Keith A. Reynolds 0:00
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Speaker 1 0:24
So, I would say this, in combination with the national shortage of primary care as a whole, as well as shortages in many specialties, has really led to urgent care truly becoming this front door to healthcare for many Americans and

Austin Littrell 0:51
Welcome to Off the Chart, a business and medicine podcast featuring lively and informative conversations with healthcare experts, opinion leaders, and practicing physicians about the challenges facing doctors and medical practices. My name is Austin Luttrell. I'm the associate editor of Medical Economics, and I'd like to thank you for joining us today. In today's episode, I sat down with Dr. Andrea Giamalva, Chief Medical Officer at Experty, to talk about how urgent care has quietly become the front door to healthcare for a growing number of Americans. We get into the data behind the primary care shortage, where the relationship between urgent care and primary care tends to break down. How technology can get the right patient to the right place at the right time, and why she believes AI-enabled tools may finally bring some humanity back to the exam room. Andrea, thank you so much for joining us. And with that, let's get into the episode. Andrea Gianelva, thank you so much for joining me today.

Speaker 1 1:42
Yeah, great to be here.

Austin Littrell 1:44
Before we get started, could you take a moment and introduce yourself and Expertity Health?

Speaker 1 1:48
Sure, I'm the Chief Medical Officer at Experiment Health. Experimentity is the leading platform for on-demand health in the country. So, what we do is we provide AI-enabled technology that serves the entire patient and provider journey, that includes EMR, patient engagement, practice management, RCM services, teleradiology, and even one packs, so very robust. And my background is I'm a family medicine physician by training, and spending most of my time really in the urgent care space, since that is the majority of the work that Xperity does.

Austin Littrell 2:20
Great, yeah, and I guess just to kind of jump into that, we will be talking about urgent care and kind of its relationship to primary care. Could you talk a little about how the role of urgent care in the American health, American healthcare system has changed over the last decade, and where you see it kind of heading in the future?

Speaker 1 2:37
Yeah, I'll actually start a little further back. So urgent care really started kind of in the 1970s but was formalized and more kind of standardized in the industry from the 1990s to the 2000s so not a young industry per se, but also not an old industry. So, needless to say, though, it has proven to be one of the most innovative in its time. So, mostly starting with emergency medicine physicians, it did pivot to a more broad spectrum of training over time. So now we see a lot more family medicine, internal medicine, pediatrics, as far as kind of the training pathway leading into the urgent care space. So I would say this, in combination with the national shortage of primary care as a whole, as well as shortages in many specialties has really led to urgent care truly becoming this front door to healthcare for many Americans, and so that means that patients are presenting for more than maybe just a cough or a cold or a scrape or a cut, they're coming through the urgent care doors or maybe entering into a telehealth visit with a question that could lead down many paths, right, is it an urgent care visit? Is it kind of a primary care visit? Does this pivot to a specialty care visit? Do you just simply need ancillary services? So, really, that is kind of the crux of what the changes that we're seeing. But, in addition, many clinics are now changing their offerings to things like employer-paid services, maybe even per member per month models, where they are kind of an open door to employers that have chosen to pay a set fee, and their employees can just present to those doors at any point in time for whatever they might need, and also some considerations for other adjacencies, like weight loss therapy, hormone therapy, mental health services. So it's really no longer just that kind of cough and cold clinics, they're multi-channel digital front door access come with your care needs, and we'll find the right path forward for you. That's really what the face of these clinics is today.

Austin Littrell 4:28
Great, and I mean, you kind of touched on it there with, with obviously the clinician shortages and all aspects of healthcare. How much of that growth and urgent care do you think reflects a genuine consumer preference for convenience versus just patients who you know can't get in to see a primary care doc.

