Primary Care: Healthcare’s Front Door and the Urgent Care Opportunity

Vertical: Primary/Urgent Care
Author: JC Lupis
Date: July 2019

Who Controls Healthcare’s Front Door?

Primary care practices are now in a fierce battle for control of healthcare’s front door and face competition from numerous fronts. For example, retail health clinics are proliferating – estimated to already number at least 2,800 – and recent news indicates that CVS will open 1,500 HealthHUB stores over the next 2 years. Meanwhile, primary care practices must also contend with competition from telemedicine startups, such as American Well, and larger companies such as Apple, which is rolling out its own employee clinics.

A recent survey found that 45% of 18-29-years lacked a primary care physician (PCP) (compared to 28% of 30-49-year-olds), with the authors noting that “many young adults are turning to a fast-growing constellation of alternatives.” All told, visits to PCPs fell by 18% between 2012 and 2016, despite an aging population that should necessitate more primary care visits. Primary care providers are tasked with devising models that meet patients’ demands for convenience while also developing trusting relationships.

Urgent Care Gains Steam

A key development in the primary care space has been the increasing role of urgent care centers (UCCs): estimates place urgent care at almost one-fifth of all primary care visits. The urgent care industry is rapidly growing, climbing from 6,100 centers in 2013 to 8,774 as of November 2018. The sector is benefiting from payment models that encourage use of lower-cost outpatient settings, as well as heightened consumer demand for UCCs, which offer greater convenience in the form of shorter wait times, lower prices, and walk- in care.

There is an opportunity for primary care providers to partner with UCCs. In today’s new era of patient centricity, primary care providers able to offer after-hours care will be best-positioned to respond to patients’ ever-increasing demands for convenience in healthcare access points. Moreover, UCCs can act as a first point-of-entry for patients: according to the Urgent Care Association, more than one-third (35%) of patients seeking care in a UCC in 2017 were unaffiliated with a primary care physician or medical home.

The PCMH Offers An Opportunity

Partnerships between urgent care and PCPs also allow for an integrated care model that bridges retail medicine and primary care. One such model is the patient-centered medical home (PCMH): a team-based approach in which primary care providers coordinate comprehensive, patient-centered, and accessible care. This type of model – which offers convenient after-hours care and a bundled payment system – fits well in a healthcare system that is moving away from the fractured fee-for-service model.

UCCs are excellent partners for primary care practices in the PCMH model. PCPs can shift acute care patients to affiliated UCCs, allowing PCPs to focus on preventative care and the chronic care examinations that offer more favorable reimbursements. At the same time, sending overflow patients to affiliated UCCs typically results in greater efficiency and cost savings.

Developments in medical record technology have enabled greater communication between providers groups in the PCMH model. This control over healthcare data is crucial to seamless comprehensive care delivery and also proves beneficial to patients, who are better able to track their health information.

Primary Care Market: Key Data Point

One-quarter (25%) of patients do not have a regular primary care physician.

Source: Association of American Medical Colleges

Primary Care Market: Key Chart

Percentage of Physicians in Physician-Owned Practices, in 2018

GHA-Primary-Care-Practice-Employment

GHA’s Primary Care Market Brief includes the following sections:

  • Primary Care Market-At-A-Glance
  • Primary Care Market Developments
  • Key Primary Care Market Data
  • The Mergers & Acquisitions Landscape

To inquire about a copy, please contact research@ghadvisors.net.