Amanda Wilde (Host): Meaningful Medicine is a Novant Health podcast, bringing you access to leading doctors who answer questions they wish you would ask. From routine care to rare conditions, our physicians offer tips to navigate medical decisions and build a healthier future. Join Meghan Huffman, Vice President of Digital Health and Virtual Care Network, and Dr. Roshni Patel, Chief Strategy Officer at Primary Care from Novant Health, as we talk about virtual primary care. I'm your host, Amanda Wilde. And Meghan, Dr. Patel, thank you so much for being here today.

Meghan Huffman: We're so happy to be here. Absolutely excited to talk about this. Very important.

Host: Novant Health is launching a 24/7 virtual primary care. Meghan, what problems were you aiming to solve or what needs were you looking to address with this new service?

Meghan Huffman: Thanks, Amanda. I think it's so important that we always start at Novant Health with the problem that we're trying to solve. And if we look at what's happening right now, especially in North Carolina, 33% of our residents live in a rural area. And out of 1,700 people that we have in the state, there's only one primary care physician. And that's a big problem when we think about access and getting patients care to that access. And so, we said, "Okay, how are we going to do that? How do we get access to these rural areas?" We know, I use this analogy a lot, but I don't have a primary care physician tree in my backyard that I can go shake and physicians are falling off. If I did, I would use it, and I would put all these primary care physicians in person everywhere we could possibly do it. But that is not the situation that we have.

Less physicians are going to medical school, less physicians are choosing to be primary care physicians, and the reality right now is we have to figure out how do we take the physicians we do have and expand that access all across our states in North and South Carolina to get patients the ability to talk to a primary care physician. And that's really the problem that we're trying to solve, and the goal that we have by launching virtual primary care.

Roshni Patel, MD: The other side of that is also patients, right? So, how do patients want to access us? There are lots of different types of patients who want to access the healthcare system. And depending on what their constraints are, we are trying to help build options to help meet patients where they are.

We definitely have a workforce shortage that is there. So, we definitely need to increase the amount of avenues for that access to be simpler, easier, and we really want it to be as patient-friendly, at the same time, clinically responsible, that we can build it.

Host: Well, Dr. Patel, with that in mind, can you describe what virtual primary care is and how it's different from the telehealth visits that we're used to?

Roshni Patel, MD: So, virtual primary care is a telehealth service, but it's a little bit different than what we call episodic care or maybe just acute care type of telehealth. In virtual primary care, we're really trying to build a longitudinal care service where patients are accessing us as a primary care clinician in order to provide that kind of longer-term service where you can reliably know that you can come and access us virtually. And we want to be able to make that a simple digital front door experience where you can have virtual primary care even past the traditional hours of our typical 8:00 to 5:00 clinics.

Host: Now, Meghan touched on access as being a real motivator for virtual primary care. Dr. Patel, who is virtual primary care best suited for? I mean, who do you think will get the most out of this service?

Roshni Patel, MD: So, going to answer that a couple different ways. One of them is kind of which style patient would be the right style patient? And so, I'm going to say that first from a logistical standpoint of, you know, the patients who are either I'm going to say schedule-y challenged; maybe they have very busy, hectic, work lives, and they cannot actually leave work to come in to see their primary care physician, but they do have some needs that need to be addressed. Maybe they're not acute or emergent style needs, but they're nonetheless things that are on their mind that they want to help discuss at a physician's office, but they just can't get there. So, that's one of the logistic kind of types of patients. You know, I think of people like busy moms or shift workers, and I say busy moms, but as in busy moms and dads, any parent who's trying to manage multiple schedules, it's quite challenging to sometimes take care of yourself. And so, that's an easy thought for understanding the style of patient. And then, also maybe older patients who have transportation issues or any patient who has a transportation issue where they can't physically come into the clinic in order to get that care.

