If the U.S. is serious about fixing the cost of healthcare, then it’s time to focus on one of the root causes of its spiraling costs: the roughly 20 percent of U.S. patients who have chronic conditions drive about 85 percent of America’s total annual medical spend.
So says Tim Barry, co-founder and CEO of VillageMD, which through its subsidiary, Village Medical, provides value-based primary care services by 2,800 physicians in 9 states including New Hampshire, Texas, Florida and Illinois. That starts, he told Karen Webster, with giving primary care physicians (PCP) — those he calls the front door to the healthcare system in the United States and are the chronic care patient’s most frequent touchpoint — better tools, better tech and a new business model to serve them.
“Primary-care doctors — people who go into the profession of family practice, internal medicine and geriatrics — have been given a raw deal,” he said. “The healthcare system has not given them what they need in order [to] deliver the best care they can. And so we said: ‘We’re going to change that.’ And we started providing the doctors with more resources, more data — all these tools and capabilities so that they can deliver care 24 hours a day, seven days a week.”
For nearly a decade, Village MD has focused on rebuilding primary care provision, with a sharper eye toward improved clinical outcomes via a more comprehensive service set offering. And as of this month, they’ve enlisted a powerful partner in their quest to make high-quality primary care accessible to those patients who need it most. In partnership with Walgreens, Village MD will be offering patients access to primary care clinics spread across 500 to 700 stores in 30 underserved U.S. markets.
Better chronic care condition management, Barry said, means that providers need to be in constant touch with their patients — contact he says is made more accessible through Walgreens locations as a touchpoint. And those improvements, and the healthier patients they create, will, over the long term, lower the cost of healthcare for everyone.
Why It Takes A Village of Experts To Properly Manage Primary Care
Chronic-condition patients, living with diabetes, COPD or hypertension, aren’t on a part-time schedule such that their condition only affects them when they enter doctors’ offices. It’s something they live with 24-7 and primary-care providers signing on to the Village MD platform, he noted, are doing so because they want to be able to really structure patient care plans around that reality.
VillageMD aims to free up PCPs to provide that kind of care by a variety of mechanisms. It takes doctors out of the business of managing the byzantine billing systems that U.S. healthcare is famous for, Barry said, by paying them a salary while VillageMD takes on the world of billing Medicare, Medicaid and private insurance on the back end.
Barry also said that VillageMD offers access to a suite of telemedicine and digital-management tools that make it easier for doctors to do what they went into medicine to do — drive better patient outcomes through treatment. Barry added that true to the company’s name, VillageMD also makes doctors just part of a comprehensive care team that includes pharmacists, social workers and others who collaborate to ensure patients fully execute their treatment plans. This, he noted, allows the company to directly take on one of the bigger — and most expense-driving — challenges in patient care: non-compliant patients who don’t take their medicine or follow through on treatment plans once they leave a doctor’s office.
“The goal is to offer an access point to a comprehensive model that says: ‘For as long as you’re trying to manage a condition, we’ve got a team of people and we’ve got a set of technologies that are going to be working with you to make sure that we get better outcomes,” Barry said.
When that happens, he said, they see significant improvement in medication-adherence rates. And part of that is making sure that patients can afford their medications and that they know how to take their medications and they know what foods they should and shouldn’t eat when they’re trying to take the medicine. Getting the greatest efficacy out of the treatments, means that adherence rates increase.
Better adherence and more comprehensive patient management kicks in a virtuous cycle in terms of cost, Barry said. For example, when diabetic patients comply with doctors’ advice and take their medications properly, their blood sugar levels typically go down. They then have fewer serious medical complications that land them in the emergency room or admitted to a hospital and their overall health improves.
He said the incidence of high-cost interventions thus decreases, lowering the patients’ costs of care. Barry said such prevention is better for both the patient and the medical system as a whole compared to doing heroic interventions when someone’s condition has gone from chronic to critical.
The Walgreens Partnership And Building The Solutions
The U.S. medical system, after decades of dawdling with a problem that has been steadily building up, now finds it, he noted, as a “$4 trillion problem with inefficiency” and as such is finally looking ready to embrace the idea that major change is necessary.
It has to, Barry noted, as middle-income Americans, in the face of out-of-control cost growth, are seeing even moderately serious health issues taking a major bite out of their savings.
“We have to be comfortable as a society to acknowledge that if we spend $10,000 on healthcare, $3,000 of that might easily be coming out of someone’s paycheck because patients are paying for it,” Barry said. “We can’t ignore that. We have to acknowledge that this creates barriers to healthcare and creates barriers to access. We know the cost of healthcare in this country should not be more than the cost of a mortgage, but yet it is.”
And in low-income and other medically underserved communities where chronic-illness cases outstrip national averages, the situation is worse — the system is stranding patients with a physical lack of access to the care they need.
The Walgreen partnership, he noted, and the Primary Care clinics it will build, is the beginning of spreading out that access to a rebuilt PCP experience and wider scale. Unlike the “minute clinics” offering at an increasing number of CVS locations, the Village MD clinics aren’t meant to be alternatives to emergency rooms, useful though those types of facilities are. These, he noted, are creating access points for patients who might not otherwise have access to primary care services that are comprehensive and not entirely tied to episodic office visits.
Patients shouldn’t need to overcome the friction of finding a PCP and traveling to a major metro hospital an hour away from their homes. Barry said that to make primary care effective, it has to be easy to access in a variety of ways.
That’s because America can’t fix healthcare and its skyrocketing costs without fixing primary care for the demographic that uses it most and generates the vast majority of U.S. medical costs. Barry said healthcare can’t get healthy until it does a better job of keeping patients healthy over time.
“We should always be focused and incentivizing clinical outcomes,” he said. “We should be talking about … driving to a better experience for someone, because when they’re feeling good about the care they receive and motivated for additional positive behavior change, that improves their health. [That’s] a good thing for them — and good for them, as it turns out, is also what is good for the whole system.”