Speaker 1 4:42
Yeah, I mean, without like a directed, you know, direct to consumer survey per se. I think the best way to answer this is really just look at the market data we have, and so there is clearly a generational shift happening in patients choosing a PCP or not. So the percentage of patients that do not have a PCP. Is definitely increasing generationally, so what we see is around 10% of baby boomers don't have a PCP, so that leaves, you know, 90% do. Then we pivot to Gen X, and it's, you know, reaching about 20% that don't have a PCP. By the time you get to millennials, it's around 30% and really have a really strong preference for what we would consider what we call retail clinics, which can be, you know, that urgent care experience, and then finally you get to Gen Z, and the data is showing nearly 40% don't have a PCP, so they are choosing to not have a PCP, or to your point, simply don't have access, because the access piece is the other market data that we know and understand, which is that some studies estimate that shortages anywhere from 20,000 all the way to 80,000 primary care providers will be evident by 2037 So we're like 1011 years away from a major national shortage, and we're feeling the pain of that already. Furthermore, there's just healthcare deserts across the country, and interestingly, these are the areas where there is an increased presence of urgent care. So a healthcare desert from primary care perspective might be the kind of ideal location where an urgent care will pop up and meet the needs of those patients. Now, pivot to what is the patient kind of demand and expectation. Well, we're living in what we'll call the Amazon Uber DoorDash world, right? This has kind of been created for us as a culture, and it's maybe the first time that healthcare is actually stepping up to the demands of the culture and so what that looks like is is you know recognizing that the patient demand for convenience and access and so stepping up and being that kind of Amazon Uber Door Dash experience but still providing excellent quality care and ultimately you know insurance plans do vary from a cost comparison perspective, but there's no question that urgent care is way more cost effective than an emergency room visit, and so when it comes to, like, should I go to the emergency room versus urgent care, the cost comparison is a no-brainer, and unfortunately, it's very hard for the primary care world to respond to this on-demand expectation, just simply because of the pressures that primary care faces, like I mentioned, I'm a family medicine physician. I spent 11 years managing a panel of nearly 3000 patients. I completely understand the pressures that primary care is facing and the difficulty to get those needs met day in and day out.

Austin Littrell 7:15
Great, and that's a really interesting point. I mean, I really think it is. It's a cultural shift there, looking for that more convenience, that's an interesting angle. I want to talk about how primary care and urgent care can work together, and kind of that relationship there. How do you see that relationship and primary care, urgent care functioning together in a well-designed healthcare system? Where does that relationship work well versus where does it break down or kind of have hardships?

Speaker 1 7:39
Yeah, I think the most difficult area for healthcare to grasp is getting the right patient to the right place at the right time, and the reality is that if we are coming up to a significant supply and demand issue in America, we have to recognize that there are some patients that truly need the full breadth and scope of a primary care practice and all of the benefits that it can provide in terms of case management, chronic care, kind of follow up, consistent kind of walking along that path in that journey with the patient, versus a very straightforward, otherwise healthy patient that maybe takes one or two medications and maybe would have a best fit for this kind of on demand, almost like urgent care type experience, and so really we're at a crux in, you know, in time where we must leverage technology to ensure that this trifecta of the right patient to the right place at the right time happens, and if we can make that happen, we could see where settings like primary care and urgent care can truly meet the needs of the patients, and not getting, you know, the urgent care patient in the primary care setting, or the primary care patient in the urgent care setting, and this could be the first time in the history of the healthcare industry that patients are truly getting the care they need in a timely manner, and we're not getting bogged down in one, you know, location versus another, but really, in the ideal state, I think primary care services can happen outside of a designated primary care office, and the way that can happen is if places like urgent care sites have the tools and the support necessary to support things like their chronic disease management, preventive care needs, anticipatory guidance, and maybe even pivoting the patient to that higher level of care when it's indicated. That's a pretty tall order for the typical urgent care setting today, so certainly work still needs to be done for this to be done well, and it really, it looks like kind of risk stratifying patients to where the more complex, time-intensive visits should probably stand in that realm of primary care, and the more straightforward patients can be managed in the urgent care space, and that could be the answer to helping meet these demands faced by primary care today, it's, it's really, you know, in a lot of ways a very unreachable target or goal with the current supply and demand constraints in the primary care setting.

