PRIMARY CARE IN THE NEW HEALTH ECONOMY: TIME FOR A MAKEOVER - PWC

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PRIMARY CARE IN THE NEW HEALTH ECONOMY: TIME FOR A MAKEOVER - PWC
Primary care in the
                                New Health Economy:
                                Time for a makeover

Health Research Institute
November 2015

At a glance
Rather than playing its
historical role as gatekeeper
to a splintered array of
specialties, primary care
has to become the nexus,
providing simplicity, value
and better health outcomes.
Table of contents

The heart of the matter................................................................. 2

Executive summary...................................................................... 2

An in-depth discussion................................................................. 4
    Why primary care needs a makeover: Consumers and other purchasers
    want better convenience, quality and cost ...............................................4
        CVS Health: Onward and upward in the New Health Economy...........5
    Today’s segmented primary care market: Newcomers and innovative
    approaches displacing traditional practices.............................................7
        Iora Health: Putting value back into primary care one
        relationship at a time.........................................................................9

A la carte primary care.............................................................. 13
        Hispanics: Primary care’s consumer mavericks................................15

What this means for your business............................................. 16

Conclusion................................................................................. 19

Endnotes.................................................................................... 20

Acknowledgments...................................................................... 22
The heart of the matter
The primary care market is poised for a makeover. Faced with new payment
models and an aging population with chronic conditions, the health sector looks
to a reimagined primary care ecosystem to help deliver on the promise of value.

Executive summary                             An in-depth analysis by PwC’s Health      Key findings
                                              Research Institute (HRI) suggests         HRI interviewed 25 executives
An impersonal, splintered healthcare          forecasts of looming physician            from industry, trade associations
system confounds consumers and costs          shortages—perhaps 90,000 by               and academia and surveyed 1,500
more and more each year. Overall,             20253 —are based on outdated care         clinicians and 1,000 consumers on the
the nation spends $3.2 trillion1 on           delivery models. In the New Health        future of primary care and found that:
medical care with mixed results.              Economy, with the emphasis on
By 2020, 81 million Americans are             giving purchasers greater value for       • Purchasers are banking on
expected to suffer from multiple              their healthcare dollar, do-it-yourself     primary care to save money.
chronic health conditions,2 further           consumers and integrated care teams         The US government is pumping
taxing the system. Revving up the             armed with a black bag of virtual tools     billions of dollars into primary care
role of primary care—with digital             are poised to reinvent primary care         improvement and innovation.4
technology, a focus on prevention and         and close the gap.                          Employers are igniting change by
expanded roles for non-physicians—                                                        adding lower cost, more convenient
offers a cost-effective remedy.               Primary care must synch up with the         primary care options: 48% of
                                              pulse of the American people and            employers will make telehealth
After decades of being undervalued            assuage the twin pressures of cost          services available to employees
in a fee-for-service system that              and competition in the health sector.       in 2015.5
emphasizes transactional medicine             Incumbent players with a desire to
at times of distress, primary care is         succeed over the long term will look to
poised for an extreme makeover. The           new entrants to help them adapt in a
time is right for its true worth to be        vastly changed market.
revealed—and rewarded.

“We need to flip the system on its
head,” said Nancy Gagliano, MD,
senior vice president at CVS Health                An in-depth analysis by PwC’s Health Research Institute
and chief medical officer of                       (HRI) suggests forecasts of looming physician shortages—
CVS/minuteclinic.                                  perhaps 90,000 by 2025—are based on outdated care
Rather than playing its historic                   delivery models. In the New Health Economy, with the
role as gatekeeper to a scattered                  emphasis on giving purchasers greater value for their
array of specialties, primary care                 healthcare dollar, do-it-yourself consumers and integrated
has to become the nexus, providing                 care teams armed with a black bag of virtual tools are
simplicity, value and better health
                                                   poised to reinvent primary care and close the gap.
outcomes. That will mean taking risks
and challenging old assumptions.

2   Primary care in the New Health Economy: Time for a makeover                                            Health Research Institute
• Consumers are selecting primary               Recommendations                           • Pull it all together: The future
  care that fits their lifestyles. As           As the health sector undergoes rapid        of care will be based on a triage
  busy individuals take on greater              transformation, health systems must         system that rearranges the
  responsibility for their health bill,         reimagine primary care to stay ahead        traditional patient office visit to the
  many by-pass the family doctor. Yet           in the New Health Economy. This HRI         most-appropriate, least-expensive
  about eight in 10 consumer survey             report recommends four strategies           clinicians and sites of care.
  respondents said they would be                for competing:                              Successful companies will offer a
  open to non-traditional ways of                                                           combination of services through
  receiving basic medical attention.            • Know what you’re good at and              a primary care ecosystem that
                                                  whom to serve: Traditional                embraces the health needs of the
• New entrants are disrupting the                 healthcare organizations need to          whole person, rather than isolating
  health industry with innovative                 inventory strengths and identify          one acute problem for attention.
  primary care models. Newcomers                  consumer targets. Consumers
  offer convenience and value to                  want multi-dimensional health
  consumers and purchasers through                interactions with a broad team of
  five modern options: convenient                 experts. Since there is money to
  care, house calls, at-your-service              be made in all consumer markets,
  care, digital health, and nurse-led             look beyond health status and
  care.                                           consider location, income, age and
                                                  individuals’ health and wellness
• Some traditionalists are adapting
                                                  priorities when deciding how to
  to stay relevant: About one-third
                                                  staff up and build clientele.
  of physicians told HRI they have
  changed their business model                  • Explore new roles: Nurses,
  to adapt to changing models of                  pharmacists, behavioral health
  care. Some have started providing               specialists and other non-physicians
  entirely new services to compete                have big roles to play in progressive
  with new entrants on virtual                    primary care models such as
  care and one-stop-shopping                      patient-centered medical homes,
  conveniences such as co-locating                accountable care organizations
  care team offices with lab, imaging,            and at-your-service care practices.
  physical therapy and other                      Primary care teams that explore
  complementary services.                         new roles are expected to surpass
                                                  others.
• Seven core consumer markets
  are emerging. Companies must                  • Partner where it makes the most
  cater distinctly to seven major                 sense: One-third of physician
  consumer markets identified by                  practices are partnering, or
  HRI by delivering a la carte care to:           planning to partner, with industry
  the frail elderly, consumers with               newcomers such as retailers,
  complex chronic disease, consumers              telecommunications companies and
  with chronic disease, consumers                 data companies that use tried-and-
  with mental illness, healthy                    true approaches to expand their
  families, healthy adult enthusiasts             market footprint. New entrants are
  and healthy adult skeptics (See                 also teaming up. Partnerships with
  Figure 5, page 14).                             community organizations such as
                                                  schools, churches and community
                                                  centers should also pay off.

