How Does Virtual Primary Care Work?

February 21, 2022

First Stop Health

The patient's experience in virtual primary care involves a combination of scheduled and unscheduled virtual visits and in-person healthcare services. 

1. Virtual primary care offers the flexibility of scheduled appointments and unscheduled virtual visits. 

Virtual primary care gives patients the opportunity to schedule appointments with a primary care physician of their choosing. Patients can then continue to see that same physician in the future, allowing for continuity. Scheduled visits are available during normal business hours. 

For unplanned urgent care needs such as a bladder infection or sudden rash, the patient has the choice of scheduling an appointment with their chosen primary care physician or requesting an immediate visit with one of the virtual urgent care doctors who are available 24/7. 

Regardless of which physician the patient sees, all the physicians share the same electronic medical record so they can view the patient’s past medical history and current medications.

2. Virtual primary care doctors order in-person lab tests for patients. 

Virtual primary care doctors order blood testing in patients for a variety of reasons. For diabetes, a Hemoglobin A1c blood test — which measures blood sugar control over several months — should be performed 2 to 4 times per year. For screening, a cholesterol level should be checked every several years. 

Virtual primary care doctors order in-person labs such as a Hemoglobin A1c or cholesterol test electronically via their electronic medical records system (EMR) to a free-standing lab such as Quest or LabCorp.  

There are over 4,000 Quest and LabCorp locations across the country that are in-network with most health insurance plans. The patient goes in-person to the free-standing lab of their choice and has their blood drawn. 

The results of the lab test are automatically sent back to the virtual primary care doctor's EMR via data feeds that have already been established. The virtual primary care doctor then communicates the results to the patient, explains the implications and discusses possible next steps. 

The lab will bill the patient’s insurance, the insurance network’s discount will be applied and the claim will be processed just like it normally would. If the test is for a specific diagnosis — such as the Hemoglobin A1c test in diabetes — then the patient would owe their out-of-pocket cost as dictated by the plan design (e.g., the copay amount). If the test is for preventive screening — such as the cholesterol test — then the patient would have 0 out-of-pocket costs since the test is part of the plan’s preventive benefits. 

3. Virtual primary care doctors refer patients to in-person specialist care. 

Virtual primary care doctors refer patients to in-person specialists in certain medical situations. For example, if a patient has an abnormal mole that is concerning, then the virtual primary care doctor may refer the patient to a dermatologist for a biopsy of the mole.  

While the First Stop Health (FSH) Virtual Primary Care practice does NOT bill insurance, the in-person specialist will. Accordingly, our Virtual Primary Care practice collects the insurance network information of the patient so the office staff can find an in-network specialist. 

The specialist referrals are also screened for cost, quality, location and appointment availability that is convenient for the patient. 

4. Virtual primary care doctors refer patients for in-person imaging. 

Virtual primary care doctors order imaging tests such as plain X-rays, mammograms and occasionally CT scans, MRIs and ultrasound scans. Like the lab ordering process, imaging orders are performed electronically and delivered directly to the imaging facility.  

Our Virtual Primary Care practice uses the patient’s plan information to order imaging only from in-network imaging centers that are also screened for cost, quality, convenient location and appointment availability. 

If prior authorization is needed for advanced imaging such as a CT scan or MRI, the virtual primary care practice will provide the necessary documentation to the insurance company to obtain the authorization. 

The FSH Virtual Primary Care practice will retrieve the results from the imaging center and circle back with the patient to discuss the results and next steps. 

5. Virtual primary care helps patients with prescription medication management.  

Primary care physicians can treat most conditions with low-cost, generic medications. First-line treatment for diabetes is a medication called Metformin which is generic and costs less than $5 a month. There are dozens of blood pressure medications, most of which are generic and cost less than $5 per month as well. Cholesterol-lowering statin medications are mostly generic and cost less than $5 per month. 

Prescriptions are ordered electronically by the virtual primary care physician to the pharmacy of the patient’s choosing. No hardcopy script is needed. 

If a brand-name medication that requires prior authorization is needed, the virtual primary care physician will work with the patient’s PBM (Pharmacy Benefits Manager) to prescribe the necessary step-therapy medication or provide the clinical documentation needed to obtain the authorization. 

The full scope of virtual primary care goes beyond the above description. However, one can see that virtual primary care is an innovative way to provide patients with the coordinated ‘medical home’ they deserve for their healthcare. 

This article is also available in video format. Watch First Stop Health's Chief Medical Officer Dr. Eric Bricker explain how Virtual Primary Care works. Click here to watch!

Learn more about our Virtual Primary Care solution 

Originally published Feb 21, 2022 6:11:58 PM.