⏳The Doctor is in... but when?

Understanding long wait times in primary care. Plus, democratizing health benefits using AI.

In an ideal world, getting an appointment with a primary care physician would be as easy as ordering a pizza. You’d call, get an appointment for the next day. But in reality, it’s more like trying to get tickets to a Beyonce concert – everyone wants it, but only a few can get in.

What’s in for today:

  • Why the long wait to see a doctor?

  • Democratizing health benefits using AI

  • First state to ban prior authorization for inpatient mental healthcare, trends in telehealth visits and outpatient payments

LET’S TALK!

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Why the wait?

The 2022 survey from AMN/Merrit Hawkins found that it takes an average of 26 days to schedule a new patient physician appointment in 15 of the largest cities in the United States (Read more here).

This extended wait time for appointments indicates broader issues in the healthcare system. Some of the reasons for these delays include:

  • Increasing Demand: An aging population means more people will need medical care. In 2021, people 65 and older accounted for 34% of the need for physicians. The same age group is predicted to account for 42% of the demand by 2034.

  • Primary care physician shortage: There is a growing shortage of primary care physicians (PCP). Many physicians are retiring, and not enough new doctors are entering the field to replace them. KFF Health News reports that Medical Students in the U.S. are less likely to choose primary care as a specialty. By 2034, it is predicted that there will be a PCP shortage of between 17,800 and 48,000 (2).

  • More specialization: Investments in primary care also in the U.S. lag compared to other high-income countries. In the U.S., 12% of doctors are generalists (or PCPs), compared with 23% in Germany and as many as 45% in the Netherlands.

What is being done?

Policymakers and health systems are aware of these challenges and are taking steps to address them. Here are some current initiatives:

  • A bipartisan legislation on primary care was passed to address the primary care problem in the U.S. The bill aims to increase training opportunities for doctors and nurses, as well as expand access to community health centers.

  • Nurse Practitioners (NPs) and Physician Assistants (PAs) can handle many tasks traditionally performed by doctors, thus alleviating some of the burden on primary care physicians. An estimate suggests that allowing NPs and PAs to deliver primary care (allowed in 22 states) has the potential to decrease primary care shortage by 70%.

  • The use of telehealth has made it possible for patients to have virtual consultations, which can be more flexible and quicker to arrange than in-person visits.

Why should you care?

The way primary care works is changing. Before, one doctor would manage your care and know your medical history well. Now this is changing. Understanding the reasons for long wait times and the actions taken to address this issue is important for a few reasons:

  •  Proactive Health Management: Knowing about potential delays can encourage you to schedule routine check-ups well in advance, rather than waiting until an issue becomes urgent.

  •  Alternative Solutions: Being aware of telehealth and the roles of nurse practitioners and physician assistants can provide more options when you need timely care.

  •  Advocacy: Informed patients can advocate for better healthcare policies and practices, contributing to broader changes that benefit everyone.

TRACKING: AI IN HEALTHCARE

  • AI Health Coach: Thrive AI Health is a joint venture between OpenAI and Thrive Global that aims to democratize health benefits using AI. The mobile app will leverage AI to act as a health coach, offering personalized recommendations based on users' health data and daily routines.

    Through hyper-personalization, it has the potential to address health issues by promoting behavior changes that can prevent and optimize disease treatment. This AI-driven approach could democratize health improvements, making individualized health guidance accessible to more people and potentially reversing chronic disease trends through collaboration among policymakers, healthcare providers, and individuals (Read more here).

POLICY & INDUSTRY NEWS

🩺Illinois Governor, JB Pritzker signed the Health Protection Act into law, which could make the state of Illinois the first state to ban prior authorization for in-patient adult and children’s mental healthcare. The law also bans “junk” insurance plans or short-term limited duration plans in the state (insurance plans that offer temporary and incomplete coverage) (Read more here).

🏥Use of telehealth decreased: A recent research study found that individuals enrolled in high deductible health plans are less likely to use virtual mental healthcare when they have to pay out-of-pocket. When cost-sharing was reintroduced, with an average cost of $29.50 per visit, patients attended an average of 1.5 fewer telemental health visits per month, and 11.7% stopped visits altogether. This suggests that financial barriers have a significant impact on the decreased utilization of telehealth services.

🥼Increase in outpatient payments: The CMS has proposed a 2.6% increase in outpatient payments for hospitals in 2025. The proposed rule also includes changes to payment structures for remote services, quality reporting, and partial hospitalization programs. The aim is to align hospital payments with the physician fee schedule for remote services. Comments are being sought until September 9, and the final rule is expected in early November.