3   Primary care in the New Health Economy: Time for a makeover                                             Health Research Institute
An in-depth discussion

 New approaches to primary care for            models from scratch and then swiftly      half of Americans have at least one
 the old, young, sick and well may             expanding their footprint and services.   chronic disease and 52% are at risk for
 reshape the health sector by giving           (See page 5: CVS Health: Onward and       developing one.8 The United States tops
 consumers and purchasers the choice,          upward in the New Health Economy).        the list of most obese countries.9
 service and quality they want—at
 more competitive prices. Industry             A recent HRI survey of 1,500 clinicians   Why the reluctance to visit
 newcomers—many of whom never                  suggests that some pioneering             the doctor?
 attended medical school—are shaking           practices acknowledge that competing      Today’s consumer wants on-demand
 things up, offering care anytime              with industry newcomers requires a        service, whether purchasing a sweater
 anywhere. Even some traditional               new set of tools. Nearly one-third of     or playing a song. But try calling the
 primary care practices realize                physicians said they have changed         doctor’s office and hours can pass
 that, to survive, they must rethink           their business model to respond to        before a human connection is made.
 their approach.                               non-traditionalists in the market         By then, many have gone to the
                                               and about one-fifth said they have        emergency department for a quick fix
                                               started providing new services such as    at a higher cost.
“We need to flip the                           virtual visits and one-stop-shopping to
                                                                                         Even when an appointment can
                                               compete with them.
 system on its head.”                                                                    be made, the travel-and-wait time
Nancy Gagliano, MD, CVS Health                 And people want these new easy and        generally far exceeds the five or 10
                                               affordable services. An HRI survey of     minutes spent with an overextended
                                               1,000 consumers found that 81% of         physician. Wait times to see a
 At the same time, the US government,          respondents would be open to              family practitioner average 19.5
 employers and health plans—with               non-traditional ways of getting           days, surpassing wait times of other
 the objective of reclaiming value for         medical attention. Those options          specialists including cardiologists (16.8
 their health dollars—are nudging the          would include retail health clinics,      days) and orthopedists (9.9 days).10
 industry toward new payment models            virtual visits, clinician house calls,

                                                                                           81%
 that reward smarter, more                     do-it-yourself home diagnostics and
 cost-effective approaches to clinical         remote monitoring through a medical
 care and overall health.                      device or smartphone app.
                                                                                           Consumers open to non-
 The result is primary care with               Why primary care needs                      traditional care delivery
 a modern twist predicated on                  a makeover: Consumers
 technology-enabled care teams, new            and other purchasers want
 care sites, data-driven decisions             better convenience, quality               Even best-in-the-field care is not worth
                                                                                         the wait, according to two-thirds of
 and superior customer service. Such           and cost
 sophisticated personalized attention                                                    consumers responding to the recent
 can detect health problems early,             Americans often postpone critical         HRI survey. Consumers are fighting
 monitor chronic conditions and                early care. When chronic disease          back, demanding convenient care that
 prevent costly and invasive treatments        goes unmanaged, the results are           provides value for their dollar.
 later. Instead of merely bending the          devastating. Each year chronic disease    Fifty-four percent said they would not
 cost curve, new entrants are trying           causes 70% of deaths in the US6 and       travel farther for the best care and 81%
 to shift healthcare costs along a             accounts for 86% of the nation’s $3.2     said they would not pay more.
 different curve: building new care            trillion in healthcare spending.7 About

 4   Primary care in the New Health Economy: Time for a makeover                                             Health Research Institute
CVS Health: Onward and upward in the New Health Economy

CVS Health made its primary care debut in                  CVS Health believes convenient,                          offering infusion services to patients
2006 when it opened its first retail clinic.               community-based care is important to                     with chronic diseases such as rheumatoid
Almost a decade later, the company now                     extending the traditional primary care                   arthritis, multiple sclerosis and cancer
owns and operates nearly 1,000 clinics and                 practice’s reach. “Diabetic patients are                 in their own homes and in more than
partners with more than 60 health systems                  inside of a CVS pharmacy six to eight times              85 locations nationwide, including 65
in 25 states to deliver primary care. Half of              per month,” she said. “But they typically                outpatient centers.iv
the country now lives within 10 miles of a                 only see their primary care provider once
CVS/minuteclinic.i                                         a quarter.”                                              Earlier this year CVS Health announced
                                                                                                                    a partnership with direct-to-consumer
Yet CVS Health is not necessarily looking                  CVS Health also fills data gaps between                  telehealth giants American Well,
to take the place of the traditional primary               retail care settings and its partner health              Doctor-on-Demand and Teladoc to offer
care provider. Through its health system                   systems. If a patient from one of its                    consumers and its health system partners
affiliations the company aims to become                    partners seeks care at a CVS/minuteclinic                even more options for primary care.v As
part of a community-based care model that                  anywhere in the country, the patient                     a reflection of its broader commitment
“maximizes the impact of primary care                      may have his record sent to his primary                  to care delivery, CVS Caremark changed
physicians, allowing them to coordinate                    caregiver.iii                                            its name to CVS Health in 2014, casting a
a patient’s care across various sites,” said                                                                        message to the industry that the company
Nancy Gagliano, MD, senior vice president                  But retail clinics are just the beginning for            is in it for the long haul – and a force
of CVS Health and chief medical officer of                 CVS Health. While most health systems                    beyond the prescription business.
CVS/minuteclinics.                                         still worry about losing primary care
                                                           office visits to more convenient walk-in
In fact, CVS Health and a group of eight                   retail clinics and debate how to compete
family medicine associations – including                   with them and whether to partner, the                       Half of the country
the American Academy of Family                             company has leaped ahead into offering an                   now lives within
Physicians – announced in November                         expanded array of care services.
that they will collaborate to improve care                                                                             10 miles of a
coordination between traditional                           With its purchase of Coram last year, the
                                                           retailer turned health company began
                                                                                                                       CVS/minuteclinic.
primary care practices and pharmacy-
based retail clinics.ii

