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Access Your Health Care Wherever You Are with Virtual Primary Care · Meaningful Medicine with Novant Health

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Amanda Wilde (Host): Meaningful Medicine is a Novant Health podcast, bringing
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you access to leading doctors who answer questions they wish you would ask.
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From routine care to rare conditions, our physicians offer tips to navigate medical
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decisions and build a healthier future.
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Join Meghan Huffman, Vice President of Digital Health and
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Virtual Care Network, and Dr.
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Roshni Patel, Chief Strategy Officer at Primary Care from Novant Health,
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as we talk about virtual primary care.
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I'm your host, Amanda Wilde.
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And Meghan, Dr.
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Patel, thank you so much for being here today.
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Meghan Huffman: We're so happy to be here.
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Absolutely excited to talk about this.
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Very important.
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Host: Novant Health is launching a 24/7 virtual primary care.
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Meghan, what problems were you aiming to solve or what needs were you looking
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to address with this new service?
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Meghan Huffman: Thanks, Amanda.
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I think it's so important that we always start at Novant Health with the
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problem that we're trying to solve.
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And if we look at what's happening right now, especially in North Carolina, 33%
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of our residents live in a rural area.
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And out of 1,700 people that we have in the state, there's
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only one primary care physician.
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And that's a big problem when we think about access and getting
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patients care to that access.
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And so, we said, "Okay, how are we going to do that?
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How do we get access to these rural areas?"
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We know, I use this analogy a lot, but I don't have a primary care physician
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tree in my backyard that I can go shake and physicians are falling off.
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If I did, I would use it, and I would put all these primary care physicians in
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person everywhere we could possibly do it.
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But that is not the situation that we have.
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Less physicians are going to medical school, less physicians are choosing
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to be primary care physicians, and the reality right now is we have to figure
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out how do we take the physicians we do have and expand that access all
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across our states in North and South Carolina to get patients the ability
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to talk to a primary care physician.
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And that's really the problem that we're trying to solve, and the goal that we
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have by launching virtual primary care.
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Roshni Patel, MD: The other side of that is also patients, right?
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So, how do patients want to access us?
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There are lots of different types of patients who want to
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access the healthcare system.
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And depending on what their constraints are, we are trying to help build options
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to help meet patients where they are.
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We definitely have a workforce shortage that is there.
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So, we definitely need to increase the amount of avenues for that access
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to be simpler, easier, and we really want it to be as patient-friendly,
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at the same time, clinically responsible, that we can build it.
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Host: Well, Dr.
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Patel, with that in mind, can you describe what virtual primary care
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is and how it's different from the telehealth visits that we're used to?
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Roshni Patel, MD: So, virtual primary care is a telehealth service, but
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it's a little bit different than what we call episodic care or maybe
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just acute care type of telehealth.
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In virtual primary care, we're really trying to build a longitudinal care
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service where patients are accessing us as a primary care clinician in order
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to provide that kind of longer-term service where you can reliably know that
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you can come and access us virtually.
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And we want to be able to make that a simple digital front door experience
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where you can have virtual primary care even past the traditional hours
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of our typical 8:00 to 5:00 clinics.
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Host: Now, Meghan touched on access as being a real motivator
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for virtual primary care.
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Dr.
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Patel, who is virtual primary care best suited for?
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I mean, who do you think will get the most out of this service?
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Roshni Patel, MD: So, going to answer that a couple different ways.
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One of them is kind of which style patient would be the right style patient?
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And so, I'm going to say that first from a logistical standpoint of, you
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know, the patients who are either I'm going to say schedule-y challenged;
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maybe they have very busy, hectic, work lives, and they cannot actually
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leave work to come in to see their primary care physician, but they do have
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some needs that need to be addressed.
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Maybe they're not acute or emergent style needs, but they're nonetheless
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things that are on their mind that they want to help discuss at a physician's
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office, but they just can't get there.
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So, that's one of the logistic kind of types of patients.
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You know, I think of people like busy moms or shift workers, and I say busy
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moms, but as in busy moms and dads, any parent who's trying to manage multiple
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schedules, it's quite challenging to sometimes take care of yourself.
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And so, that's an easy thought for understanding the style of patient.
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And then, also maybe older patients who have transportation issues or any
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patient who has a transportation issue where they can't physically come into
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the clinic in order to get that care.
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Meghan Huffman: I think the other nice thing is that our hours are so extended
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that it can really meet anyone's schedule.
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So if you really can't see a physician during a typical 8:00 to 5:00 when
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clinics are open, a lot of times your only option is to go to an urgent
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care or to go to emergency room.
