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The Argument for More Unicorns: Lessons From Covid-19 in Primary Care

Last week my entire company paused. We shared a video conference call and heard from our leadership that we were doing a great job, that we were doing the right job, and that whatever the post-C-19 future might hold, our c-suite was committed to the health and safety of not only our patients, but our team members.  

As a primary care doctor at Iora Primary Care, I see exclusively Medicare patients. By definition, because they are eligible for Medicare (either by age or disease status), all of my patients are high risk for getting very sick from COVID-19 if they are infected, and I feel lucky to work for an organization that has been swift to adapt to the needs and safety of my patients and my team. 

Most healthcare professionals these days have similar worries: How do I keep myself, my patients, and team safe? Do we have enough personal protective equipment (PPE)? Where should I send patients who have symptoms concerning COVID-19? Should I isolate myself from my family after seeing patients? As a primary care doc, I was also worried about still caring for my patients with chronic diseases like diabetes, heart failure, depression, anxiety, and substance use disorders if we were asking people to stay home. 

I was thrilled to realize that unlike most outpatient clinics, Iora was already well-positioned to meet the ongoing primary care needs of our patients in non-traditional ways. Many aspects of my practice that are considered unique to primary care have become essential during this time. Now that COVID-19 is forcing outpatient care to become more virtual, some practices are scrambling to acquire the technology and educate their workforce to do things that are part of the standard care we provide at Iora already. 

A few of the resources that set us apart: 

  • Providers on call 24/7 – we have a call service that routes after-hours inquiries to a physician. 
  • Virtual care – we have an electronic medical record (EMR) that allows us to designate whether our care will be by phone, video, or in-person. We have technology and partnerships that allow us to contact patients in non-traditional but HIPAA-compliant ways.
  • Population-based care – we have a robust process to identify high risk acutely or chronically ill patients, and regularly scheduled time for the team to discuss them and address their needs.
  • Completely paperless practice – even our faxes and phone service are web-based, so the shift to virtual care (and, if needed, remote work) is much easier than practices that still rely on paper faxes, forms, notes, or “brick-and-mortar” communication.

The main reason most of this is possible, though, is the biggest thing that sets us apart from most primary care practices: value-based payment. Most of our patients are reimbursed through partnerships with Medicare insurance plans that pay flat rates (adjusted for severity of illness) for us to take care of our patients. As a result, “taking care of our patients” can look pleasantly different than a typical doctor’s visit. 

Although Iora has been using this type of model for almost ten years, more and more practices are moving away from the traditional fee-for-service economy of modern U.S. healthcare. Even the Centers for Medicare and Medicaid (CMS) has recognized the value of letting healthcare teams decide how we take care of our patients and announced the expansion of their risk-sharing payment models through things like Direct Contracting and Primary Care First initiatives. More recently, emergency measures have been passed to allow even fee-for-service clinics to practice more like mine—with virtual care and relaxed requirements on documentation for billing.

Despite our ability to continue to care for our patients in creative and non-traditional ways, it’s taken some fancy footwork to support team members who need to be home for illness or childcare, and to explain these new options for care to our patients. This has been understandably stressful for teams and leaders on the ground like me. Our national and local leadership has shone through here, too, embracing transparency and being proactive with efforts to protect patients and teams.

Throughout all of it, the entire company has been incredibly flexible—from the c-suite to the frontlines. And that’s rare in healthcare, too. On our company-wide video call, our president, Alexander Packard said, “Our culture is built for moments like this.” Iora fosters “a culture of ‘we’ – supporting each other so we can support our patients.” 

The bottom line is that the version of primary care that I get to practice is still a unicorn in the traditional healthcare / insurance model, but recent challenges have helped highlight the many benefits of value-based payment primary care. I’m grateful to work at Iora and hopeful that if the COVID-19 pandemic can be compared to the Biblical flood, this time the unicorn might make it onto the ark because it’s time the horses of primary care learned how to fly.