care for some, especially individuals in rural areas with limited medical services. The ability to phone or video conference a doctor adds a level of convenience that was not available prior to the advent of telemedicine. Still, reducing the time it takes to travel to a clinic and wait to see a provider doesn’t equate to dramatically better accessibility for most people. Patients still need a dedicated block of time and a private setting to see a doctor via telemedicine. This still takes planning and time away from work or personal schedules. 

On-demand text-based care, which doesn’t require a private setting or advanced scheduling, flips this accessibility matrix on its head. Employees can receive care from anywhere—including public places—at any time. They can receive a diagnosis or medical advice from the bus or their desk, while standing in line at the grocery store or lounging on the living room sofa, all without missing work, rescheduling existing commitments or worrying about a babysitter. 
Arena Sports, a sports corporation that offers this option, has seen eager adoption among employees. Company CEO Don Crowe recently said, “It was a no-brainer for us because it lets our staff address health issues immediately, without disrupting their busy schedules. We know the quicker our employees address illness, the quicker they’ll get better. But they don’t want to take time out of their day to go to the doctor. Recently, an employee who didn’t feel well at work used the app to text with a doctor, and within a few minutes, she had a diagnosis. The doctor called in a prescription, which she picked up on her way home from work.”

Quality

Traditional telemedicine relies upon networks of outsourced and loosely affiliated physicians that are incentivized by volume—the more patients they treat per day, the more they are paid. This has created a number of problems in the quality of care. For one, the physician networks used by telemedicine providers are often comprised of contracted physicians, PAs and nurses governed by varying quality standards. The result is inconsistent care for patients.  
When physicians are incentivized to deliver a higher standard of care, rather than see a high volume of patients, overall quality increases significantly. By using technology to make visits more efficient, the text-based approach allows physicians to singularly focus on treating illness and delivering a high-quality experience for every patient, every time, helping patients establish and maintain a positive relationship with primary care. 

Furthermore, quality primary care visits have dramatically lower antibiotic prescription rates than those of traditional telemedicine visits, which supports the medical field’s overarching effort to improve antibiotic stewardship. 

A recent Cleveland Clinic study analyzed 13,000 telemedicine encounters between physicians and patients suffering from a variety of respiratory infections. It found that patients receiving care from telemedicine doctors were more likely to end up with a prescription for antibiotics than those who had longer, more personalized consultations. Two-thirds of patients in the study received an antibiotics prescription, compared to those who sought care in medical offices, where clinicians were reported in 2018 to write the fewest antibiotic prescriptions per total number of visits (7.1%). Still, the CDC says that at least 30% of antibiotics prescriptions are unnecessary. Researchers have theorized that “it takes longer for a physician to explain to a patient why they don’t need antibiotics than it takes to prescribe them.” 

Conversely, text-based virtual care is designed to incentivize doctors for quality over quantity and provide an experience wherein the doctor has ample time to spend with the patient. When doctors spend adequate time with patients to understand their medical issue,  properly diagnose them, explain why they don’t need certain medications and answer questions—as they do in the text-based care model—antibiotic prescription rates decline. 

A text-based modality also enables better quality control. Charts and records of the visit contain an unbiased, accurate account of everything discussed between doctor and patient. This is a much more precise approach to quality control than what’s typical among brick-and-mortar or traditional telemedicine providers. 

We all know that healthcare, particularly primary care, is in crisis. It’s time for providers and employers to work together to fix the issues around cost and accessibility without sacrificing quality. Doing so requires a head-on approach with solutions that can scale without trade-offs. Emerging offerings operationalize best practices, standardize care quality, automate rudimentary tasks and enable a team-based, real-time approach to care that ensures optimal outcomes for patients. Text-based virtual care is the first innovation in decades that can simultaneously win across all of the key challenges to get employers out of the whack-a-mole rut.

Robbie Cape is CEO and Co-founder of 98point6.