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And the nice thing here is, that you can actually schedule an appointment
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at 8 o'clock at night if that's what's best for your schedule.
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And so, we want to make sure, just like Dr.
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Patel said, we're trying to meet patients where they're at and
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what's most convenient for them
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Host: Well, Meghan, do you envision primary care being
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replaced by virtual primary care?
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Meghan Huffman: So, this is always a tricky question when people talk
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about virtual care, and I never think that virtual care is ever going to
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replace the need of our in-person clinics and our in-person physicians.
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It is really just another tool in the toolbox to where we can reach patients,
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we can give them the care that they need.
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And it's really about what is clinically most appropriate for
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the service that we're delivering for what the patient needs.
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And that's really our main focus, is to say sometimes virtual visits
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are the right clinically appropriate for that particular patient.
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And there's other situations where that's not always true.
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But we want to make sure that we at least have that offering for
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when it is clinically appropriate.
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And when patients do want it, we're able to offer that service.
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Host: Dr.
6:13
Patel, what kind of health needs can be handled virtually?
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Roshni Patel, MD: The best types of health needs that can be met are, you
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know, the easiest ones I think of are, for example, chronic conditions, patients
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who are diabetics or have high blood pressure, maybe high cholesterol, any
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mental health need discussions that can be done well in a virtual space.
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There are certain things that, you know, just truly can't be.
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A physical exam, like your annual physical exam.
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You can do parts of a physical exam visually through a virtual setting.
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But then, there are certain parts that just cannot be correctly
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done, competently done, thoroughly done in a virtual setting.
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And so, you know, we don't anticipate this type of service to
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completely replace anything that can be done in an in-person setting.
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But there is going to be a lot of those, what I call them, chronic conditions
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or things that are consistently occurring to that patient where we
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can help discuss, navigate their care needs, help understand kind of what
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are their next steps, maybe medications that might need some adjustment.
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Those sorts of things are the best ones.
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Host: As we talk about managing chronic conditions through virtual
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primary care, are there examples of conditions that may benefit from earlier
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intervention through virtual access?
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Roshni Patel, MD: I think prevention medicine is an
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excellent example of that, right?
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So, let's say, somebody in the family recently had something happen with
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their heart and you're wondering, "Oh my gosh, is that going to be me next?
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How do I help figure out what are the types of things that
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we need to talk through?"
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Let's understand and update things like their family history, and
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then we can talk through what are the evaluation points needed.
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And again, all of that evaluation cannot occur during the virtual space.
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But at least, the right discussion is completed and then the right
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maybe testing that needs to be ordered, the orders get placed.
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And then, the next steps can be taken off of that.
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Host: Now, you mentioned that virtual care does not replace in-person
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care, but what kinds of symptoms or concerns still require in-person care?
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And how does a clinician decide when a patient needs to be seen in person
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rather than a virtual primary care visit?
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Roshni Patel, MD: True emergencies, just like if you called my clinic
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today, my brick-and-mortar clinic, the first message that you get, whether
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it's Novant Health or any other health institution, is, "If this is an emergency,
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please hang up and call 911," right?
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So, emergencies themselves cannot be managed correctly in the virtual space.
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If I'm evaluating a patient, and this is true whether this is
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brick-and-mortar or in-person, at some point in that evaluation, I have to
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understand, "Can I, in this current setting that I am in, manage this
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person's healthcare needs fully?"
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And if I cannot do that, right, whether you're in person or virtually, then my
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job is to help say, "Wait," and then help get them to the right next steps.
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And part of the beauty of being within a system like Novant Health
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is we have so many tools and services at our disposal that I can help
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patients get them to the right place to get them the right clinical care.
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But I want to say, Amanda, it's a clinical radar that we have running at all times.
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So, what I mean to say is it's not true just in the virtual setting.
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It's true in all settings.
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Host: In the virtual setting, if a patient needs lab work or imaging or, as you
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mentioned, going to another specialist or a different referral, how is that handled
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in the virtual primary care setting, Dr.
10:13
Patel?
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Roshni Patel, MD: Right.
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If you were seeing me as a patient, I would have completed your evaluation.
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We would have talked through what those next steps are.
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If it involves lab orders and/or imaging, I would place those orders.
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And then, you would be directed to the in-person facility site
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to get those things completed.
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If that was labs, that might be a separate lab facility.
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And then, imaging, of course, would happen at imaging places.
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Host: And then, Meghan, will virtual primary care patients have an ongoing
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relationship with a care team, or will they see a different clinician every time?