Meghan Huffman: I think the other nice thing is that our hours are so extended that it can really meet anyone's schedule. So if you really can't see a physician during a typical 8:00 to 5:00 when clinics are open, a lot of times your only option is to go to an urgent care or to go to emergency room. And the nice thing here is, that you can actually schedule an appointment at 8 o'clock at night if that's what's best for your schedule. And so, we want to make sure, just like Dr. Patel said, we're trying to meet patients where they're at and what's most convenient for them

Host: Well, Meghan, do you envision primary care being replaced by virtual primary care?

Meghan Huffman: So, this is always a tricky question when people talk about virtual care, and I never think that virtual care is ever going to replace the need of our in-person clinics and our in-person physicians. It is really just another tool in the toolbox to where we can reach patients, we can give them the care that they need. And it's really about what is clinically most appropriate for the service that we're delivering for what the patient needs. And that's really our main focus, is to say sometimes virtual visits are the right clinically appropriate for that particular patient. And there's other situations where that's not always true. But we want to make sure that we at least have that offering for when it is clinically appropriate. And when patients do want it, we're able to offer that service.

Host: Dr. Patel, what kind of health needs can be handled virtually?

Roshni Patel, MD: The best types of health needs that can be met are, you know, the easiest ones I think of are, for example, chronic conditions, patients who are diabetics or have high blood pressure, maybe high cholesterol, any mental health need discussions that can be done well in a virtual space.

There are certain things that, you know, just truly can't be. A physical exam, like your annual physical exam. You can do parts of a physical exam visually through a virtual setting. But then, there are certain parts that just cannot be correctly done, competently done, thoroughly done in a virtual setting.

And so, you know, we don't anticipate this type of service to completely replace anything that can be done in an in-person setting. But there is going to be a lot of those, what I call them, chronic conditions or things that are consistently occurring to that patient where we can help discuss, navigate their care needs, help understand kind of what are their next steps, maybe medications that might need some adjustment. Those sorts of things are the best ones.

Host: As we talk about managing chronic conditions through virtual primary care, are there examples of conditions that may benefit from earlier intervention through virtual access?

Roshni Patel, MD: I think prevention medicine is an excellent example of that, right? So, let's say, somebody in the family recently had something happen with their heart and you're wondering, "Oh my gosh, is that going to be me next? How do I help figure out what are the types of things that we need to talk through?"

Let's understand and update things like their family history, and then we can talk through what are the evaluation points needed. And again, all of that evaluation cannot occur during the virtual space. But at least, the right discussion is completed and then the right maybe testing that needs to be ordered, the orders get placed. And then, the next steps can be taken off of that.

Host: Now, you mentioned that virtual care does not replace in-person care, but what kinds of symptoms or concerns still require in-person care? And how does a clinician decide when a patient needs to be seen in person rather than a virtual primary care visit?

Roshni Patel, MD: True emergencies, just like if you called my clinic today, my brick-and-mortar clinic, the first message that you get, whether it's Novant Health or any other health institution, is, "If this is an emergency, please hang up and call 911," right? So, emergencies themselves cannot be managed correctly in the virtual space. If I'm evaluating a patient, and this is true whether this is brick-and-mortar or in-person, at some point in that evaluation, I have to understand, "Can I, in this current setting that I am in, manage this person's healthcare needs fully?" And if I cannot do that, right, whether you're in person or virtually, then my job is to help say, "Wait," and then help get them to the right next steps.

And part of the beauty of being within a system like Novant Health is we have so many tools and services at our disposal that I can help patients get them to the right place to get them the right clinical care. But I want to say, Amanda, it's a clinical radar that we have running at all times. So, what I mean to say is it's not true just in the virtual setting. It's true in all settings.

Host: In the virtual setting, if a patient needs lab work or imaging or, as you mentioned, going to another specialist or a different referral, how is that handled in the virtual primary care setting, Dr. Patel?

Roshni Patel, MD: Right. If you were seeing me as a patient, I would have completed your evaluation. We would have talked through what those next steps are. If it involves lab orders and/or imaging, I would place those orders. And then, you would be directed to the in-person facility site to get those things completed. If that was labs, that might be a separate lab facility. And then, imaging, of course, would happen at imaging places.