CVS Health strengthens its foothold in the primary care market

       2006                                2009                                       2014                                         2015
       • Opens its first                   • Establishes first CVS/                   • Purchases company                          • Announces plans to buy
         retail clinic                       minuteclinic health                        Coram, expands into                          and rebrand Target’s
                                             system affiliations                        infusion centers and                         pharmacies and clinics
                                                                                        home infusion                              • Partners with Teladoc,
                                                                                      • Changes name to CVS                          American Well and
                                                                                        Heath to solidifiy the                       Doctor-on-Demand
                                                                                        company’s broader
                                                                                        emphasis on care

i.      Data shared with HRI by Nancy Gagliano on November 10, 2015.
ii.     CVS Health Announcements: Ehley B “Political Pulse: Examining the latest in health care policy every
        weekday morning” November 13, 2015 http://www.politico.com/tipsheets/politico-pulse
iii.    PwC Health Research Institute. Healthcare delivery of the future: How digital technology can
        bridge time and distance gaps between clinicians and consumers, 2014.
iv.     https://www.cvshealth.com/about/history
v.      “CVS Health to Partner with Direct-to-Consumer Telehealth Providers to Increase Access to Physican Care” CVS Health, August 26, 2015,
        https://www.cvshealth.com/content/cvs-health-partner-direct-consumer-telehealth-providers-increase-access-physician-care

5       Primary care in the New Health Economy: Time for a makeover                                                                             Health Research Institute
In fact, more than one-third (36%)                                    Primary care physicians are not being                          Without a strong primary care
of consumers with a primary care                                      effectively deployed. According to the                         backbone in the health system, the
physician told HRI that they have                                     HRI survey, they spend more than                               emergency department—the highest
also gone to a retail clinic such as                                  one-third of their time doing                                  cost setting for outpatient care14 —
Walgreens or Target for treatment                                     something other than providing                                 continues to be overused. On average,
of ear aches, sore throats, cuts                                      medical care. Tasks include discussing                         37% of these visits are for non-urgent
and broken bones, and even some                                       social barriers to care and behavioral                         services.15 One study projected that
monitoring of chronic disease. An                                     health issues with patients and                                $4.4 billion could be saved annually if
overwhelming majority (95%) have                                      performing administrative work.                                these visits took place in retail clinics
been satisfied with the care.                                                                                                        or urgent care centers.16
                                                                      Only 23% said they are highly
Allegiance to one primary caregiver                                   satisfied with how frequently they                             After years of primary care erosion,
is waning in today’s healthcare maze.                                 are able to work at the top of their                           the US government and other
Only about half of consumers said                                     training and 40% said they refer                               purchasers are recognizing the
that it was very important that they                                  patients to specialists somewhat                               value that has been lost. Rather than
have one clinician to coordinate all                                  regularly because of staffing and time                         bolstering the old model, however,
their medical needs and the needs of                                  constraints rather than a health issue.                        the push is toward using technology
their family.                                                                                                                        and consumer preferences to find
                                                                      In fact, family practitioners, general                         new approaches. The US government
The other half—including the 81                                       internists, pediatricians and                                  is pumping billions of dollars into
million Americans that will be living                                 obstetricians and gynecologists—                               primary care improvement and
with multiple chronic conditions by                                   traditionally referred to as primary                           innovation (See Figure 1).17
202011—require a care hub to manage                                   care providers—deliver a fraction of
a wide variety of health issues. When                                 overall primary care services today.                           New payment models such as
5% of the population consumes 50%                                     Higher cost medical specialists such                           the National Council on Quality
of the healthcare dollars,12 something                                as cardiologists and pulmonologists                            Assurance’s (NCQA) patient-centered
has to change. Primary care providers                                 provide up to 40% of primary care                              medical home model and Medicare
could be the change agents, but not                                   services in the US to treat the growing                        accountable care organizations also
using the traditional model. Each                                     number of Americans with conditions                            focus on revving up the role of primary
patient requires more attention                                       such as diabetes, congestive heart                             care.18 Models such as these might
than physicians alone can cost-                                       failure and chronic obstructive                                get a lift from recent legislation that
effectively provide.                                                  pulmonary disease.13                                           persuades physicians to practice in an

Figure 1: The US government is pumping billions of dollars into primary care improvement and innovation

                       $1.6b                                    $11.8b                                         $3.6b                                         $11b
                   Workforce training and                       Reimbursement and                        Medicaid annual wellness                      New community health
                       loan support                               quality bonuses                                 visits                                     centers
               New primary care training                       Increase primary care                       Cover the cost of annual                  Establish community health
               programs, including loan                    reimbursement rates and new                   checkups and preventative                   centers and expand primary
             repayments and scholarshipsi                    bonuses for Medicaid and                     care services for seniorsiii                care services in federally-
                                                                     Medicareii                                                                       qualified health centersiv

                                          $322m                                            $10b                                   $240m
                                        Comprehensive Primary                       Center for Medicare and                     Primary Care Extension
                                           Care Initiative                           Medicaid Innovation                               Program
                                     Reduce hospital readmissions                  Develop innovative payment                   Educational support and
                                      and emergency room visitsv                   and care models, including                     assistance to increase
                                                                                         primary carevi                        preventative care servicesvii

i.,ii.,iii.,vii.   Abrams, M, Nuzam, R, Mika, S, and Lawlor, G “Realizing Health Reform’s Potential” The Commonwealth Fund (January 2011)
iv.                US Department of Health and Human Services “Health Centers and the Affordable Care Act” http://bphc.hrsa.gov/about/healthcentersaca/index.html and “HHS awards nearly
                   $500 million in Affordable Care Act funding to health centers to expand primary care services” September 15, 2015 http://www.hhs.gov/news/press/2015pres/09/20150915a.html
v.                 Hancock, J “Mixed Results for Obamacare Tests in Primary-Care innovation” Kaiser Family Foundation. January 30, 2015; http://khn.org/news/mixed-results-for-obamacare-
                   tests-in-primary-care-innovation/
vi.                Centers for Medicare & Medicaid Services “The CMS Innovation Center” Accessed October 23, 2015 online at https://innovation.cms.gov/initiatives/#views=models