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Meghan Huffman: This was a really important part of us, of our decision
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when we launched virtual primary care.
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We wanted it to be as close as that in-person longevity
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relationship as possible.
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And so, the way we've set this up is that any time a patient comes to
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virtual primary care, once they see that physician the first time, it'll
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automatically show up in their myChart to where they can continue to have
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follow-up visits, an ongoing relationship.
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We think that's a really, really important piece of offering any kind
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of healthcare from a primary care lens, especially in the virtual space.
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We want patients and that caregiver or that physician to know each other,
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and have that relationship and be able to book a quick visit and know, "Dr.
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Patel's going to take care of me.
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We know each other.
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They know my history.
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They know the backstory."
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That is critical and very important.
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So, we have set that up in a way that you should expect when you
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come to virtual primary care that will be your ongoing physician.
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Roshni Patel, MD: I think that continuity is really important.
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So, I'm going to say as a primary care physician myself, you know, we
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work hard in our brick-and-mortar clinics to help make sure patients are
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being able to have the access to see the same person through their care.
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We also want to make sure that's happening in the virtual primary care setting.
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And truthfully, you know, the conversations are what create that bond
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or that relationship, and that's going to be true whether that's through a
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virtual screen or if it's in person.
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Host: So, it is possible to have that really personal feeling and privacy
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with your doctor through a screen.
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Meghan Huffman: Yes.
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Absolutely.
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Roshni Patel, MD: It's not just possible, but it is the goal.
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I was laughing to say, you know, we've gotten so comfortable now
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culturally to allow relationships to build through a screen.
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I'll say even my family, like if I call anybody in my family, we FaceTime them.
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I don't just pick up the phone and do an audio call, because it is
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really nice to have that second enhancement of adding video with that.
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Host: Well, Dr.
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Patel, because this does work so well on that level, do you envision
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virtual primary care eventually replacing traditional primary
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care brick-and-mortar offices?
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Roshni Patel, MD: There's always gogoing to a part of human care that needs human
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in-person to human in-person interaction.
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There is something incredibly special about that and that's not
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going to go away no matter how advanced technology ever gets.
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There is something just about, you know, humanity, itself and the comfort that
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you will get with another human near you.
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Host: Meghan, this is not Novant Health's first venture into virtual care.
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What have you learned from providing more than 500,000 virtual visits so far?
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Meghan Huffman: This was one of my favorite questions that I saw
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on this for the podcast today.
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I get so passionate about this space.
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I think it's important to kind of take a little bit of a step back
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to say, right now, the healthcare industry is really saturated with
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direct-to-consumer healthcare tech companies and consumer companies in
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a way we've never really seen before.
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And we've noticed a lot of companies out there offering they can be your
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primary care specialist, or they can provide virtual urgent care or menopause
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care or weight management care.
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And we looked around and we said, "Wait a second.
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We have some of the best physicians in the world.
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You know, why are we not doing this?
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We should be able to offer patients the same type of service, except
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for, in our humble opinion, better," because we have health system.
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We've been doing this for a really long time.
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And so, we did start a virtual menopause clinic, which has
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been unbelievably successful.
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We're able to meet so many women where they're at, women who never thought they
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would be able to have a conversation with a physician who is an expert in this space
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that we're able to provide that care for.
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And what we've learned is that the patients coming to Novant Health's
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virtual services are not just super easy.
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We're going to hand them HRT, or we're going to hand them GLPs.
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We're going to do another script fill.
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That is not the service that we're providing.
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We are really taking care of these patients in a holistic manner,
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and we're not just treating whatever you come to us for.
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So if you come for menopause or come in for virtual primary care, we're
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looking at you as a whole person.
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And Dr.
15:07
Patel referenced this earlier.
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We're saying, "Okay, we've got your labs back.
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Maybe something's come, and you need to see someone in cardiology,
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or you need to go see oncology."
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We've had so many cancer patients also come through, really complex
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patients, and we're treating them holistically and getting them to the
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right next space in this beautiful way where we're packaging up the notes.
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It's all in the same EMR.
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We're having doc-to-doc conversations before you get to your next appointment.
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I think that's the beauty.
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And what we've learned through this is we're able to take care of the whole
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person, even if this is just how they came through that initial front door.
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There's so many more avenues.
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So, we've learned that, first and foremost.
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And second of all, we've just learned that convenience really makes the difference
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of someone keeping their appointment.
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We've seen so many women say, "I just kept scheduling appointments and putting
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it off and canceling and rescheduling.
