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1. Opening remarks
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November 17, 2021

2. What is a primary care physician (PCP)?
● PCPs are specialists in Family Medicine, General internal medicine, pediatrics and
OB/GYN.
● PCPs are skilled in 4 C’s- first Contact, Continuity of care, Comprehensiveness
and care Coordination for persons with any undiagnosed sign, symptom, or health
concern.
● PCPs provide the foundation of Quadruple aim- Quality, Cost, Care outcomes and
Provider satisfaction.
● Patients are best served when their care is provided by an integrated practice care
team led by a PCP.
(source: American Academy of Family Physicians)
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3. Family doctor house call
1960s: 40% of doctor
engagement
2019: PCPs reduced to 1/3rd of all doctors
majority work as employees
42 out of every 100 people visited the ER for
care (record 141M visits in 2014)
The PCP care and ratio trends- moves care to the ER
Solo practices
1970: 58% of doctors were
self-employed
Emergency rooms
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Only 1 PCP for 1429 patients in 2020
48% owners, 48% employees, 4% contractors (2016)

4. Primary care access exploded; specialists real-time
Chatbots Virtual Care
New urgent care clinics New concierge clinics
Retail clinics
Onsite clinics
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5. Primary Care trends
2019
1% of visits were virtual
2021
17% of visits are virtual
1986
44% of doctors had
brick-and-mortar solo
practices
2021
The number of freelance
doctors is approx 48,000 and
growing
2020
9,300 Urgent Care clinics
7,000 Onsite clinics
2,700 Retail clinics
2014/2015
6,400 Urgent Care clinics
1,050 Onsite clinics
2000 Retail clinics
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6. Primary care visits declining
Supply dropping:
- 31% of doctors work in primary care
Demand dropping:
- 64% of 30 yr olds have a primary care doctor; down from 71% in 2002
- From 2007-2016, the annual mean number of visits per person to primary
care physicians decreased by 20%
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7. High-deductible plans keep patients away from PCPs
“My patient Pete is 55 years old and has a great job (and employer-sponsored
health insurance) at a bank. Pete has high blood pressure, high cholesterol and
hyperparathyroidism. He also has a high-deductible health plan (HDHP). Despite
his health issues, Pete hasn't come into my office more than once a year for
the past three years because of the out-of-pocket costs.”
Robert Raspa, M.D., is a member of the AAFP Board of Directors.
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8. US spends twice as much as other countries
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9. US spends half on PC compared to other countries
14% for
OECD countries
vs
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10. Industry largely fee-for-service based
48% - fee-for-service
57% -value-based
reimbursement models
70% - fee-for-service
(solo practices)
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11. Are insurance companies aligned to lower costs?
“Insurance companies seem willing to gamble that they will be able to pocket the
premiums of consumers with high-deductible plans who won't seek care, but
that approach is certainly not best for patients or health care in our country.”
(AAFP)
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12. Challenge to the health system -- Older generation
Cohort: Sick and aging
By 2030, there will be 71
million people over 65, up
from 46 million today
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13. Challenge to the system -- Younger generation
Cohort: Falling through the cracks
● Don’t see a PCP
● Have higher rates of depression
than other generations
● Smoke/vape: Nearly one-third
high schoolers vape
● K-12: 1 in 5 are obese (more
than tripled in a generation)
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14. VC investing in digital health tops $20B in 9 months
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15. Primary Care Market map
AI-navigators
Virtual care
Tech-enabled clinics
Direct 2 Consumer/Pharma
Connected devices
Disease management
Home care
Created by: 15

16. Consolidation
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17. Who are the winners?
Value based: Embrace economic models that prioritize prevention/primary care;
achieve quadruple aim.
Collaborative: Leverage tech / careteam/specialty approach for frequent check-ins
or real-time decision making.
Service oriented: Deliver a modern “customer” (not patient) facing experience.
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18. Opening remarks
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