Austin Littrell 9:49
Great, yeah, and I mean we just talked about it there, I mean, obviously primary care stretched thin, like every aspect of healthcare is stretched thin, right, but I mean, especially so in primary care, um. Um, what ways could a well-run urgent care infrastructure actually reduce that burden on primary care physicians, rather than maybe add to care fragmentation, and you know, patients going one place and then coming to another? And

Speaker 1 10:10
right, I think you know the communication is key. So, making sure that there is a conduit by way there is clear communication between what is happening for that patient across their entire patient journey, so keeping that patient context clear, and that making sure that clarity is present to anybody that is caring for them first and foremost. In addition, you're not wrong, primary care physicians are stressed extremely thin. There was a study done in the last couple of years where they basically confirmed that it would take 27 hours a day for a primary care physician to actually manage the panel of patients they're expected to manage, undoable, right. So, essentially putting the right tools in the hands of the providers that are taking care of their patients. So, I'd love to give more tools to primary care as well, but as we look at the urgent care space and how they can help support it, really pivots back to when that patient is front and center and in their office and exam room, how can we help close care gaps, and how can we deliver the right type of care to the right type of patient? Again, not overstepping our bounds into the really, you know, complex patients that maybe need that case management support and need that more, you know, holistic, thorough, you know, type of approach that primary care can provide, but really being a partner along the way, you know, enough of this, like their world, our world, it's all of our world in terms of taking care of these patients.

Austin Littrell 11:28
So we talked about the kind of that cultural shift, obviously. You know, I like that you call it like a DoorDash type of world. Could you talk a bit more about how patient expectations around access and convenience have changed, and what does that mean for urgent care and primary care, and kind of how they think about the patient experience.

Speaker 1 11:45
Yeah, I mean, expectations are really high, and you know, when you pause and think about it, the stakes are way higher in healthcare. We should really be holding ourselves to an extremely high standard when it comes to the patient experience. The patient experience has opportunity to kind of make or break that final outcome for the patient as well, if they have a poor experience, if they don't trust the healthcare provider that engaged with them, if they don't trust the process, they may not follow through on the recommendations that were provided, and that may result in a poor outcome for them. And really, for the longest time, healthcare has lagged behind in terms of this patient experience, and it's, you know, a time, a shift in healthcare, in terms of how we approach the patient, as well, to where we actually think of them as the customer. It's really difficult to adjust and change that mindset, however, because there is such a uniqueness and just kind of special rarity between a patient and provider, or patient and physician, and that that word "patient" is so very unique and special to us in healthcare, but we do have to step back and recognize they're also customers, they have a choice, they can choose where they go. So, how can we engage with them in a way that is exceptional and helps them have the best possible outcome? So, you know, we've developed tools such as Care Agent. Care agent is an agentic tool that kind of helps walk alongside the patient throughout their entire journey. I kind of liken it to, you know, you place an order for a pair of shoes and you immediately get a text message that the order has been received, or you kind of start to get the steps along the way outlined for you, or that you know the path that your shoes are on. Why can't we have the same for ourselves in healthcare? And so that's really what we've been diving into is we've been developing this tool, which is super exciting. So, really following the patient along that entire journey, and then we pivot to thinking about the in-clinic experience technology, like the AI Scribe technology we're developing, where we can seamlessly transform these office visits back into these true human interactions, so all while still providing, you know, stellar documentation, appropriate patient insights, and follow-up plans, but really bringing that humanness back into the equation that's been pulled away for far too long in the kind of last decade of data entry on behalf of clinical staff.

Keith A. Reynolds 14:02
Hey. hey there, Keith Reynolds here, and welcome to the p2 management minute. In just 60 seconds, we deliver proven, real-world tactics you can plug into your practice today, whether that means speeding up check-in, lifting staff morale, or nudging patient satisfaction north. No theory, no fluff, just the kind of guidance that fits between appointments and moves the needle before lunch, but the best ideas don't all come from our newsroom, they come from you. Got a clever workflow hack, an employee engagement win, or a lesson learned the hard way? I want a feature. Shoot me an email at K reynolds@mjlifesciences.com with your topic, quick outline, or even a smartphone clip. We'll handle the rest and get your insights in front of your peers nationwide. Let's make every minute count together. Thanks for watching, and I'll see you in the next p2 management minute.