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But when this virtual option came by, I was able to do it during my planning
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period at school," or "I was able to do it right before I went to pick the kids
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up" or, you know, whatever their story may be, this really just gave them an
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avenue they didn't have before to just take control of their own healthcare.
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So, we've learned that the patients love it.
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We've also learned the physicians love it.
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It's a very easy way for physicians to spend that one-on-one time
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with their patients without having other distractions.
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And not that our brick and mortars are always distracted, but it is just a quiet
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time that you can have that conversation.
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So, we've learned a lot, and we've learned that this is something that
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we have to do as a healthcare system.
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Roshni Patel, MD: I think through our virtual offerings, I honestly
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think people felt like it was going to be another way in which
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healthcare is going to get fragmented.
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But in my opinion, I actually think it's one of the better ways in which
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we've been able to help connect the dots better and actually help the
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patient get connected to the next steps along their healthcare journey.
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I feel like, in a lot of the avenues for care that we've offered patients,
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a lot of times patients are getting the feeling of fragmentation.
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Because at any single point, it feels very incomplete, the torch didn't
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get passed along to the next stop.
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At the same time, you know, just like in brick and mortar, we want
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the patients to come back in, and we want that avenue to be fast and easy.
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And I think that's also one of the things that virtual visits
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has been able to help diminish.
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That is that time to come back in and touch the healthcare system, get the next
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piece of advice to like, you know, again, move that torch along in the journey.
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So, my additional comment is that one of the things I think we learned is that we
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are able to help reduce the fragmentation by offering solutions like this.
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Host: That's interesting because you mentioned, Meghan, how Novant Health
17:59
has expanded into some specialty areas like menopause care, preventive
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cardiology, and weight management.
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And I think what you're saying, Dr.
18:06
Patel, is the successes you have seen in those programs sort of informed this new
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virtual primary care offering, making it more holistic rather than more fragmented.
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Meghan Huffman: Yeah, I think you're spot on with that.
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It's something that we've really taken seriously to make sure that
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patients don't feel like we're dropping the ball or that there's a gap.
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And I think a lot of this goes back to what we started with, what's the problem
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we're trying to solve, and that's access.
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We're trying to make sure patients don't have to wait so long to
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get in to see a specialist.
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And a lot of times, we're able to augment some of that by having some
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virtual visits up front to start getting the ball rolling, start getting
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that next step happen where we can get labs going, we can get images
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going, we can make sure patients are getting to the right next spot.
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And I think that's a really important piece of what we're trying to really hone
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in on with all of our virtual specialties.
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And you're starting to see these getting specific like menopause or like weight
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management, and soon to come headache or sleep, is that we want patients to see
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the right type of physician at the right time so that we're not wasting anyone's
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time or anyone's expertise as we go along.
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And I think that virtual care is a really good avenue to be able to get
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some of that done on the forefront as we're figuring out what are
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the right next steps for patients.
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Host: Meghan, Novant Health is partnering with K Health to bring this virtual
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primary care service to patients.
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What does that partnership look like and what does this mean for patients?
19:32
Meghan Huffman: Yeah.
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So, we started to partner with K Health.
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We looked at some of the technology that they have around their AI capabilities.
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And what they showed us was, is that they're able to do a virtual dynamic
19:43
intake with patients prior to their visit to really start to ask some of
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those questions that would normally get asked in a brick-and-mortar by a nurse
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or a CNA that's rooming the patient to kind of get that background information.
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What are you coming in for today?
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It's dynamic in its answer.
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So based on the answer you gave it before, it is going to
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ask another type of question.
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And then, at the end of that, it's going to summarize all of it and put it right
20:07
in front of the physician so that way that physician can get a quick summary
20:10
of what you just said, intake that information, and be very ready and present
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for whenever that visit's to start.
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And we really like that capability from K Health.
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And they have opportunities that we can start to create AI intakes
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for several different types of specialties, just to help the
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visits go along a little bit faster.
20:27
We still need our nurses.
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We still need our CMAs.
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That's not going to change.
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But this is just another tool in their toolbox to help us, you
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know, get patients' information a little bit quicker, get it
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summarized for the physicians.
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We really like that.
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Also, K Health provides another tool that we've been using called PatientGPT.
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We're calling it Aubrey.
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And so, Aubrey is our AI navigator here at Novant Health.
20:51
It can help answer your questions, can get you to that right level of care.
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And so, when you ask a question, and it really does need to be answered
20:58
by a physician, we can connect you right then and there to virtual
21:01
primary care or to a brick-and-mortar if that's what your preference is.
