I grew up watching and learning from my father, a beloved community-based family physician in Greene County, OH. He represented a philosophy of medicine that is almost forgotten in today’s busy and complicated healthcare world, one that always put the needs of his patients first. We’d spend Saturday mornings making a few stops to see patients before tennis or a family outing. He would see a dying patient in the middle of the night or do a quick diagnosis at the grocery store without a second thought, all while running a small business, raising a family, and navigating sweeping changes across the industry.
Medicine has made great strides over the last few decades, but with those advancements have come more specialization, greater complexity, and ballooning costs. The industry’s band aid for higher prices has been to drive more “efficiency” into the practice of medicine, putting pressure on physicians to see more patients in less time and adding administrative hurdles to providing great care. Emerging value-based care models look to address the underlying causes of our disjointed and expensive delivery system by rewarding physicians like my dad for taking the time to truly address the needs of each patient. In my eyes, delivering care this way was the purest form of healthcare one could practice.
However, as I embarked on my own journey in medicine and public health, I saw first-hand just how difficult it would be to practice this kind of healing care I believed in. Everywhere I looked, clinicians were specializing or choosing procedural fields, yet the essence of why many of us went into healthcare, to truly connect with another human being, to bond and understand someone’s life context, and to guide and partner with them through some of life’s most celebratory and most challenging times, seemed to be displaced in a fee-for-service world that demands volume and interventions over value and trust.
Through the past decade of practice across multiple care settings, there has been one model I practiced in that felt, to me, most pure to the type of medicine and devotion that someone like my dad had towards his patients and community. At CareMore, a large value-based advanced primary care organization, I served as a high-risk PCP and a clinical leader. As a physician, I was given the time and resources I needed, surrounded by a robust interdisciplinary team, equipped with real-time clinical decision-support and evidence-based guidelines. This experience offered hope as to what the future of our industry could look like. We employed community health workers, care managers, nurses, social workers, counselors, specialists, pharmacists, and an energized support team who were all empowered with the tools and technology to really understand who we were caring for and solve real problems for them. This model allowed us the opportunity to stay true to the promise we should make to all our patients: that we will deliver the same quality of care we would want for our own families.
The COVID-19 pandemic has impacted the entire healthcare industry in challenging ways, many which will never fade completely. Resignations, early retirements, and disillusionment are rampant, especially across primary care and community-based clinicians. Yet, we’ve seen a level of resilience, commitment, and service from physicians and clinicians that reminds me why I wanted to train as a doctor and serve.
Like many Americans during the pandemic, I relocated back home to a small rural village with less than 6,000 residents. As I navigate our own healthcare needs as a newly growing family, the dearth of robust advanced primary care models in my area is startlingly apparent. We are surrounded by amazing clinicians in rural communities, dedicated to serving their patients, however, a crippled infrastructure, lack of investment, and a dwindling workforce introduce more challenges than many small practices can often overcome on their own.
During the last two years, we’ve lost more primary care physicians in our country than any other specialty. Many physicians, who dedicated decades of their lives to train and serve, feel marginalized by constant downward pricing pressure, increasing fee-for-service churn, and lack of support and resources. Burnout rates are higher in rural settings and primary care physicians are leaving the workforce at the highest rate we’ve ever seen, but the next generation of physicians are not generally raising their hands to jump into these opportunities and tackle many challenging practice dynamics.
And the numbers show it – while 25% of the US population lives in rural areas, only 10% of our nation’s physicians practice here. Many elements of patient care are more complicated in rural settings, driven by the access to care challenges as well as social and health needs specific to these communities. As a result, patients living in a rural area have a higher prevalence of all the most common chronic conditions and a 40% higher chance of preventable hospitalizations compared to urban counterparts.
Despite the significant headwinds we’re facing in our rural communities, there is much room for hope and optimism.
Advanced primary care models like Oak Street Health, ChenMed and CareMore truly work, both for patients and their care teams. Today, these care models are largely deployed in urban and suburban settings because of the investment and infrastructure required, yet, even then, less than 5% of Medicare-eligible patients are served in a robust advanced primary care model and even fewer for those covered by commercial insurance or Medicaid.
We started Hopscotch Health because we believe healthcare should be simple and accessible for all patients, including those in rural communities. We also believe there’s an incredible opportunity to partner with physicians and practices in rural areas to deliver the proven aspects of a team-based care model. Our founding team has seen what is possible when you give clinicians the support they deserve: patients, families, and communities get the care they need. We are building Hopscotch to make this possible.
Over the past four months, I’ve spent countless hours with independent primary care physicians and many others practicing and serving in rural communities. Many of these heroes remind me of my father – they display grit, determination, compassion, focus, and commitment to their patients every day. In the broader communities, I’ve observed some incredible things too. The social and support systems are strong, including the sacred trust between a physician and a patient. There is a deep sense of pride and commitment among residents, a genuine care for family and neighbors, and a desire to serve and strengthen the communities in which they reside. These strengths can and should be celebrated and are core to the model we are building.
As a practicing internal medicine physician, I have acutely felt the crisis in primary care that we’ve been experiencing for decades, but I’ve also seen first-hand the power of coordinated team-based care and always putting the needs of our patients first. As someone living in rural America, I have personally experienced the challenging access issues, but also the pride and beauty of these amazing communities. We founded Hopscotch to help bring the vision of advanced primary care to countless individuals living in rural communities all over the country. We will work tirelessly to empower clinicians like those I’ve met along the way, like my father, to deliver amazing world-class care to the people we serve.
We cannot wait to share more with you over the coming weeks and months. In the meantime, if what we are building resonates with you, please reach out – we’d love to hear from you!
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