Coordinating Virtual Primary Care and In-Person Care

September 6, 2022

Emily Kunisch

When virtual care and in-person specialist care work in tandem, patients receive the best whole-person health guidance. With virtual primary care, patients can meet with a trusted doctor quickly and conveniently, whether it’s urgent, preventive or chronic care management that is needed. Virtual primary care can act as adjunct care and support the continuity of care even if a person uses a primary care physician (PCP) and provides better care coordination with in-network specialists.  

According to a recent Commonwealth Fund report, just 50% of American PCPs said there is sufficient coordination with specialists and hospitals for patient care plans.1 Compared to other high-income countries, the US falls far behind in care coordination. Here are some ways virtual primary care improves care coordination with in-person care:  

Care Management 

More than 50% of Americans live with a chronic disease and strong care coordination is essential for the management of ongoing conditions.2 Plus, people with a chronic condition account for 86% of healthcare spending.3 Virtual primary care supports the management of chronic diseases as people are more inclined to seek care due to its convenience: Patients can talk to a doctor via app, website or with a phone call. A better managed and treated chronic condition makes for more healthcare cost savings.  

Whether a person has a chronic condition or is searching for a hands-on healthcare experience, virtual primary care can: 

  • Coach and guide patients on new diets, medication, or other lifestyle modifications 
  • Order routine labs and screenings and review them with patients 
  • Coordinate appointments with a variety of in-network specialists 
  • Ensure medication adherence and compatibility 
  • Act as a gatekeeper and advocate for patients' health 

By managing in-person care, virtual primary care tracks and optimizes the many touchpoints of a patient’s healthcare journey.  

Closing the Referral Loop 

Seeing in-person specialists might be crucial for a person’s health. However, according to an analysis of EMR (electronic medical record) data of referrals from a large primary care network, “just under 35% of appointments have a documented completed specialty appointment.”4 Patients are being referred to specialists to support their health, yet they are not following through with appointments. Reasons for this include recommended specialists having long wait times (for example, a 22-day average wait time to see a cardiologist), being in a geographically inconvenient location or being out-of-network, which results in higher costs. There is also limited follow-up to encourage a patient to schedule an appointment when referred to a specialist.  

In a virtual environment, doctors can spend more time with the patient and find the right specialist for them. With the support of virtual nurses, patients receive specialist referrals based on their preferences (i.e., gender, age or race), geographic location, soonest availability and in-network status. Plus, a hands-on virtual team sends reminders for appointment scheduling to encourage patient accountability and even shares patient information with recommended specialists so they can reach out to the patient with sooner appointment availability.  

Importance of Referring to an In-Network Specialist 

Most doctors find it too challenging to figure out whether a specialty doctor is in-network for a given patient. In fact, 79% of doctors end up referring patients to out-of-network doctors, which causes patients to spend more on healthcare costs.5 An analysis found that patients who use care outside of their insurance plan pay from 118% to 1,382% more than in-network care.6 

Virtual Primary Care from Frist Stop Health is carved out from the medical plan which means better alignment and outcomes for patients. Patients are referred to in-network specialists to ensure they receive the best care at the best cost.  

First Stop Health (FSH) Virtual Primary Care 

FSH Virtual Primary Care delivers patient-first care to coordinate and manage the many touchpoints of members’ healthcare journeys. FSH virtual doctors focus on whole-person well-being care for members and keep the referral process managed to bridge together treatment plans, ensure medication adherence, and assist members when and where they need it. Plus, our nurses ensure that referred specialists are in-network, in a geographically convenient location and are taking patients in a reasonable timeframe.  

Learn more about our Virtual Primary Care solution

  1. https://www.commonwealthfund.org/publications/issue-briefs/2022/mar/primary-care-high-income-countries-how-united-states-compares 
  2. https://www.cdc.gov/pcd/issues/2020/20_0130.htm 
  3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5798200/ 
  4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5910374/ 
  5. https://www.healthcaredive.com/news/physician-referral-issues-causing-more-out-of-network-care/530726/ 
  6. https://www.cnbc.com/2015/09/30/the-much-higher-costs-of-out-of-network-health-care.html 

Originally published Sep 6, 2022 2:32:53 PM.