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So, we're really excited about the technology and the partnership
21:06
that K Health brings to the table.
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Roshni Patel, MD: I'll add from a clinical lens, our partnership with
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K Health has really been a success because one of the things that K Health
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has done, they are a tech company at heart; however, they are very invested
21:21
in making sure they're building a tech product that's built responsibly from
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a clinical angle, and that is something that was very refreshing to see.
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I will say sure, there's lots of efficiencies and things like that are
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going to happen because of tech advances.
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But to be able to have a partner that's allowing, you know, that clinical
21:41
responsibility to stay at the forefront of each project is quite different.
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And I think that is what helped that partnership be a success.
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Host: Now, I know we talked about this earlier about accessibility and what kind
21:57
of patient might benefit from virtual primary care and has a lot to do with
22:01
scheduling and transportation issues.
22:04
But just to sum up, Dr.
22:05
Patel, how should patients decide whether virtual primary care is right for them?
22:12
Roshni Patel, MD: Part of my answer is you don't know until you try, right?
22:15
So if you've never had a virtual visit before, I think part of it is, you
22:19
know, just understanding kind of what does that mean to have a virtual visit.
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They will be pleasantly surprised to be able to see the value and the
22:28
quality of care that is able to be delivered from a virtual setting.
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I'm not sure that there is an automatic yes or no answer there.
22:37
The yes or no answers most of the time come from our clinical radar again.
22:43
You know, there are true things that really just cannot be
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completed in a virtual setting.
22:48
True emergency interventions cannot occur in a virtual setting, right?
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So, I think the not right for you for a virtual visit has to be much more
23:01
of a clinical radar type of question, and that's where we believe the tools
23:06
like our PatientGPT Aubrey Navigator is going to be a helpful way for you
23:14
to understand should we be directing you to virtual care or should we not?
23:18
Host: Well, I'd like to end by asking you both this question,
23:22
maybe starting with you, Meghan.
23:23
Is there anything else patients should know before their first
23:27
virtual primary care visit?
23:29
Meghan Huffman: Yeah.
23:29
So, kind of like I was mentioning earlier, there is an AI intake,
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so we're asking patients to get to their virtual visit about 15 minutes
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early so they can complete that intake and be prepared for the visit.
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The other thing is just a reminder for patients that this is an office visit.
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It is a professional situation.
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And so, having a little bit of that patient conduct as it relates to don't
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be driving in the car trying to take your visit, don't do a virtual visit with a
23:56
lot of distractions in the background.
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You want to make sure that you're in a HIPAA-compliant environment.
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You need to be someplace that we can see you, that we can hear you.
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You need to be dressed appropriately.
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So, I think those are some things just to remember.
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We know you're sick or we know you don't feel good.
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But, you know, come to that visit prepared just like it would be in person, so that
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way we can give you as the patient the best clinical experience that we can.
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Roshni Patel, MD: And I'll add in there that, over the years, there's
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been a desensitization to what occurs or the expectations of what
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should occur in a healthcare visit.
24:30
And when I say desensitization, as in, you know, sometimes people
24:35
will equate the 15-minute timeframe that they have allotted for a visit
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with a healthcare provider as equal to me getting grocery, you know,
24:45
picking up milk at the grocery store.
24:47
That is fine time-wise, it may be approximately equal.
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But we have a lot of very important things that we are going to be discussing.
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And so, you know, we want to make sure that patients also understand that we
25:02
want them to be fully understanding that the respect is both ways.
25:07
We want them to understand that we very much value and we want to make
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sure that the clinical decisions that we're going to be giving them, the
25:15
navigational advice and guidance that we're going to be giving them, we're
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giving that to them with respect to their needs in a very personalized and
25:25
customized fashion, and that takes time.
25:28
That also takes a lot of expertise and learning.
25:30
So, it may not feel very hard and fast every single visit, you know, and it
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shouldn't be that it's only valued when somebody's life is on the line, right?
25:41
Every single visit should have that same sort of value and respect both ways.
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Host: I think we're learning that there is a lot of thought being put into this,
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a lot of respect, and a lot of expertise.
25:54
Thank you both so much for helping us understand the basics and the
25:57
complexities of virtual primary care.
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I wish you continued success with this wonderful program.
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Roshni Patel, MD: Thank you.
26:04
Meghan Huffman: Thanks, Amanda.
26:05
Host: To find a physician, visit novanthealth.org.
26:09
For more health and wellness information from our experts,
26:12
visit healthyheadlines.org.