6        Primary care in the New Health Economy: Time for a makeover                                                                                               Health Research Institute
alternative payment model to achieve          HRI examined five emerging models         calls diminished from 40% of all doctor
higher reimbursement.19                       in today’s primary care market:           visits to 1%.22 Rather than becoming
                                              Convenient care, in-home care,            extinct, however, new companies
Employers are igniting change too.            at-your-service care, and                 are finding that there is value in
Some large employers are now                  nurse-led care.                           repurposing old-fashioned care for the
adding lower cost, more convenient                                                      contemporary patient-consumer.
primary care options—such as virtual          Convenient care is well ingrained
care—to employee benefit packages.            through retail health clinics and         Although many HRI-surveyed
Forty-eight percent of employers will         urgent care centers that many             physicians expressed reluctance at
make telehealth services available to         consumers rely on in lieu of an           home visits, consumers are ready for
employees in 2015.20                          appointment with their regular            it. According to the HRI survey, nearly
                                              doctor. Visits to these clinics tripled   two-thirds of consumers would be
The case for change in primary care           from 2010 to 2014, and the six largest    interested in having a clinician treat
is evident. This report explains how          retail chains have put over 1,600         them at home. And new companies are
a segmented market of traditional             such storefronts on the streets.21 An     forming to meet this market.
healthcare organizations and new              overwhelming number of consumers
entrants is responding by bringing            (95%) are satisfied with the care,        Home care offers fresh alternatives that
innovation to the market and                  and the steady flow is reducing           may prove increasingly competitive,
competing for customers.                      unnecessary visits to emergency           especially among the elderly. A
                                              departments. Physicians in traditional    successful government model is
Today’s segmented                             practice that HRI surveyed concede        paving the way for private businesses
primary care market:                          that these sites have increased access    to bring healthcare back into the
Newcomers and innovative                      and patient satisfaction.                 home. The Centers for Medicare
approaches displacing                                                                   and Medicaid (CMS) found that
traditional practices                         Cleveland Clinic, Texas Health            participants saved over $25 million
                                              Resources, and Kaiser Permanente          in the first year of its Independence at
Modern players in primary care                are partnering with retail health         Home Demonstration—an average of
A growing ecosystem of companies              clinics to extend their reach into the    $3,070 for each of the 8,400 Medicare
that have primary care capabilities           community. “Now the hospitals and         beneficiaries that participated. CMS
is disrupting the market with                 health systems are knocking on their      also noted fewer hospital readmissions,
business models that bank success             doors to partner versus the other way     more follow-up contact, and less use of
on convenience, good service and              around,” said Tine Hansen-Turton,         inpatient and emergency department
evidence-based protocols. The menu            executive director of the Philadelphia-   services for chronic conditions.23
keeps growing across physical and             based Convenient Care Association.
virtual realms, offering a broader team
of clinicians and community-based             These health systems use retail
collaborations that are tailored toward       clinics to triage patients with lower
                                                                                           “Just as the health food
consumer preferences.                         acuity health issues away from more           aisle once had 100
“Just as the health food aisle once
                                              expensive mothership locations. Some          items and now has
                                              are also developing joint programs
had 100 items and now has 1,000,              to manage patients needing chronic            1,000, primary care is
primary care is now being segmented           disease management.                           now being segmented
down to more and more options,” said
Chris Stenzel, senior vice president          House calls are coming back in                down to more and
for business development and                  modern forms, including an                    more options.”
innovation at Kaiser Permanente, who          Uber-like model of providing
                                                                                            Chris Stenzel, Kaiser Permanente
is responsible for the health system’s        on-demand service through a
retail health strategy.                       downloaded app. In a 50-year stretch,
                                              from the 1930s to the 1980s, house

7   Primary care in the New Health Economy: Time for a makeover                                            Health Research Institute
Using slightly different models, many         enters notes into the electronic health     care that insurers typically do not
health industry startups are providing        record. If additional clinical support is   cover, including wellness coaching
in-person visits with the ease and            needed, the paramedics have                 and integrative services such as
swiftness of on-demand smartphone             real-time audiovisual teleconnectivity      acupuncture and naturopathy to
apps. One company in New York                 with Geisinger emergency                    complement medical care. It often
City, Pager, uses Uber to dispatch            physicians.26                               partners with employers or insurance
doctors and practitioners for $200.                                                       firms in half a dozen major cities. The
The startup recently announced a               The program has reduced the rate           company’s founder, Dr. Tom X. Lee,
partnership with Walgreens to expand          of admissions and ER visits for heart       both a physician and an MBA, has
the retailer’s virtual care services in       failure patients by 50%, lowered the        created a model that cuts in half the
New York City and San Francisco. 24           30-day hospital readmission rate for        average number of patients seen each
An app called Heal can be downloaded          heart failure by 15%, and prevented         day by primary care physicians from
to bring a doctor to the house for a          an estimated $2.1 million in charges        25–30 to 15–16.
range of nonemergency services such           that Medicare would not have
as treating strep throat and stitching        reimbursed. Geisinger reported 100%         Lee claims that One Medical does
lacerations.                                  patient satisfaction with the program.      this at one-third the cost of a
                                              A similar program exists in Canada          traditional practice by reducing
Partnerships are already forming.             through a partnership between               overhead through new technology,
Centura Health, Colorado’s largest            Atlantic Canada and insurance giant         more efficient processes and a
hospital chain, is teaming up with            Medavie Blue Cross.                         patient-centric design.27
True North Health Navigation, which
offers on-scene care to 911 callers in        Subscription-based, at-your-service         Another newcomer, Iora Health—
lieu of a costly ambulance ride to the        care focuses on personalized,               which targets specific patient
emergency room.25                             boutique-like care without the              populations through relationships
                                              exorbitant fees long associated with        with employers, unions and health
The training of fast-responding               traditional medicine. Competing most        plans—boasts that it is “restoring
paramedics to care for people on the          directly with traditional practices,        humanity to healthcare.” Physician
scene rather than rushing them to the         these lower-cost concierge companies        CEO Rushika Fernandopulle fears
hospital is a growing trend. Known            offer consumers shorter wait times          that primary care has turned into a
as community paramedicine, trained            and more personal attention. This           series of transactions. “We want to
paramedics are dispatched in chronic          team-based model treats the “whole”         get rid of the transactions and build
disease management, medication                person in one location with short           the relationships,” he said. One of
compliance and home safety. They              waiting times, savvy technology             the most important relationships is
can take vital signs and administer IV        systems and access to nutritionists,        with a health coach. (See page 9—
medications and work with doctors             diabetes specialists, and much more.        Iora Health: Putting value back into
and others on a team to coordinate                                                        primary care one relationship at
future care.                                  One Medical offers tech-enabled             a time).
                                              primary care practices that are
Geisinger Health System’s Mobile              focused on improving quality and            Venture capitalists have given both
Paramedic Program in central                  affordability. The company accepts          One Medical and Iora Health a real
Pennsylvania is one example. While            most forms of insurance and charges         boost in recent years and 71% of
in the patient’s home, the paramedic          a $150 to $200 annual fee to support        physicians HRI surveyed believe
                                                                                          that this model will become more
                                                                                          dominant over the next decade.