Austin Littrell 14:53
You touched on the technology there, obviously, with things like AI scribes and AI in every form. Feel like are there operational or technical or technology driven efficiencies that urgent care has developed out of a necessity, you know, they're moving a lot faster than maybe primary care practices could realistically adopt.

Speaker 1 15:12
Yeah, I mean, I think that much of the technology could easily cross over, but the difference still being kind of that supply and demand constraint in primary care, so a lot of times they're just kind of digging themselves out of a very deep hole of a lot of work and a lot of kind of administrative burden. So certainly there's tools that will start to kind of help make that a reality, I think, in the primary care space. The interesting thing is that urgent care has always had the ability to be more flexible with scheduling, you know, they're the clinic that's ready for the patient's expectations for care in this Amazon era, because they've always been this retail healthcare experience, they've always been doors wide open, really just come in, come, come as you are, come in, you know, when you're able to, and so they kind of had the upper hand for several decades now, and so as we think about this on-demand approach, it's really been part of the DNA of urgent care since the start, so I think an area that primary care can learn from, and maybe adjust accordingly, is kind of this hybrid approach that might be more realistic. So, really, risk stratifying the right patients to the right place at the right time, and then the care should proceed as follows. So, timely, effective, kind of just right for the patient's needs is really the direction that all areas of healthcare need to go, and that's also kind of a hard pill to swallow in primary care as well. I can completely relate to, you know, being a little more comfortable when I looked at my schedule and saw that I had some of my quote unquote easier patients for the day, but the reality is, is it probably would have been better for me to see the more complex chronic patients and allow some of those patients to be seen in a different care setting when we think about the capabilities and the accessibility and the availability of where care providers are in this day and age, so again getting back to that right patient, right place, right time, and leaning into technology to allow us to do those risk stratifications.

Austin Littrell 16:54
Great. And just to clarify, when you say kind of those in the right place, you mean like telehealth, as

Speaker 1 17:00
yes, yeah, could be that it just seems a telehealth visit, that it needs, you know, an urgent care type centric visit that it needs the full complement of primary care, right. So, if we think of these kind of like leveling up of the patient and recognizing the right location they should get to, I can't help but think of, you know, certain days on my schedule in primary care where it was a breeze, and that's fine, right? Some of us need a little bit of an easier day at times. Physicians work very hard to get the work done, and I get that, but we also have to recognize that if we are coming up on a time when there is going to be a significant supply and demand issue, we will have patients that are forgotten or lost in the shuffle, and so if we can really right size the type of patient visit that needs to happen and get them within the right context of the right provider setting, and again, that could be telehealth visits, that could be, you know, a quick in and out visit at the urgent care setting, or a more complex and robust visit in the traditional primary care setting.

Austin Littrell 17:55
Great, how should urgent care and primary care be thinking about their respective lanes, especially as advanced practice providers are taking on larger roles in both settings.

Speaker 1 18:07
Yeah, so advanced practice providers are absolutely advancing in both settings and across the industry, which is a very exciting time, but also an opportunity for us to step back and ensure that the right tools and the right support are in place. So, I think about, you know, the primary care model, and does it make sense to have, you know, a lead physician with a team of advanced practice providers, and that team is kind of the extension of their network of expertise and care, care, you know, quality, and being able to provide for those care gaps, etc. And then we pivot to the urgent care space, and really, if we are, you know, thinking more about the getting the patients in and taking care of more than just the coughs and the colds, we really should be thinking about that network perspective as well, where we're maybe not meeting the needs to the extent that primary care is, in terms of, you know, extremely complex patients, or, you know, care care continuity issues, and working with care coordinators, etc. but we have a team that consistently is able to take care of those patients that have, like, the top five, you know, diabetes, hypertension, hyperlipidemia, thyroid conditions, maybe, you know, in women, osteoporosis, or maybe they're able to take care of those most common complaints for women's health or for men's health, so really thinking about kind of segmental distribution of like how and when and where can these patients get to these teams, but ultimately making sure that those teams are well trained and well prepared. So I think it's really important to provide clarity around the provider and staff expectations, and once that clarity is in place, we can be very certain about where the patient should be seen, and how we're going to provide that care for them.

