The Future of Primary Care: CEO Ryan Schmid Speaks at CIT

Each year, CIT hosts an annual healthcare conference in New York to bring together healthcare executives, industry leaders, private equity investors, and other professionals to discuss the financial state of healthcare and its future. As one of the top 50 banks in the country, CIT promotes healthcare innovations that bring more value to patients, companies, and investors alike.

For the second year in a row, Vera CEO Ryan Schmid was invited to speak on the subject of primary care. This year, Schmid talked about the future of primary care, why we need it, and how it’s being delivered effectively already.

For those who weren’t able to make the conference, we wanted to share some of Schmid’s presentation, illuminating why primary care once failed and how we’re now fixing it.

How Primary Care Fell Apart

After the 1950s, true family medicine gave way to a focus on “fee for service” primary care. The motivation for such a change was clear. Health systems with financial motivations realized they could use primary care to increase utilization of their most expensive services.

By positioning primary care providers as gatekeepers, health systems incentivized referrals and created a system with high utilization and a significantly reduced quality of care. “It also started to lead to primary care access issues as providers became disenchanted with models of care delivery,” says Schmid.

In the end, high utilization packed waiting rooms, making it hard for patients to get in to see their providers. And when they did, the care they received was hasty and superficial. So, they started looking elsewhere, taking their health concerns to places where they could get immediate attention, like emergency rooms.

But emergency rooms weren’t meant for bumps and bruises, so the market adapted, leading to the launch of more urgent care centers. It was an improvement, but it didn’t address the whole problem.

“The access issue was partially solved, but now people were getting disjointed care with no preventive care and little to no condition management,” notes Schmid. More change was needed.

Putting Primary Care Back Together

Urgent care’s accessibility victory led to more questions and a renewed focus on bringing back a version of primary care “where people could get the right care that is meaningful to them that would reduce utilization and ultimately costs,” says Schmid. That renewed focus led to three major developments in care delivery, each with its own pros and cons.

1. Direct Primary Care/Concierge Medicine — While it offers a much better model of care, direct primary care misses one crucial piece of the puzzle—a lack of focus on the importance of a dedicated care team and the role of informatics on population health.
2. ACOs — While well-intentioned, their position within the health system or aligned with a payer makes them prone to bureaucratic and incentive issues.
3. Employer-Based On-Site Clinics — This model solves for access issues but is often seen as glorified urgent care close to work or a place where you go for workers comp.

The best form of primary care combines the strengths of all three of these models, resulting in the future of primary care: population primary care.

The Benefits of Population Primary Care

“You have a care team that's focused on only one specific population. Their mission? To be responsible for the health of the entire population, whether they ever set foot in the clinic or not. This ensures that incentives are 100% aligned.” — Ryan Schmid

Population primary care combines informatics, a focus on population health, preventive care, and a highly accessible clinic to create the future of primary care. Here’s how it works.

• Sophisticated informatics allows care teams to understand what is happening at both the population and individual level.
• Dedicated care teams focus on a biopsychosocial care model, so members are able to engage and change all aspects of their health.
• Population health and care team approach allows for true care coordination and referral management

And the final piece to the puzzle? Better access.

Why Consider a Clinic?

More and more employers are switching to on-site or near-site clinics as the method of advanced primary care delivery. From mergers between industry leaders like CVS and Aetna to Amazon’s own clinics, the tide has shifted. Employers are investing in on-site clinics because of their ability to improve care, decrease costs, and reduce complexity.

Improve Care

On-site clinics are the vehicle by which you break the damaging cycle of yo-yo secondary care and specialist utilization. By making primary care easy to access, you increase the quality of the patient care you provide to employees.

Decrease Cost

By providing the majority of a patient’s care at a fixed cost, employers can use the clinic to strip out unnecessary medical spend.

Reduce Complexity

Integrating other programs and services into the clinic makes your health care ecosystem more efficient. Occupational health, safety, and other wellness services can all be delivered from one hub, thus reducing complexity and the number of vendors you have to manage.

How Vera Delivers on the Future of Primary Care

Our on-site clinics hone in on the three factors that make population primary care so effective. Here’s how.

Whole Person Care

Clinics provide access to a holistic model which fundamentally transforms the patient experience, improving outcomes and empowering individuals to take control of their health.

Whole Community Empowerment

By leveraging our model to engage 100% of your population, we can drive positive impacts beyond the individual to affect your whole culture, creating well-being throughout your organization.

Whole Trend Reduction

“It’s about getting healthcare costs under control, sustainably,” says Schmid. “By actually changing behavior and improving health outcomes you bend the cost curve long term.”

By combining best practices for population health, whole person care, and engagement, we’re improving outcomes and reducing costs. Take a look at the savings generated after five years at Seattle Children’s on-site clinic.

• Average savings of $77.80 PMPM
• Average ROI of 79.9%.
• $24.66 (28.9%) savings on facility inpatient PMPM
• $25.19 (27.2%) savings on facility outpatient PMPM
• $25.25 (29.3%) savings on professional services.

Primary care already failed once, but now we have a chance to correct the mistakes of the past. With rich informatics, a focus on population health, and dedicated care teams that provide whole person care, we’re changing primary care from the ground up.