    60%                     of consumers say they would be
                            open to a virtual doctor’s visit
                            HRI Consumer Survey 2015
                                                                                          Digital health has seeded booming
                                                                                          businesses in virtual care, remote
                                                                                          monitoring, and do-it-yourself home
                                                                                          diagnostics. Burgeoning wireless

8   Primary care in the New Health Economy: Time for a makeover                                               Health Research Institute
Iora Health: Putting value back into primary care one
relationship at a time
The ability to build and maintain               Iora practices start the morning with a         company has designed specific programs to
meaningful doctor-patient relationships         30-minute morning staff huddle to discuss       manage severe or chronic illnesses such as
is nearing extinction among primary care        patients, group visits, patient-accessible      diabetes and congestive heart failure.
practices. But in the New Health Economy,       electronic health records and virtual
Massachusetts-based startup Iora Health         care. Fewer patients allow for longer           Fresh thinking even permeates Iora’s billing
—with more than $48 million in investor         appointments – which often run a full           practices. Employers and insurers receive a
backing1—is breathing life into the way         hour – and patients can view their records      one-line email each month that includes the
consumers can connect to their care team.       on a screen in the exam room, which             cost of all the patients’ services instead of
                                                makes them feel more involved in their          separate bills for physician care, lab tests
“We want to get rid of the transactions and     care and results in a better dialogue with      and specialty services.
build the relationships,” Iora CEO Rushika      caregivers.
Fernandopulle told HRI.                                                                         One health insurance giant has been
                                                The different Iora practices closely mirror     attracted to the company’s innovative
Co-founded by Fernandopulle – a Harvard-        the needs, characteristics and preferences      business model: Humana now partners with
trained physician – in 2014, Iora Health        of the populations they serve (See Figure       Iora to deliver care to its Medicare Advantage
focuses on highly personalized primary          2 below). Depending on the complexity           members at eight locations in Denver,
care as the key to better health outcomes       of health needs in each Iora group,             Seattle, Phoenix and Tucson. The insurer
and happy, empowered patients. Rather           Fernandopulle said that patient loads           already reports seeing positive results.3
than relying on fee-for-service, the            range from 600 for the sickest practices to
company partners with insurers, unions                                                          Iora’s unique approach is starting to pay off.
                                                1,500 for the healthiest, both presenting
and employers in value-based payment                                                            The number of Iora’s patients with controlled
                                                stark contrasts to the average patient load
schemes that focus on achieving improved                                                        hypertension improved by 25% last year
                                                of 2,3002 for a traditional primary care
health outcomes for targeted patient                                                            alone.4 At one Iora practice, hospitalizations
                                                practice.
populations.                                                                                    were 37% lower when compared to a
                                                Services are tailored to each practice. For     traditional practice and two other practices
Iora’s model is team-based; meaning that        example, what is simply referred to as          reported a 30% reduction in emergency
clinicians such as nurses, social workers,      yoga class at Iora’s Collective Primary Care    room visits.5 Eighty-five percent of Iora
nutritionists and diabetes specialists are      practice in New York City is “Hammer            patients say they would recommend the
as important as physicians when caring          Time” to the New England carpenters’            company to a friend.6
for patients. At the center is a health         union members at another Iora clinic.
coach who, Fernandopulle explained,                                                             Iora offers the industry a sneak preview of
                                                Hammer Time is yoga using carpentry
is responsible for 80% of the patient                                                           what outcomes-focused, convenient, and
                                                tools to remove the potential stigma of
interactions and ensures continuity of                                                          customer friendly should mean for primary
                                                such exercise for macho men who suffer
care. The health coach connects patients                                                        care in the future.
                                                from back pain and other musculoskeletal
with specialists and helps them identify        issues. In Nevada, where Iora serves the
activities to achieve their health goals.       culinary workers of the Las Vegas strip, the

Figure 2: The many faces of partnership and population health at Iora Health

 Practices                           Partners                           Location           Patient population

 Culinary Extra Clinic               Culinary Health Fund               Las Vegas          Hotel and restaurant casino workers with severe
                                                                                           and chronic illness
 Dartmouth Health Connect            Dartmouth College, King Arthur     New Hampshire      Adults with diverse health needs
                                     Flour, NE Carpenters Fund
 Grameen VidaSana                    Grameen America                    Queens             Hard-working, low-income women in immigrant
                                                                                           communities
 Hartford HealthCare Health Center   Hartford HealthCare                Connecticut        Hartford HealthCare employees and families
 Iora Primary Care (2)               Tufts Health Plan                  Massachusetts      Seniors with Medicare Advantage or Senior Care
                                                                                           Options plans
 Iora Primary Care (multiple)        Humana                             Denver, Seattle,   Seniors with Medicare Advantage Plans, Adults
                                                                        Tucson, Phoenix    over 55
 Iora Primary Care                   NE Carpenters Benefits Funds       Dorchester         Members of the New England Carpenters union
 Turntable Health                    Downtown Project                   Las Vegas          Las Vegas residents
 Collective Primary Care (2)         The Freelancers Union              New York City      Members of the Freelancers Union health plan