Host: And then, Meghan, will virtual primary care patients have an ongoing relationship with a care team, or will they see a different clinician every time?

Meghan Huffman: This was a really important part of us, of our decision when we launched virtual primary care. We wanted it to be as close as that in-person longevity relationship as possible. And so, the way we've set this up is that any time a patient comes to virtual primary care, once they see that physician the first time, it'll automatically show up in their myChart to where they can continue to have follow-up visits, an ongoing relationship. We think that's a really, really important piece of offering any kind of healthcare from a primary care lens, especially in the virtual space. We want patients and that caregiver or that physician to know each other, and have that relationship and be able to book a quick visit and know, "Dr. Patel's going to take care of me. We know each other. They know my history. They know the backstory." That is critical and very important. So, we have set that up in a way that you should expect when you come to virtual primary care that will be your ongoing physician.

Roshni Patel, MD: I think that continuity is really important. So, I'm going to say as a primary care physician myself, you know, we work hard in our brick-and-mortar clinics to help make sure patients are being able to have the access to see the same person through their care. We also want to make sure that's happening in the virtual primary care setting. And truthfully, you know, the conversations are what create that bond or that relationship, and that's going to be true whether that's through a virtual screen or if it's in person.

Host: So, it is possible to have that really personal feeling and privacy with your doctor through a screen.

Meghan Huffman: Yes. Absolutely.

Roshni Patel, MD: It's not just possible, but it is the goal. I was laughing to say, you know, we've gotten so comfortable now culturally to allow relationships to build through a screen. I'll say even my family, like if I call anybody in my family, we FaceTime them. I don't just pick up the phone and do an audio call, because it is really nice to have that second enhancement of adding video with that.

Host: Well, Dr. Patel, because this does work so well on that level, do you envision virtual primary care eventually replacing traditional primary care brick-and-mortar offices?

Roshni Patel, MD: There's always gogoing to a part of human care that needs human in-person to human in-person interaction. There is something incredibly special about that and that's not going to go away no matter how advanced technology ever gets. There is something just about, you know, humanity, itself and the comfort that you will get with another human near you.

Host: Meghan, this is not Novant Health's first venture into virtual care. What have you learned from providing more than 500,000 virtual visits so far?

Meghan Huffman: This was one of my favorite questions that I saw on this for the podcast today. I get so passionate about this space. I think it's important to kind of take a little bit of a step back to say, right now, the healthcare industry is really saturated with direct-to-consumer healthcare tech companies and consumer companies in a way we've never really seen before.

And we've noticed a lot of companies out there offering they can be your primary care specialist, or they can provide virtual urgent care or menopause care or weight management care. And we looked around and we said, "Wait a second. We have some of the best physicians in the world. You know, why are we not doing this? We should be able to offer patients the same type of service, except for, in our humble opinion, better," because we have health system. We've been doing this for a really long time. And so, we did start a virtual menopause clinic, which has been unbelievably successful. We're able to meet so many women where they're at, women who never thought they would be able to have a conversation with a physician who is an expert in this space that we're able to provide that care for.

And what we've learned is that the patients coming to Novant Health's virtual services are not just super easy. We're going to hand them HRT, or we're going to hand them GLPs. We're going to do another script fill. That is not the service that we're providing. We are really taking care of these patients in a holistic manner, and we're not just treating whatever you come to us for.

So if you come for menopause or come in for virtual primary care, we're looking at you as a whole person. And Dr. Patel referenced this earlier. We're saying, "Okay, we've got your labs back. Maybe something's come, and you need to see someone in cardiology, or you need to go see oncology."

We've had so many cancer patients also come through, really complex patients, and we're treating them holistically and getting them to the right next space in this beautiful way where we're packaging up the notes. It's all in the same EMR. We're having doc-to-doc conversations before you get to your next appointment. I think that's the beauty. And what we've learned through this is we're able to take care of the whole person, even if this is just how they came through that initial front door. There's so many more avenues. So, we've learned that, first and foremost.

