As CareATC's Chief Medical Officer, Dr. Greg Biernacki has spent over 35 years in primary care, from Air Force flight surgeon to NASA to practicing family medicine across multiple health systems. We sat down with him to discuss the trajectory of primary care, CareATC's unique role in shaping it, and what patient-centered care truly looks like in practice.
Primary care has always traditionally been about a provider (physician/NP/PA) being the quarterback of a patient’s care. Unfortunately, in America we've really diverged from that. My journey as a physician began in the Air Force as a flight surgeon. I then transitioned into a flight surgeon role with NASA followed by practicing family medicine in three different not-for-profit healthcare systems. I saw over my 35 years in primary care how care became less about quality and more about quantity. How many patients can you move in an hour? It got a lot harder to do that quarterback of care, especially with the rise of specialists. Because of the payment methodology by which physicians are paid, you're actually paid to do something to somebody as opposed to talk to somebody. The talking specialties, family practice, pediatrics, internal medicine, psychiatry, are just the least paid. Especially with physicians coming out of medical school with such high debt, people aren't choosing primary care anymore. They're choosing to be specialists because they can make a whole lot more in an hour.
What we're trying to do at CareATC is restore care balance and get back to primary care being the quarterback of care. We're also addressing not just quality of care in a primary care setting, but offering solutions for mental health, physical medicine, collaborative care and novel products like functional medicine that focus on stress reduction, sleep, nutrition, gut health, and more. We've brought that to bear in a virtual product we can offer clients for those seeing extremely high GI claims who aren't getting results from their gastroenterologist, or those with syndromic problems like chronic fatigue syndrome or fibromyalgia that don't have a test to diagnose them but have a symptom complex and just don't seem to get better with traditional care.
We also know that pharmaceutical spend is a pain point for both our patients and clients, especially in those drugs that require infusion therapy such as immunomodulators or chemotherapy agents, which are often marketed direct to consumers on TV and are exorbitantly expensive. For example, one patient on a drug called ULTOMIRIS requires infusions at around $800,000 per infusion, six times a year. What we'd like to do is offer those same infusions at a lower cost, in the home, sourcing medications at a less expensive price. Same medication, but at a fraction of the markup you'd get in a specialist office or infusion center. Instead of $800,000, we're talking $80,000. And because it's a small population receiving these, we only have to convert maybe 10 patients to see astronomical savings.
We also need to ensure we are strong in our mental health and physical therapy offerings, because that really rounds out our primary care offering. So, what I see for the future is that CareATC is trying to go back in time and be that quarterback of care that primary care should be, while also offering mental health, physical therapy, collaborative care for disease management, novel products, infusions, and virtual offerings.
Virtual offerings are important because where and when a patient wishes to receive care is undergoing change. My generation likes to go to a physical place. Younger generations do not. They want the care they want, they want it now, they don't want to go somewhere, and they want it preferably on their phone. If you can do it via text, even better. We've markedly improved our virtual app for patients enfranchised with a clinic, but now we also have a product for those who are not, say a large client with employees spread all across the country who is looking for health access equity. Now we can reach out and touch them.
Last thing on where I see things going, AI is absolutely going to play a part in future care. You can put in symptoms and out will come the most likely diagnoses and what you might want to do next. It will speed up the time to get to diagnoses as well as proper treatment. The one thing I will say about AI is you have to be careful, because it's garbage in, garbage out. If you are a good provider and you add AI to your care, you become a great provider. If you're not a good provider, you get worse because the information you're putting in is pointing you in the wrong direction.
A lot of it is developing our app so that you can have as equivalent of a visit as possible. Post-COVID, virtual care has to be as equivalent as possible to what you would receive in an office. Ensuring it looks right, that the provider is dressed properly, that they arrive on time, that you have good visual quality, so that you can get those cues you need in a person-to-person relationship. What does their face say? What does their body language say? It also allows us to interact with our EMR so we can do our e-prescribing and everything we can do in the office, through the app.
