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Winter Bootcamp: The future of health care


Understanding the differences between convenience-based care and practice-based care in a changing health care world.


The practice of medicine, like health care in general, is changing at unprecedented speed. This dynamic was vividly illustrated with the rapid pivot to telehealth brought on by the COVID-19 pandemic. According to a December 2021 report from the U.S. Department of Health and Human Services, the number of Medicare visits conducted through telehealth rose from about 840,000 in 2019 to
52.7 million in 2020, a 63-fold increase.

But the challenges to health care delivery go beyond coping with the rise of telehealth. Practices also face staffing shortages, competition from retail outlets, and stagnating or declining reimbursements, to name just a few. In addition, patients increasingly expect to receive care at times and locations that are convenient for them, rather than just during standard business hours in a physician’s office. They also want to communicate regularly with providers through tools such as text messaging and patient portals, along with face-to-face visits.

For medical practices, survival in this new environment will require a laser-like focus on improving efficiency and flexibility, understanding patients’ needs, and having the ability to communicate with patients — in short, a ground-up reconsideration of all aspects of their operations.


The market is changing, so it is critical to have awareness of the interrelationship between convenience-based care and practice-based care.

The transition to a hybrid care model requires focus on enhancements to office workflows.

Reducing appointment no-shows has a major impact on practices bottom line.


Justin Mason, MBA

Andrew Barbash, M.D.

Understanding the challenges

Independent medical practices are facing significant challenges to their survival in the current health care business environment, says Justin Mason, MBA, president of Updox, a provider of integrated communication platforms.

These challenges include:

Competition from retail clinics, with major players such as CVS, Walgreens and Walmart expanding their footprint. “The convenience of these models is undeniable,” Mason says.

Consumer expectations of “I want it now” — being able to receive care where and when they want it. It is, Mason says, an expectation that retail clinics are designed to support through extended hours and easy accessibility, “all while you’re buying wine and bread.”

Rising costs and inflation. “Costs are rising faster than revenues, and reimbursement rates are dropping,” Mason notes.

Staffing shortages and burnout. Increased resignations among providers and staff are resulting in longer wait times, lower quality care and reduced access to care, especially in traditionally underserved communities

The emergence of hybrid care delivery models in which care is provided using telehealth and asynchronous forms of communication in addition to the traditional in-person patient encounter.

Growing regulatory burdens and compliance requirements that impose time and monetary costs on practices and limit doctors’ ability to provide high-quality care.

Underlying many of these challenges is the massive quantity of paperwork and administrative tasks facing medical practices, explains Andrew Barbash, M.D., Updox co-founder.

To manage these tasks, it’s helpful to think of them in three broad categories:

  • Patient-facing tasks, such as appointment reminders, telehealth visits, messaging and intake forms.
  • Internal-practice-facing tasks, such as workflow issues, secure internal team messaging, and managing communications and documents arriving via fax or patient portal.
  • Outside-business-facing tasks, such as secure message and document exchanges and communications with other providers and with payers.

“At the end of the day, it all boils down to workflow because health care consists of a series of transactions, and each of those transactions involves work,” Barbash says. “And the work has to be done by the patient, (the) practitioners, the staff that support those practitioners, and (the) people external to the practice, such as other specialists and third-party payers.”

He adds, “In an increasingly complex world, with advances in medical knowledge (and) more technologies and interventions, the work in many ways is increasing.”

What that adds up to for medical practices is a need to get work done more efficiently, particularly when it comes to patient engagement. He cites the example of clinics with large numbers of underinsured patients discovering at the start of the COVID-19 pandemic that many of their patients had cell phones and could receive medical care through them.

“That was very leverageable in terms of increasing the efficiency of how patients are engaged,” he explains. He calls the use of text-based messaging “an absolute breakthrough for health care practices. It’s a dramatic advance in efficiency but also provides a more dynamic methodology by which patients and practices can interact with each other.”

The ongoing, asynchronous communication texting also has a value to patients and their caregivers, Barbash adds, because it lessens the chance of their coming in on the wrong day or without the required paperwork.

Most practices also need to become more efficient in processing incoming paperwork, Barbash notes. “You can’t just wait for a solution that says, ‘The industry will just pay you for the time it takes to fill out a form.’ You have to start focusing on how to make that process more efficient.”

Barbash notes that technology can further benefit practices by increasing the number of patients seen per day by, for example, using text message appointment reminders to reduce patient no-shows. In addition, practices can use telehealth to provide care for patients who find it difficult to reach the office for an in-person visit.

Barbash calls the ability to send intake forms to patients before their visit a “tremendous advance” by enabling the gathering of information directly from patients and their caregivers.

“Sometimes what they provide you under those circumstances is different and better than what they would provide in the office,” he says.

These and other uses of new communication technology can help counter what Mason calls “headwinds” in the macro trends facing small medical practices in the form of new market entrants, staff burnout and inadequate reimbursement. “Practice efficiency and patient experience are inextricably linked to revenues and profitability,” he says. “Managing a practice so as to get efficient outcomes is absolutely critical.”

Solutions & takeaways

  • Patients today have many options in terms of how, when and where they get health care, so practices must be prepared to use video, texting and other forms of communication to keep patients engaged.
  • Practices can maximize patient engagement by tailoring messaging according to the time of year, such as sending vaccination reminders before the start of the school year.
  • Having patients fill out intake forms online before their appointment saves time during the visit and enables the provider to focus on the patient’s specific needs.
  • Combining virtual and in-person visits allows practices to increase the number of patients seen per day and bring in additional revenue.
  • To meet the challenges posed by competition from retail health care outlets and declining reimbursements, independent practices should look for efficiencies in their document management and workflow.
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