Austin Littrell 19:43
When a patient uses urgent care repeatedly, but doesn't have an established primary care relationship. I mean, you talked about that, obviously, that's a lot more, you know, as we're seeing with Gen X and millennials and Gen Z. What responsibility does the urgent care side have to help close that gap, if any? And where do the.. what are the practices? Barriers to doing so.

Speaker 1 20:01
Yeah, this is a really interesting question, because there's multiple aspects of the patient journey and the patient context to actually consider. So, first off, the patient has to be willing to engage in this care gap closure, right? They have the final say in the care that they want. So, if they showed up and they have a sore throat and all they want to talk about is their strep diagnosis, we have to be cautious to not force them or push them in some other direction that they were not expecting to go, because we could push them far enough away that they just don't want to see a doctor again, and that's, you know, first, do no harm. We don't want to be creating a context in which a patient doesn't feel safe or comfortable presenting to another clinic. Additionally, there's unfortunately very specific payer relationships between urgent care clinics and payers, and so in some contracts, for example, urgent care clinics are prohibited from providing preventive care, specifically, you know, primary care, or even closing care gaps. So this is clearly a barrier that has to be either overcome by contract negotiation or some recognition in the industry, in the market, that there will be times that urgent care might, you know, work towards closing care gaps, even if it's not explicitly in the contract, and also, you know, many providers in the urgent care space, they've entered this space with an expectation about the type of care they'll be providing, so if the goal or the plan would be to move forward with care gap closure opportunities, like when the patient presents, that means urgent care clinics and organizations have to kind of consider their culture and maybe adjust some expectations around the clinical staff that's kind of gets back to the clarity I was mentioning earlier, so we really want to make sure that they have the tools necessary to engage, but also that they're the types of providers that are ready and empowered to, you know, step into those care gaps with the patients and making sure that they're comfortable with that, more primary care directed care, so really the opportunity is huge, but there are some of these kind of constraints that we have to think about and really consider. Sometimes, you know, large organizations are making these choices, but sometimes it's individual clinics, and so there's just a lot of moving parts along the way to make sure that we can actually make this a successful opportunity for patients,

Austin Littrell 22:01
excellent. Is there anything that I didn't ask about that you think we might have glossed over, or just that you'd like to share with the audience?

Speaker 1 22:08
Yeah, I mean, I think just that AI-enabled technology is more than just the latest fad. I really do think that for the first time in a long time we can actually use technology to bring humanness back into this patient provider experience, because really, for far too long, you know, technology has kind of progressively chipped away and taken away human interaction and the ability to like really get better and more work done, and it's kind of created more burden and more administrative load, and in some ways taken away capacity to see more patients and get the work done. So I really think the time is now, and it's such an exciting time to be here for the journey ahead, for what's coming in healthcare.

Austin Littrell 22:44
Excellent, Andrew Giammalva. Thank you so much again for joining me today.

Speaker 1 22:48
Yes, it was great to be here

Austin Littrell 22:53
once again. That was Dr. Andrew Giamalva, Chief Medical Officer at Experity. On behalf of the whole medical economics and physicians practice teams, I'd like to thank you for listening to the show, and ask you, please subscribe, so you don't miss the next episode. As always, be sure to check back on Monday and Thursday mornings for the latest conversations with experts, sharing strategies, stories, and solutions for your practice. You can find us by searching off the chart wherever you get your podcasts, and if you'd like the best stories that Medical Economics and Physicians Practice published, delivered straight to your email six days of the week, subscribe to our newsletters at Medical economics.com and Physicians practice.com Off the chart, a Business of Medicine podcast is executive produced by Chris Mazzolini and Keith Reynolds and produced by Austin Latrell. Medical Economics and Physicians Practice are both members of the MJH Life Sciences family. Thank you.

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