And second of all, we've just learned that convenience really makes the difference of someone keeping their appointment. We've seen so many women say, "I just kept scheduling appointments and putting it off and canceling and rescheduling. But when this virtual option came by, I was able to do it during my planning period at school," or "I was able to do it right before I went to pick the kids up" or, you know, whatever their story may be, this really just gave them an avenue they didn't have before to just take control of their own healthcare.

So, we've learned that the patients love it. We've also learned the physicians love it. It's a very easy way for physicians to spend that one-on-one time with their patients without having other distractions. And not that our brick and mortars are always distracted, but it is just a quiet time that you can have that conversation. So, we've learned a lot, and we've learned that this is something that we have to do as a healthcare system.

Roshni Patel, MD: I think through our virtual offerings, I honestly think people felt like it was going to be another way in which healthcare is going to get fragmented. But in my opinion, I actually think it's one of the better ways in which we've been able to help connect the dots better and actually help the patient get connected to the next steps along their healthcare journey.

I feel like, in a lot of the avenues for care that we've offered patients, a lot of times patients are getting the feeling of fragmentation. Because at any single point, it feels very incomplete, the torch didn't get passed along to the next stop. At the same time, you know, just like in brick and mortar, we want the patients to come back in, and we want that avenue to be fast and easy. And I think that's also one of the things that virtual visits has been able to help diminish. That is that time to come back in and touch the healthcare system, get the next piece of advice to like, you know, again, move that torch along in the journey. So, my additional comment is that one of the things I think we learned is that we are able to help reduce the fragmentation by offering solutions like this.

Host: That's interesting because you mentioned, Meghan, how Novant Health has expanded into some specialty areas like menopause care, preventive cardiology, and weight management. And I think what you're saying, Dr. Patel, is the successes you have seen in those programs sort of informed this new virtual primary care offering, making it more holistic rather than more fragmented.

Meghan Huffman: Yeah, I think you're spot on with that. It's something that we've really taken seriously to make sure that patients don't feel like we're dropping the ball or that there's a gap. And I think a lot of this goes back to what we started with, what's the problem we're trying to solve, and that's access.

We're trying to make sure patients don't have to wait so long to get in to see a specialist. And a lot of times, we're able to augment some of that by having some virtual visits up front to start getting the ball rolling, start getting that next step happen where we can get labs going, we can get images going, we can make sure patients are getting to the right next spot.

And I think that's a really important piece of what we're trying to really hone in on with all of our virtual specialties. And you're starting to see these getting specific like menopause or like weight management, and soon to come headache or sleep, is that we want patients to see the right type of physician at the right time so that we're not wasting anyone's time or anyone's expertise as we go along. And I think that virtual care is a really good avenue to be able to get some of that done on the forefront as we're figuring out what are the right next steps for patients.

Host: Meghan, Novant Health is partnering with K Health to bring this virtual primary care service to patients. What does that partnership look like and what does this mean for patients?

Meghan Huffman: Yeah. So, we started to partner with K Health. We looked at some of the technology that they have around their AI capabilities. And what they showed us was, is that they're able to do a virtual dynamic intake with patients prior to their visit to really start to ask some of those questions that would normally get asked in a brick-and-mortar by a nurse or a CNA that's rooming the patient to kind of get that background information.

What are you coming in for today? It's dynamic in its answer. So based on the answer you gave it before, it is going to ask another type of question. And then, at the end of that, it's going to summarize all of it and put it right in front of the physician so that way that physician can get a quick summary of what you just said, intake that information, and be very ready and present for whenever that visit's to start.

And we really like that capability from K Health. And they have opportunities that we can start to create AI intakes for several different types of specialties, just to help the visits go along a little bit faster. We still need our nurses. We still need our CMAs. That's not going to change. But this is just another tool in their toolbox to help us, you know, get patients' information a little bit quicker, get it summarized for the physicians. We really like that.

