The push to address care gaps in women’s primary care will require collaborative effort from providers, payers, policymakers, and investors.
The medical industry will have to see considerable buy-in from clinicians, payers, policymakers, and investors alike in order to fill the care gaps that plague women’s primary care, according to researchers from Manatt Health and the Commonwealth Fund.
This latest paper follows up on a previous one in which the researchers outlined where gaps in care access and quality lay for women’s primary care and why those gaps have emerged.
By and large, care gaps experienced by women stem from lapses in sex-specific, sex-aware, and gender-sensitive care for women. Primary care has fallen short in caring for women’s specific healthcare needs, especially those that evolve over their life spans.
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Many of these same gaps are related to those experienced by members of the LGBTQIA community, the researchers acknowledged, although those patients also have their own unique challenges.
This latest paper looks at how clinicians, payers, policymakers, and investors need to change in order to address those gaps. More specifically, the researchers noted the healthcare industry must focus on the following pillars:
- Preparing primary care providers to deliver comprehensive primary care to women throughout their lifetimes
- Building integrated primary care teams
- Dedicating primary care visits for building trust and patient-provider relationships, and linking patients with community-based care and resources when needed
- Adopting care models that expand access to primary care regardless of race, age, ethnicity, and other sociodemographics
- Prioritizing racial and gender diversity among clinical leadership
“Policymakers, payers, clinical leaders, entrepreneurs, and investors each have a role to play in closing these gaps and overcoming these barriers,” the researchers said.
“Clinical leaders and entrepreneurs need to continue to focus on designing and implementing these new models, while policymakers, payers, and investors need to accelerate this evolution by aligning incentives and developing accountability metrics to ensure redesigned primary health care models meet women’s needs.”
MAKING CHANGE AT THE TRAINING, EDUCATION LEVEL
The first step toward making meaningful change is to adjust how primary care providers receive education. Medical education needs to focus on women’s primary healthcare needs and encourage partnership with specialty providers.
Central to this will be a focus on cultural competency, the researchers asserted. The push for health equity begins when clinicians are students and are beginning to learn how to communicate with patients.
Additionally, medical schools should focus on sex-specific differences in healthcare. Presenting students with information about how certain illnesses manifest in and impact men and women will be essential for promoting equity between the genders at the ground floor.
“Medical training should emphasize empathy towards all patients and acknowledge systemic racism, the intersectionality between gender and race/ethnicity, and pervasive misconceptions in diagnosis and treatment (for instance, a mistaken belief in women’s high pain tolerance) to improve awareness of and responses to implicit and explicit bias,” the researchers added.
CREATING INTEGRATED PRIMARY CARE TEAMS
The notion of a multidisciplinary care team is not necessarily new; team-based care has long been touted as important to creating a holistic healthcare experience for patients.
“Creating primary health care teams that include multidisciplinary providers and providers with women’s health expertise can help to ensure that women’s needs are comprehensively and cost-effectively addressed in a timely fashion,” the researchers said.
But it is not enough to simply have a multidisciplinary care team, they added. Care coordination and integration is also necessary. Fragmented care may hamper health outcomes, result in repetitious care, or allow certain elements of health to fall through the cracks.
This will require practices to spread responsibility across different provider types, including physicians, advanced practice providers, medical assistants, case workers, nutritionists, and other members of the clinic team.
Meanwhile, organizations need to design new entry points for women. This will make care more accessible for individuals experiencing different social risk factors.
REDESIGNING WELLNESS VISITS FOR INTEGRATED PRIMARY CARE
By and large, annual primary care visits should include a deeper dive, leveraging the expertise of the multidisciplinary care team outlined above.
Visits should be personalized based on patient demographics and healthcare needs, and account for different life stages, i.e. puberty versus menopause.
“The visit should include timely conversations with women prior to the onset of key life transitions, such as menopause,” the researchers said. “In addition, primary health care visits should include routine screenings for nonclinical needs, such as food and housing insecurity, homelessness, interpersonal violence, and other social needs.”
Central to these efforts will be the patient-provider relationship, which clinicians should also build during these annual visits.
Virtual care tools, like video visits, present the opportunity for the patient and provider to continue this relationship between annual wellness visits, the researchers added.
Of course, designing a deep and holistic visit will not be easy, and it does not wholly fit into the current model for primary care. New care delivery and reimbursement models would help providers transition to these deeper visits.
More specifically, full or partial capitation models as part of the patient-centered medical home (PCMH) could reimburse providers for the time spent in a deep, empathic patient visit rather than simply volume of services rendered.
EXPANDED USE OF DIGITAL HEALTH IN PRIMARY CARE
The healthcare industry has seen exponential growth in development and adoption of various virtual health models, including remote patient monitoring technologies, telemedicine, and patient-facing mobile health management apps. These tools may be integrated into the primary care setting to expand scope of care.
The time is ripe for this, the researchers said. Patients and providers alike have never been more poised to integrated digital health into primary care, as made evident by the telehealth boom at the onset of the COVID-19 pandemic. If permitted to continue moving forward, these types of technologies will seriously improve convenient access to care.
“While digitally enabled primary health care models have tremendous potential, much work is needed to continuously evaluate and demonstrate their efficacy and impact,” the researchers noted.
“Moreover, most innovations are currently only available to a limited subset of the population that can pay out-of-pocket or is commercially insured. Moving forward, these ventures must seek to expand the reach of proven models to lower-income populations.”
POLICYMAKERS, PAYERS, AND INVESTORS
There is also room for healthcare policymakers, payers, and investors to disrupt the system. Efforts to expand Medicaid, invest in federally qualified health centers (FQHCs), restructure primary care reimbursement, and require more diversity in clinical leadership are all at the disposal for policymakers and payers.
At the same time, healthcare entrepreneurs and investors can tip the industry on its head, creating new entry points and innovations to equitably expand access to primary care. Promoting equal representation in leadership positions and carefully awarding grant funding will also push closer to health equity.
Source: Patient Engagement Hit