9   Primary care in the New Health Economy: Time for a makeover                                                        Health Research Institute
equipment gives all primary care               caregivers—connecting generalists           Nurse-led care has the potential to
players the tools to compete efficiently.      with specialists. For example,              make a sharp ascent in the primary
Even so, new companies offering                Carolinas Healthcare has implemented        care market if states continue to
solely virtual care, remote monitoring         behavioral health in many of its            relax the restrictions they have on
and telemedicine have become well              primary care practices to connect           nurse practitioners’ ability to practice
situated in a short period of time.            primary care teams with specialists         without physician oversight. By the
                                               for on-demand advice. Patients can          end of 2014, more than half of states
Analysts expect the global telehealth          also visit virtually with social workers,   were weighing expanding the clinical
market to exceed $30 billion by                psychologists, and behavioral health        duties of nurses.
2020.28 Gone are the days when                 nurses without having to leave the
consumers required face time with              primary caregiver’s office. The health      The master’s-trained nursing
their doctors; now, 60% of consumers           system plans to expand the program to       workforce is blossoming with help
say they would be open to a virtual            each of its 200 primary care practices.     from government programs such
doctor’s visit. Companies such as                                                          as the Medicare Graduate Nurse
PushCare, Teladoc, and Doctor-on-              HRI research shows that consumers           Education Demonstration, which has
Demand bring a doctor to the house             and clinicians are placing more faith in    doubled the number of graduates
through a simple app download.                 DIY at home diagnostic tests for simple     across five sites since 2012—and the
                                               ailments such as strep throat, ear          introduction of the doctor of nursing
Government payers and major private            infection and urinary tract infection.      practice degree in 2006. The supply
insurers are starting to make the shift        HRI estimates these tools threaten          of primary care nurse practitioners
from physical to virtual. In January,          more than $64 billion in traditional        is expected to increase by 30%
Medicare began reimbursing clinicians          provider revenues.34                        from 2010 to 202036 and, unlike
$40 per patient per month for offering                                                     studies that project major physician
patients 24/7 virtual access to care.29        Remote patient monitoring is expected       shortages, workforce studies for nurse
UnitedHealthcare—which provides                to save the system $36 billion globally     practitioners foretell a surplus.37
insurance coverage for more than               by 201835 through alerts to clinicians
45 million people, will start offering         well before a patient’s health status
telemedicine doctor visits this                turns into an emergency. Companies
year in 47 states and the District of          specializing in remote monitoring              “There is a cadre of
Columbia. The American Telemedicine            promote care delivery models that are
Association estimates that 12 million          built less on the volume of interactions
                                                                                               patients who want to
Americans received such services in            with a patient and more on the                  see the primary care
2014, and that number is expected to           volume of patient data that is shared           physician every time,
double in 2015.30, 31                          among caregivers.
                                                                                               but that group is
Many of Kaiser Permanente’s health             One-third of the consumers HRI                  shrinking.”
systems are already performing more            surveyed said that they were
than half of patient visits through            interested in a wearable device                 Richard Kalish, MD Lahey Health
mobile, secure messaging or video32            that could monitor their vital signs
and virtual care accounts for                  and 85% of physicians said that the
50–60% of Iora Health’s interactions           primary care physician of the future        A growing number of consumers
with patients.33                               will spend more time using mobile           (75%) say they would be comfortable
                                               applications and health wearables           seeing a nurse practitioner or
Telehealth is also connecting care             to monitor patients. Just 10% of            physician’s assistant.38 “There is a
teams to fill knowledge gaps. Leading          physicians surveyed said they rely on       cadre of patients that wants to see the
health systems in both rural and urban         remote monitoring devices now.              primary care physician every time but
areas are using video consultations
among physicians, nurses, and other

10   Primary care in the New Health Economy: Time for a makeover                                               Health Research Institute
that group is shrinking,” said Richard                         the same year to care for medically                      Figure 3 below compares how
Kalish, MD, of the division of primary                         underserved regions. Forty percent of                    clinicians and consumers feel about
care at Lahey Health. Kalish is leading                        primary care physicians in Vermont’s                     HRI’s five emerging models in
the charge at Lahey to embed elements                          Champlain Valley were not accepting                      primary care.
of the NCQA patient-centered medical                           new patients in 2012,39 meaning
home model and extend Lahey’s                                  nurse-led practice in the state has a                    How traditional practices are
                                                                                                                        responding to threats in the
primary care reach care beyond the                             great deal of room to grow.
                                                                                                                        primary care market
traditional office visit.
                                                               Using nurse practitioners or physician                   The NCQA patient-centered medical
Two states lead the way in                                     assistants instead of more costly                        home and Medicare accountable
nurse-led primary care: Vermont—                               doctors has been estimated to save                       care organization models—which
where Appletree Bay Primary Care                               Massachusetts over $8 billion in the                     emphasize efficiency and care
opened its doors in 2014 with seven                            next decade40 and managed primary                        coordination through team-based
primary caregivers, all of whom are                            care delivered by nurse practitioners                    care—have been the most widely
faculty members of the University                              cost 23% less compared to the average                    publicized attempts by traditional
of Vermont College of Nursing and                              costs of other primary care physicians                   primary care practices to simplify
Health Sciences—and Indiana where                              in Tennessee.41                                          healthcare for consumers, reduce
Purdue Family Health Clinics opened                                                                                     emergency room visits and

Figure 3: Modern primary care models—what clinicians and consumer say

 What consumers say                                                 Modern primary care models                                                  What physicians say

 36% visited a retail clinic in the past year                                                         47% say retail clinics increase patient satisfaction
 95% were satisfied                                                                                   69% say they increase access
 89% would recommend retail clinics                                                                   83% do not partner or plan on partnering with a
                                                                                Convenient care       retail clinic

 76% value high patient satisfaction scores                                                           71% say concierge care will increase
 when choosing providers                                                                              over the next decade
                                                                                At-your-service
                                                                                     care
 60% are open to a virtual doctor’s visit                                                             42% would rely on certain DIY test results to
                                                                                                      prescribe medicine
 50% would use a DIY diagnostic test
                                                                                                      16% are implementing technology to teleconsult with
                                                                                                      patients and families
                                                                                  Digital health
 31% are interested in monitoring vital signs                                                         85% say the future PCP will rely more on mobile apps
 with a wearable                                                                                      and wearables

 75% would see a nurse practitioner or                                                                56% say nurse practitioners/physician assistants
 physician assistant for care                                                    Independent          should lead their own patient panels
                                                                                   practice
                                                                                 nurse-led care
 66% are interested in in-home care                                                                   79% believe that non-physician house calls will
                                                                                                      increase over the next 10 years

                                                                                  House calls

Sources: HRI Consumer Insight Surveys 2013, 2014, and 2015, and HRI Clinician Surveys 2014 and 2015

11    Primary care in the New Health Economy: Time for a makeover                                                                                Health Research Institute
admissions, and lower overall costs.             About one-third of physicians said they        payment systems that rewarded
Medicare recently reported $400                  have changed their business model to           clinical outcomes and efficiency
million in savings from its Pioneer              adapt to changing models of care and           rather than traditional fee-for-service
ACOs over two years.42 Despite the               about one-fifth said they have started         payments based on volume. These
generally positive results, adoption             providing entirely new services to             practices are being incentivized to
has been slow.                                   compete with non-traditionalists               find more effective ways to deliver
                                                 (See Figure 4 below).                          primary care.
While most primary care practices
cling to antiquated operating models,            These practices are investing                  With the Department of Health and
a minority is starting to realize that           primarily in virtual care, technology          Human Services’ goal of shifting more
new entrants to the health industry              to simplify the administrative                 than 50% of fee-for-service payments
herald change and, to survive,                   nuances of healthcare such as                  into value-based reimbursement
older practices must compete with                scheduling and billing, and one-               models by 2018,43,44 the health
or partner with the newer or risk                stop-shopping conveniences such as             industry might expect to see an
losing patients. For example, 69% of             co-locating care team offices with lab,        increase in the number of primary care
physicians that HRI surveyed believe             imaging, physical therapy and other            practices introducing new services.
non-traditional care models have                 complementary services.
increased access to care and almost
half believe that they have had a                Physicians were more likely to test new
positive effect on patient satisfaction.         services if they were using alternative