Also, K Health provides another tool that we've been using called PatientGPT. We're calling it Aubrey. And so, Aubrey is our AI navigator here at Novant Health. It can help answer your questions, can get you to that right level of care. And so, when you ask a question, and it really does need to be answered by a physician, we can connect you right then and there to virtual primary care or to a brick-and-mortar if that's what your preference is. So, we're really excited about the technology and the partnership that K Health brings to the table.

Roshni Patel, MD: I'll add from a clinical lens, our partnership with K Health has really been a success because one of the things that K Health has done, they are a tech company at heart; however, they are very invested in making sure they're building a tech product that's built responsibly from a clinical angle, and that is something that was very refreshing to see.

I will say sure, there's lots of efficiencies and things like that are going to happen because of tech advances. But to be able to have a partner that's allowing, you know, that clinical responsibility to stay at the forefront of each project is quite different. And I think that is what helped that partnership be a success.

Host: Now, I know we talked about this earlier about accessibility and what kind of patient might benefit from virtual primary care and has a lot to do with scheduling and transportation issues. But just to sum up, Dr. Patel, how should patients decide whether virtual primary care is right for them?

Roshni Patel, MD: Part of my answer is you don't know until you try, right? So if you've never had a virtual visit before, I think part of it is, you know, just understanding kind of what does that mean to have a virtual visit. They will be pleasantly surprised to be able to see the value and the quality of care that is able to be delivered from a virtual setting.

I'm not sure that there is an automatic yes or no answer there. The yes or no answers most of the time come from our clinical radar again. You know, there are true things that really just cannot be completed in a virtual setting. True emergency interventions cannot occur in a virtual setting, right?

So, I think the not right for you for a virtual visit has to be much more of a clinical radar type of question, and that's where we believe the tools like our PatientGPT Aubrey Navigator is going to be a helpful way for you to understand should we be directing you to virtual care or should we not?

Host: Well, I'd like to end by asking you both this question, maybe starting with you, Meghan. Is there anything else patients should know before their first virtual primary care visit?

Meghan Huffman: Yeah. So, kind of like I was mentioning earlier, there is an AI intake, so we're asking patients to get to their virtual visit about 15 minutes early so they can complete that intake and be prepared for the visit.

The other thing is just a reminder for patients that this is an office visit. It is a professional situation. And so, having a little bit of that patient conduct as it relates to don't be driving in the car trying to take your visit, don't do a virtual visit with a lot of distractions in the background. You want to make sure that you're in a HIPAA-compliant environment. You need to be someplace that we can see you, that we can hear you. You need to be dressed appropriately. So, I think those are some things just to remember. We know you're sick or we know you don't feel good. But, you know, come to that visit prepared just like it would be in person, so that way we can give you as the patient the best clinical experience that we can.

Roshni Patel, MD: And I'll add in there that, over the years, there's been a desensitization to what occurs or the expectations of what should occur in a healthcare visit. And when I say desensitization, as in, you know, sometimes people will equate the 15-minute timeframe that they have allotted for a visit with a healthcare provider as equal to me getting grocery, you know, picking up milk at the grocery store.

That is fine time-wise, it may be approximately equal. But we have a lot of very important things that we are going to be discussing. And so, you know, we want to make sure that patients also understand that we want them to be fully understanding that the respect is both ways. We want them to understand that we very much value and we want to make sure that the clinical decisions that we're going to be giving them, the navigational advice and guidance that we're going to be giving them, we're giving that to them with respect to their needs in a very personalized and customized fashion, and that takes time.

That also takes a lot of expertise and learning. So, it may not feel very hard and fast every single visit, you know, and it shouldn't be that it's only valued when somebody's life is on the line, right? Every single visit should have that same sort of value and respect both ways.

Host: I think we're learning that there is a lot of thought being put into this, a lot of respect, and a lot of expertise. Thank you both so much for helping us understand the basics and the complexities of virtual primary care. I wish you continued success with this wonderful program.

Roshni Patel, MD: Thank you.

Meghan Huffman: Thanks, Amanda.

Host: To find a physician, visit novanthealth.org. For more health and wellness information from our experts, visit healthyheadlines.org.