Fee-for-Service (FFS) medicine discourages quality primary care.

Incentivizing quick visits, not reimbursing asynchronous communication, and maintaining a narrow focus on immediate concerns, FFS favors quick care and penalizes meaningful time spent with patients.

Employers need help if they wants to lower their healthcare costs.

Most HR staff are neither experienced clinicians or experienced medical administrators - as a result they are hardpressed to craft effective primary care plans for employees.

Insurance companies are not interested in lowering the cost of care.

The medical loss ratio is gauranteed that insurers can only keep $0.15 of every $1 they earn. The incentive therefore is to make the total cost of care as large as possible so their 15% share is of as bug of a number as possible. The share price (and executive compensation) depends on it.

It’s time for primary care providers to take on risk.

Whether risk is in the form of Value-Based Care contracts or Direct Primary Care combined with Healthshares, quality preventative medicine needs to be rewarded if healthcare costs are going to come down.

Healthcare data needs to be portable.

Enough said. The Data is still not easily portable in a cost effective way.

Current DPC physicians are leading the way in primary care innovation.

I’ve met them. I’ve worked with them. The best and most innovative primary care in America is found within the DPC movement.

Effective primary care involves leveraging caregivers to move the clinical needle.

Changing individual habits is hard. Following up on healthy diet choices, exercise reminders and improved lifestyle habits requires persistence and someone “on the inside”. Leveraging caregivers and loved ones is essential to moving the clinical needle.

The best and brightest med students need to start picking primary care.

The burden of paperwork and lower compensation for PCP’s often steers the most talented medical students toward ROAD specialties. Better physicians will lead to better care and more primary care innovation.

There’s a need to fill gaps of care between visits.

Conversations about your health shouldn’t be confined to <20min semi-annual PCP visits. (If you are even lucky enough to have a good PCP) Primary care should include daily or weekly touch points. You can achieve this through digital tools to extend the care between visits.

Prevent doctors from saying the same thing over again.

A PCP will have around 100,000 patient visits in their careers. There’s no way HPI gathering and patient counseling for patient #100,000 will be as in depth as for patient #1. Help doctors take comprehensive HPIs and provide backup for patient counseling.

Virtual Primary Care needs local flair.

Successful virtual primary care hinges on possessing local knowledge—understanding where to access cost-effective lab work and imaging, familiarity with local specialists and physical therapists. A clinician without local insight operates with a significant disadvantage.

For virtual primary care to thrive, it needs reliable point of care data.

Virtual visit information gaps including obtaining reliable vital signs, physical exam findings, point-of-care lab values, caregiver insights, and other verifiable data from smartwatches or phones.

COVID-19 has really made clinicians think twice about in-person visits.

Covid has changed the game when it comes to acute sick visits. Keeping providers safe and healthy is now a priority. For example, the oropharyngeal exam puts providers at risk. Nobody thought about aerosolized viral particles in the exam room prior to Covid. There’s tremendous opportunity in making in person care safer.