Figure 4: How traditional practices are responding to threats in the primary care market

How is your practice changing its business model in response to growth in retail health clinics, concierge medicine services, on-demand
telehealth services, and other non-traditional ways to access healthcare? (Select all that apply)

No change                                                                                                                        68%

Started providing
                                                18%   Which of the    51% Virtual technology           17% House calls
certain services
                                                      following new
                                                      services have   41% One-stop-shopping             9% Group visits
                                                      you started
                                                      providing?      24% Behavioral health services   11% Other
Increased delivery
of certain services                       14%                         19% Pharmacist services

Stopped providing
certain services                     7%

Source: HRI Clinician Survey, 2015

12    Primary care in the New Health Economy: Time for a makeover                                                    Health Research Institute
A la carte primary care
In the New Health Economy,                             status but on their location, income,        For more information about their
consumers, spending more of their                      age and what they value in care.             demographic profiles, care utilization
own money, are choosing how and                        While the traditional model forces           and spending patterns see Figure 5 on
where to receive primary care.                         the sick and the healthy into the same       page 14.
Instead of one-dimensional, in-                        location, the growing trend is toward
person visits with a primary care                      segregating complex care from minor          Health status should be the main driver
physician, consumers will have                         or maintenance care.                         of where consumers go for primary care
multi-dimensional interactions with a                                                               services. The sites they choose will be
broader team of caregivers among an                    To be competitive, both traditional          different for scheduled—or planned—
array of convenient care sites.                        and new players must cater distinctly        care versus unscheduled, urgent care
                                                       to seven major consumer markets              (See Figure 6 on page 17). Health
Consumers may log in virtually for                     (shown below). Each market is defined        systems must guide them for both
care or decide to be examined in the                   by consumers’ primary health issue.          cost and health reasons.
clinician’s office or in the home. How
these interactions occur will depend
not only on the consumer’s health                                                      Complex chronic disease
For more insights about how age, geography, income                                     Consumers with complex chronic disease live with one or more
                                                                                       chronic diseases affecting multiple body systems and requiring
and care preferences impact where consumers will                                       complicated disease management. These individuals account for
go for primary care in the future, visit HRI’s online                                  $281 billion in total spending each year, with $11,000 in per capita
interactive model at pwc.com/us/futureofprimarycare                                    spending, the second highest among the seven consumer groups.
                                                                                       On average they interact with the health system 12 times and
                                                                                       have 30 prescriptions filled. About 25 million Americans, or 8%,
                                                                                       are dealing with complex chronic disease.” People with complex
                                                                                       chronic disease need intense care management and coordination
                                                       Frail elderly                   and are ideal candidates for 24/7 remote monitoring, clinician house
                                                                                       calls, patient centered medical homes, and nurse-managed clinics.
        Frail elderly consumers are over the age of 75, living at home and
        facing health issues related to falls or dementia and suffer generally
        poor health. At $92 billion in healthcare spending annually, these
        retirees are not the health system’s most expensive but they are the           Mental illness
        heaviest utilizers of care services and prescription drugs—with an
        average of 16 visits and 34 prescriptions fills—and have the highest           Consumers with mental illness face depression and mood
        per capita spending. About 5.8 million consumers, or 1.8% of the               disorders, post-traumatic stress disorder, addictions and suicidal
        American population, meet the definition of frail elderly. Frail elderly       ideations. These patients spend $23 billion on care each year
        patients need intense care management and coordination and are                 and have an average of $2,500 in per capita spending, have six
        ideal candidates for 24/7 remote monitoring, clinician house calls,            touchpoints with the system and fills seven prescriptions. About 9.4
        and either patient centered medical homes or geriatrician/internist            million, or 3%, of Americans have a mental illness as their primary
        practices with team-based care.                                                health issue. The mentally ill may find a match in medical homes
                                                                                       with integrated behavioral health services and may use on-demand
                                                                                       telehealth for unscheduled care.
                                                  Chronic disease
        Consumers with chronic disease have problems affecting a single                Healthy adult enthusiasts
        body system such as hypertension and require uncomplicated
        disease management. Because of their sheer numbers, these                      Healthy adult promoters value a regular physical, wellness/coaching
        consumers rank first in total spending at $847 billion each year,              services, and get recommended screenings. These consumers spend
        however their per capita spending of $4,800 is much less than that             approximately $30 billion on healthcare services annually, average
        of consumers in the complex chronic disease market. They average               $1,300 in per capita spending and interact with the health system
        seven care visits each year and fill 12 prescriptions. 177 million             one or two times throughout the year. About 23 million Americans
        Americans, or 56%, fit this description and are the wealthiest of the          form this group. Healthy adult enthusiasts will likely gravitate toward
        consumer markets. Consumers with chronic disease may benefit                   digital options and convenient care clinics and value the preventive,
        from population-based care teams, specialized nurse clinics and                wellness and integrative services at-your-service care practices offer.
        retail clinics that offer disease management.

                                                 Healthy families                      Healthy adult skeptics
        Healthy families are households with healthy dependent children                Healthy adult skeptics generally avoid interacting with the health
        under the age of 18. There are 62 million people living in healthy             system and are less likely to have health insurance than other
        families in the US and they spend $70 billion on healthcare each               consumer groups. This market is approximately 12 million strong with
        year. They interact with the health system slightly more than Healthy          $7 billion total and $600 per capita spending. Individuals in this market
        Adult Enthusiasts (described below)—mainly for vaccinations and                make visits to the emergency room and are admitted to the hospital at
        the occasional cold or sinus infection—but have lower spending                 nearly the same rates as Healthy Adult Enthusiasts, but they go to the
        per capita at $1,100. Healthy families will likely gravitate toward            doctor less often. Healthy adult skeptics are likely to gravitate toward
        digital options and convenient care clinics and value the preventive,          digital health options such as DIY diagnostics and DTC telehealth
        wellness and integrative services at-your-service care practices offer.        companies as well as retail clinics and clinician house calls that keep
                                                                                       them out of traditional care settings.
        For more information about HRI’s methodology for defining
        the consumer markets, see page 22.