Second, we've already put in an AI pilot to help our providers with documentation. The single biggest thing providers dislike is the time required to document in the Electronic Medical Record. Providers love being in the room with the patient, they just hate the charting. So we're piloting ambient listening AI this first quarter and it's been highly successful. It transcribes the conversation in the background, puts it in note form, and then all the provider has to do is edit the chart instead of type the chart.
We also do monthly in-services with our Vice Presidents of Medical (VPMs) and Area Medical Directors (AMDs) where we discuss clinical, EMR, and administrative updates, then push that out across our provider network. We've also encouraged our AMDs to develop in their areas a medical group mentality, so instead of being an isolated provider in a solo site, you're part of a medical group with an area group and a zone group. You're part of something bigger.
We're also well positioned through partnerships. If we can't build something better and somebody already has a great product, we white label it and use that service ourselves rather than reinvent the wheel.
Part of it is emphasizing what is important, not just to us as clinicians or to our patients, but to our clients, which is proving that we are providing better care and better clinical outcomes than they could get if they just invested that money into their local health system. We do that by emphasizing HEDIS data, which is national quality data, and measuring how a provider is doing against their peers. If we see that your partner is at this level of care for their diabetics but you're here, what are the gaps? I always believe there's really no such thing as a bad provider. There are just bad processes. So what is going on within the processes in your clinic that we could improve? What technology tools could we give you to make things better?
We also look at ensuring that we are coding our charts properly so that we can go to a client and say here is what we're finding, here are your risk adjusted scores for your population, we see that you have a lot of diabetes or hypertension or heart disease, and here are the care levers we need to pull on. .
We never want to be a quantity practitioner of medicine. We want to be a quality practitioner. It is not how many patients you see, it is what are your quality metrics and what are your clinical outcomes. Our mantra at CareATC is better clinical care equals better clinical outcomes equals reduced cost. If you are doing number one, that leads to number two, which leads to number three, which keeps us sticky with our clients so that they decide to continue to invest in CareATC.
There is this whole concept of the patient-centered medical home, which every health system says they have but very few actually do. In my own practice, which had three physicians and six nurse practitioners, we were practicing one way on Monday, got our certification as a patient-centered medical home on Tuesday, and on Wednesday we were practicing exactly the same as we did on Monday. It was basically just a paper exercise. You check the boxes but nothing changed.
Here it is different because we are under pressure not just from patients who expect great care, but from our clients as well. Our clients can be very directive and very vocal if they don't think we're moving in the right direction. That really does push us toward genuine patient-centered care.
Through our leadership structure, our Medical vice president, zone leaders, and area medical directors, we are developing that group medical practice mentality where we all help each other and stay engaged in what we are doing.
And then there is the work being done around how we interact with our patients so they feel valued and heard. That is part of training our staff, whether it is the person at the front desk or the physician in the back and everyone in between. How do you make people feel heard, welcomed, and appreciated?
I will give you two examples. The first came out of South Florida and involved one of our dietitians who took a patient with a pretty typical American lifestyle. Not eating well, mostly fast food, drinking a lot of soda, not exercising, and high stress. Through multiple sessions, the dietitian was able to connect with the patient and get their buy-in that there are things you can do to improve your health and avoid eventually going on medication. This individual only lost 10 pounds, but they dropped their total cholesterol by over 60 points, their bad cholesterol by over 40 points, and their hemoglobin A1C, which is a measure of blood sugar, by a substantial amount. They started drinking mostly water, changed their eating habits, and as a result of feeling better they started exercising. That is the power of one. If you can spend enough time with an individual and get through the initial resistance, you can get them where they need to go without ever reaching the medication stage.
The second involves access. We had a patient who was seen out of town for abdominal and pelvic discomfort. The emergency room found a mass in her pelvis and told her to follow up when she got home. She called her PCP and couldn't be seen for three weeks. She remembered CareATC, called us, and got an appointment the next day. We pulled her ER records, identified a pelvic mass, and got her a referral to GYN within a day. It turned out to be an ovarian mass/cancer, which was removed and with subsequent oncology care has had full remission. She has been loyal to us since that episode, with her noting that we saved her life and shortened the time between discovery of an abnormality and definitive care.