HFS Research, in partnership with UST, explored the healthcare ecosystem’s primary care and rehab segments to understand opportunities to reverse the decline in all attributes of the triple aim of care (cost, experience, and health outcomes). The study interacted with over 100 clinicians and administrative leaders across women’s health, mental health, pediatrics, substance abuse, cardiac rehab, and physical therapy. Key insights indicated the under-adoption of operational tech (electronic health records/ EHR and revenue cycle management/RCM), clinician interest in driving engagement to improve health outcomes, and payment transformation heading towards subscription and out-of-pocket transactions. This study anchored an illuminating discussion with over a dozen healthcare providers addressing primary care and rehab (see Exhibit 1), leading to the top ten actionable insights.
Exhibit 1: Round table participants from left to right and top to bottom representing US primary care and rehab providers: Rohan Kulkarni, Joel Martin, Melissa O’Brien, Steve Dunkerley, Gautam Khanna, Danielle Lamphier, Scott Schweiger, Sunil Athayil, Dr. Chris McCulloh, Chris Pace, Leslie Graham, Saurabh Tandon, Dr. Natasha Bhuyan, Heather Weeks, Sarah Ealy, Dr. Tamara StClaire, Sabu Bose, Luc LaFontan, Anand Nair, Velnette Fenker, Suja Chandrasekaran, and Raj Gorla
Practitioner perspective drove 10 key insights that must inform us in the future
-
Health consumer—who dat?: Health plan members, patients, employees, and customers are all avatars of health consumers and must drive the shift from sick (patient) to healthy (consumer). Instead of this lexicon, it is crucial to simply reference individuals as health consumers. This simplification can restore agency and reduce paternalism in healthcare.
-
Segmentation will be critical to optimization: Healthcare needs, clinician and health consumer communication preferences, and technology adoption vary by generation and must be included in care delivery. Increasingly tech-savvy seniors prefer to see the same clinicians, while Gens X and Z are willing to see any available primary care physician (PCP). Segmentation and equitability go hand in hand. You must leverage your data and insights to improve how you engage your health consumers and provide them with information, services, and care.
-
Nurses positively impact telehealth and mobility: The expanded use of nurses to handle telehealth calls, remote patient monitoring, triage, and coordination of care is becoming common . As nursing and telehealth services extend into rural areas via technology, they must facilitate their knowledge and capabilities with the tools they use and the information they prescribe.
-
Communication is key to healthy outcomes: Language and communication should be tailored to consumers , emphasizing convenience, access, and personalized care. It is crucial to help caregivers communicate using straight talk about their patients’ care, treatment, and outcomes. Avoiding complex medical terms and providing simple explanations—with empathy—will educate health consumers and improve outcomes.
-
Care is rarely the issue: It is the before and after abrasion that must be addressed with urgency by reducing wait times, making appointments (phone, portal) easy, eliminating duplicate forms, reducing the noise of over-communicating an upcoming appointment, and improving the follow-up to show empathy and give health consumers a reason to engage. Care is treatment, reducing frustration and unneeded friction, enabling providers and health consumers to achieve better results across the
quadruple aim of care (triple aim of care plus health equity).
-
Tech must enhance the relationship: Technology in healthcare is streamlining the administration but has separated parties due to a lack of equity, education, and accessibility. To bring clinicians and consumers closer, we must capture and extract data better and apply it more equitably. The promise of GenAI tools is high here as their application can help with assessment, triage, documentation, and collaboration. Technology won’t cure the patient, but with educated partners, it can improve the quality of care.
-
Overcome data fragmentation: Siloed health consumer data may be more acute in primary care, where discrete health care occurs. The industry must improve its data-sharing standards and strive to provide data access and analysis without disrupting the confidentiality of the care provided by PCPs and rehab… beyond the acute care setting. Better data will improve trust, privacy, and security across the medical system.
-
Tech can enable better caregiving: A vision for going beyond using technology to document and classify is essential. Technology, health consumer analytics, and AI must be expanded for clinicians to gain more holistic insights as they reduce administrative burden, improve in-person consumer interaction, and better synthesize data from different sources to improve diagnostics and care.
-
The value perception is different: Clinicians and consumers perceive value differently. Incentives (value-based care, rebates for nonsmokers) have not translated into better outcomes (across the triple aim). While a solution at scale is unlikely, improving health IQ can empower consumers to take more control of their health and care drivers.
-
Direct payment models can exacerbate equity: Clinicians are likely to connect with health consumers who have the resources to buy into concierge or subscription models, further reducing access to those with fewer resources. Health equity must be factored into direct payment models to ensure health consumers will continue to have access to care regardless of resources.
For reference, the technologies underpinning our use of the term “AI and automation” include robotic process automation (RPA), intelligent document processing (IDP), process and task mining, machine learning, generative artificial intelligence (GenAI), predictive and prescriptive analytics, low-code/no-code platforms, and APIs. In the context of this research, we use the phrase to connate critical technologies that can complement and extend the capabilities of fincrime compliance professionals.
The Bottom Line: Primary care and rehabs must urgently adopt technologies and reimagine their consumer engagement approach.
Primary care and rehab are the bookends of the care delivery continuum, with arguably the most long-term impact on preventing disease and maintaining health. Despite significant evidence to that effect, there is insufficient attention at multiple levels in the US due to declining PCP count, insufficient technology usage, lack of health consumer engagement, and deficit resource utilization. As the current demographics bring us to an inflection point, there is an opportunity to readdress the underserved PCP and rehab clinicians and leverage technologies to do more than capture data and document.