13   Primary care in the New Health Economy: Time for a makeover                                                                Health Research Institute
Figure 5: The consumer markets for primary care

                                             Complex                                                                    Healthy               Healthy
                           Frail             chronic          Chronic             Mental             Healthy             adult                 adult
                          elderly            disease          disease             illness            families           skeptics            enthusiasts       Total
Demographics
Number
of people                         5.8m               24.9m          176.3m                9.4m                62m              12.1m               23.1m        313.5 m
Average age                          82                 49                40                 29                  22                   39              39               ---
Average
family income                 $44,973               $58,623        $73,490            $70,916             $67,828            $63,663             $69,806               ---
Total spending1          $92,391.6m          $280,819.7m      $846,732.4m         $23,306.3m         $70,338.1m           $7,286.2m          $29,846.7m $1,350,720.9m

Per Capita
Spending                      $16,010               $11,284          $4,803             $2,490             $1,135                $603             $1,291         $4,309
Out-of-pocket
spending                        $2,050               $1,197            $709               $526               $167                $222               $281              $610

Spending on care
Inpatient                       $4,974               $3,248          $1,453               $345               $493                 $86               $374         $1,305
Ancillary  2
                                  $417                $722             $461               $208                  $74               $35               $170              $359
ED                                $375                $344             $210                 $96                 $64               $86                $98              $178
Office                          $2,869               $2,119          $1,219               $804               $249                $160               $267         $1,006
Other medical
services                        $7,375               $4,851          $1,461             $1,036               $255                $235               $382         $1,461

Care utilization
Total                               15.7               11.9              6.9                5.7                 1.6                   0.9            1.4               5.7
Discharges                           0.4                0.2              0.1                0.0                 0.0                   0.0            0.0               0.1
Ancillary visits                     0.8                1.1              0.4                0.2                 0.1                   0.0            0.1               0.4
ED visits                            0.5                0.4              0.2                0.1                 0.1                   0.1            0.1               0.2
Office visits                       13.9               10.2              6.2                5.3                 1.4                   0.7            1.2               5.1

Prescription drugs (out-of-pocket)
Retail drug
spending3                $14,761.5m              $96,912.3m   $167,606.7m          $6,664.6m           $3,315.3m            $659.3m            $3,037.4m   $292,957.1m
Retail drug
spending
per capita                      $2,558               $3,894            $951               $712                  $53               $55               $131              $935
Prescriptions
per capita4                         34.4               30.3            12.0                 6.9                 0.7                   0.7            1.4              10.3

Source: Medical Expenditure Panel Survey, 2012

1.   Total spending represents the Medical Expenditure Panel Survey (MEPS) reported total health expenditures for inpatient,
     outpatient, ED, office-based, provider, prescription drugs, home health, and other medical services.
2.   Ancillary includes outpatient medical services.
3.   Retail drug spending represents MEPS retail perscription drugs expenditures.
4.   The total prescriptions per capita represents MEPS-reported prescription drugs per person, including all refills. For example,
     if a person has 2 perscription and refilled them each twice in a year, the total perscriptions per capita is listed as 6.

14      Primary care in the New Health Economy: Time for a makeover                                                                               Health Research Institute
Hispanics: Primary care’s consumer mavericks

Hispanics are helping to rewrite the definition of primary care. This fastest-growing US demographic - expected to
double in size by 20501—presents enormous possibilities for the market with their estimated $1.5 trillion in purchasing
power2 and a willingness to go outside of the traditional parameters of the primary care system to find better value. This
exodus from the traditional system offers lucrative possibilities for health industry veterans and new entrants looking to
test innovative approaches.3

Hispanics will be primary care’s consumer mavericks in the New Health Economy, according to HRI’s latest consumer
survey. Across all income levels and insurance status, the group is poised to outshine other populations. Here is why:
                                                                                                                                              Hispanic
                                                                    Percentage of customers who…                                              Non-Hispanic

           Hispanics pay closer attention to costs.                 …ask about the price of a visit before a clinician raises the issue
                                                       4
Price is the most important aspect of care to Hispanics, and                                                50%
they are willing to act on this preference. The 2015 HRI survey                         28%
found that 95% of Hispanics believe it is important to obtain
                                                                    …believe that it is important to receive an accurate cost
an accurate price for health services - compared with 82%
                                                                    estimate before getting care
of non-Hispanics - and will often ask about cost before going
to the doctor or having a procedure done. Hispanics are also                                                                                            95%
more likely than non-Hispanics to rank cost above quality when                                                                            82%
selecting a medical provider.5

           Hispanics are pioneers in mobile health.                 …use mobile technology to monitor or diagnose a health problem
Hispanics have adopted mobile health at a faster rate than non-            14%
Hispanics, as many other patients are still slow to e-mail their    5%
physician or refill a prescription by text message. Additionally,
Hispanics are nearly three times more likely than non-Hispanics     …use mobile technology to make a medical appointment
to use a mobile device for health-related reasons such as                                 31%
scheduling an appointment or purchasing care, and are more          5%
willing to use technology to monitor health by checking vital
signs or glucose levels.                                            …use mobile technology to order a refill of a prescription
                                                                                       27%
                                                                                 20%

           Hispanics access a wider door                            …visited a retail health clinic more than once last year
           to primary care.                                                                                    54%
Appreciating convenience over traditional “institutional”                                    33%
medicine, Hispanics willingly gravitate toward lower-cost retail    …primarily go to a doctor for non-emergency care*
health settings and alternative care providers in the community.
According to the 2015 HRI survey, 54% of Hispanic consumers                                                               66%
- regardless of income or insurance status- have used a retail                                                                      76%
clinic at least once in the past year, compared with 33% of non-
                                                                    …would be willing to use videoconferencing to meet
Hispanics. They are also more likely to rely on non-physicians,
                                                                    with a clinician
such as pharmacists, for care and advice. In the 2014 HRI
survey, 66% of Hispanics reported going to the doctor for non-                                                           65%
emergency conditions, compared to 76% of non-Hispanics. 6                                                47%

                                                                    Source: *HRI Consumer Insight Survey, 2015 and *HRI Consumer Insight Survey, 2014

Hispanics, with their tech savvy, cost consciousness and willingness to seek care outside of the traditional doctor’s office, have
sprinted ahead of non-Hispanics in the New Health Economy. And the rapidly growing population—106 million Hispanics in
the US by 20507—provide a hefty opportunity for the increasingly segmented primary care market to offer convenience and
value.8 To compete, companies need to consider low-cost primary care options that rely on a broader team of mobile-friendly
health professionals. To learn more about the preferences, values and habits of this diverse consumer group, read HRI’s
Hispanics: A growing force in the New Health Economy.

15   Primary care in the New Health Economy: Time for a makeover                                                                 Health Research Institute
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