As we close out an exciting year and celebrate our 4 new clinics and our new care management company, we wanted to reflect on the challenges facing value based primary care clinics in 2021 and share the lessons learned from our journey to change the way primary care is delivered. If we can address these challenges, starting with our independent hometown primary care providers in North Carolina, all our communities will all benefit from better health and lower costs!

1. Value Based Care Knowledge is ScarceThe only thing scarcer than a primary care provider in this country, is a primary care provider with a firm grasp of value-based care concepts like Hierarchical Condition Coding. Independent primary clinics are facing huge financial challenges, and value-based care can provide new revenue through shared savings and incentive programs to meet the challenge. Sadly, most independent practices aren’t familiar with this how to navigate these murky waters and keep their practice independent, and it is extremely challenging to change the way we care for patients, while caring for a massive number of patients due to the primary care shortage. The challenge seems to be worse in more rural clinics, who have had less attention from the insurance companies and the ACOs, even more patients in need, and therefore slower uptake on value based care concepts and the financial stability they can bring.
2. EHRs Make it Worse
   Value based care takes time. A provider might have to use ten ICD 10 codes just to properly report the severity of a patient’s diabetes! Ask and primary care physician about their challenges, and you will inevitably hear lamentations about the number of clicks required to get through a typical day, and all this is all in addition to helping patients manage chronic conditions and lead healthier lives. With the primary care shortage, 100% of a provider’s time should be devoted to caring for patients but sadly, a huge amount of time is spent documenting in the EHR. Add to this challenge the menagerie of fragmented EHRs on the market, and the lost productivity when a physician must change their EHR, and you have one of the largest challenges facing independent primary care. Plus EHRs are outrageously expensive. It’s like buying and iPhone 13 and getting a Motorola Bag Phone from 1988. Cary Medical Management helps by not changing each clinic’s chosen EHR, but much more needs to be done to simplify the documentation and risk assessment necessary to win at value-based care and reduce the cost of EHRs. Our technology partner Smartlink Health can integrate EHRs affordably without messy HL7 interfaces, building visibility on patient health and value across platforms that EHRs universally lack.
3. COVID Makes Everything Worse
   COVID keeps patients out of the office during surges and creates a back log of delayed care that primary care providers scramble to catch up in the valleys between the waves. Physicians go from extreme financial scarcity and insecurity to catastrophic patient volume, making it difficult to plan a patient’s care, execute risk assessment ICD coding, and deal with the clicky EHR. Patient’s also suffer with their own lay offs and financial scarcity, followed by re-employment and the desire to finally address their ongoing health concerns once they regain health insurance. Primary care practices struggle with the challenging safety, personnel, and supply chain landscape, and we’ve got a perfect storm of poorly conceptualized processes and systems that have zero resiliency to a global pandemic.
4.  Regulation is Stifling Innovation
   On an average day, and primary care has to deal with no less than 6 regulators. DHHS, FTC, DOI, DOL, DEA, and FCC. Not only do we have to invest heavily in EHRs, but we also have to invest in privacy, security, and compliance in a regulation environment more expansive and stricter than any other industry. Not that regulation is a bad thing, we need to protect health privacy, ensure proper prescribing, and provide a safe working environment, but massive amounts of regulation have been created to address systemic healthcare problems in the United States, and little of it was written with the challenges of a primary care shortage, the innovation of value-based care, and the scourge COVID in mind.
5. Competition is Key
   If we are to truly address the challenges of primary care and value-based care to build healthier communities, competition is key. We need organizations like Cary Medical Management to race with others to build value based care knowledge and support our independent primary care practices. We need EHRs to compete to simplify the risk assessment process, communicate with each other, and reduce the physician burden so physicians can focus on quality care. We need the payers to compete to earn patients, employers, and our primary care service to them. We need hospitals to compete to provide the best possible acute care to attract our business, not engage in anti-competitive shenanigans. When we all want to be the best at taking care of our communities, innovation will follow, and while regulation is challenging, the rules that keep healthcare and technology companies from monopolizing our communities and independent providers can fuel innovation needed to change the way healthcare is delivered.

2021 has been another challenging year, but we are excited about what’s to come for our healthcare system. Learning the tough lessons through our family of practices, we are building a brighter future through innovative technology and expertise learned through experience. Stay tuned in 2022. We’ll share the innovative solutions and comprehensive plans we’re developing through our growing experience in the North Carolina primary care market.