Improving the patient care experience is enhanced by the availability of clinical research, particularly with the "concierge" experience offered by an integrated research partner. For patients who have a challenging time accessing healthcare, this is especially impactful. Ultimately, the goal is to ensure clinical research is on the menu of care options, so patients have access to additional opportunities.
Editor's note: D. Keith Fernandez, MD, is chief clinical officer of Privia Health.
Privia Health, a physician enablement company, began the integration of clinical research to help meet the quadruple aim of improving the health and care experience of populations, lowering the cost of care, and enhancing clinical practice and the patient experience across the communities we serve. We launched our clinical research program with the support of our integrated research organization (IRO) partner Javara, about 4 years ago, and after an initial pilot we have seen steady growth and increasing adoption.
The ability to bring patients clinical research at the point of care, with a trusted clinician, expands the ability to offer innovative care options to patients who may be interested, or may need alternatives for complex and or difficult problems not solved by usual care. Our groups, who mostly operate on a single technologic platform, are able to understand and offer research at the point of care using population health analytics and clinical decision support tools.
Improving the patient care experience is enhanced by the availability of clinical research, particularly with the "concierge" experience offered by an integrated research partner. For patients who have a challenging time accessing healthcare, this is especially impactful. Ultimately, the goal is to ensure clinical research is on the menu of care options, so patients have access to additional opportunities. As a result, improving patient experience and health outcomes can contribute to reducing healthcare costs.
Doctors are scientists first
Physicians are trained as scientists first. Integrated clinical trials are an opportunity we can offer our physicians, along with the package of enablement services that we provide as a management services organization (MSO). For interested physicians like Charles Kemp, MD, of Privia's Albany Internal Medicine in Georgia, and Cliff Yut, MD, of Highlands Woods Health in Woodlands, Texas, the benefits of adding clinical research to the practice are numerous. They say that it has been invigorating for them, energizing for staff, and great for patients.
"I enjoy being able to see patients more frequently and spend more time with them during their visit than I can in my normal clinic," says Dr. Kemp. "I like providing patient care within a different dynamic, outside of the routine."
Dr. Yut adds, "Research opens up an entirely different aspect in medicine and patient care. It is fun and exciting to be part of something that may change how we practice medicine in the future."
Clinical research can also provide physicians with an additional opportunity to earn revenue. This has been particularly key during COVID surges when patients reduced their doctor visits.
"The financial benefits allow the practice to function better as a whole rather than relying entirely on fee-for-service," says Dr. Yut. "Improvements in population health goals will also result in increased reimbursements to both the practice as well as the organization as a whole."
Perhaps one of the most impactful ways we have experienced the power of integrated clinical research is our contribution to scientific discovery. One of our trials contributed to the approval of a COVID-19 vaccine. The opportunity to help solve a massive public health problem has created a lot of excitement among our physicians, and we have since seen a robust increase in physician interest.
"Our group was part of a COVID-19 treatment trial, which was extremely rewarding for us and our patients who participated," Dr. Kemp notes. "These patients felt like they were serving the greater community and the fight against coronavirus and felt personally well taken care of. We were giving patients access to a treatment that was unique and unparalleled. Thankfully now, because of that trial, we have treatments that can keep people out of the hospital."
Getting up and running
Starting with a pilot allowed us the luxury of engaging our practices in how this program might evolve. Given the sometimes-high failure rate of clinical research programs, with high clinician drop out, it is critical to listen to concerns, involve clinicians who are excited and positive about the possibilities, and work with them in partnership to build the “right” program. In clinical research, physicians and their research partners must work together collaboratively towards the same goals. Choosing the right partner is obviously critical. We are committed to clinical research as a care option (CRAACO), and I believe that our strong partnership will help accelerate these efforts.
Trials across variety of disease states
Our group has participated in trials to treat and prevent diseases like COVID-19, type 2 diabetes, a variety of pulmonary conditions, lipid disorders, and high blood pressure. We have also participated in several OB/GYN trials, genetic studies, and population-based investigations applying predictive analytics to cancer risk. These are exciting opportunities for our physicians and their patients.
"Starting off we took the trials that we could get to gain experience and forge our reputation," Dr. Kemp says. "Now we can pick and choose the studies that are of most interest. Day in and day out I see hypertension, diabetes, and heart disease. I am eager to be involved in trials in these areas. Advances in our ability to control these conditions are needed in the medical community."
Considerations when integrating clinical research
It is essential that MSOs who are considering entering into clinical research understand the commitment and dedication necessary in order to be successful. It takes a lot of training and education to run a research project, so it’s important to have the best support teams working alongside you throughout the process. Organizations need to commit significant time investigating research partners. We chose our IRO because they are grounded in CRAACO, and we both believe in the power of research to cause positive change in healthcare for all. They have the necessary resources to partner with investigators and patients throughout the clinical trial process, combined with deep sponsor and CRO relationships which allow us to find the right-fit trials for our patient populations.
Being proactive is also key and helps us immensely as we have grown. I recently had a dinner meeting with a group of our researchers for the sole purpose of listening. I have found this to be the best way to find out what works and what does not, and this type of feedback cannot be obtained with just surveys. My job is to make sure our doctors are comfortable and having a positive experience.
Practice, physician success with research
"Clinical research is a wonderful aspect of medicine that enriches your day and can be fun, interesting and rewarding," says Dr. Yut. "But it takes a commitment to the process. If you engage in it, the returns are exceptional. If you think that it is just going to happen in the background, then you may be more disappointed or frustrated with the process."
Practices with highly engaged staff often see the most success with their research program. We have learned that the best way for a practice to be successful is to start slow with one trial and then build a program where they can run several.
Physician investigators in clinical research are accountable for the success of a program. Beyond engaging patients, they are leaders, team builders, and positive role models in the practice. Along with leadership skills they must also have curiosity and really want to pursue clinical research, not only as an avenue for continual learning and development but also as a way to give patients access to the most recent therapeutic innovations in the field.
"The hardest part of integration for me was translating research lingo into medical lingo," Dr. Kemp says. I was lucky enough to have a clinical trial navigator from the research partner on site. I had constant access to them and that really made the facilitation and integration a breeze. Managing time and optimizing your patient flow during trial visits can be challenging at first but becomes easier as you gain experience."
Dr. Kemp adds, "To have success, physicians should be curious, organized, diligent, and above all interested in spending time with patients. You’ve got to be someone who can be counted on. If you can do those things, then I think there’s no reason why you won’t be wildly successful in this."
I believe that having clinical research embedded in the practice is a differentiator for medical groups. Those who do it effectively will be sought out by patients and by payers. It is so important for us as a physician group to participate in clinical research and help contribute to improving the way we care for patients.
Dr. Fernandez is the chief clinical officer of Privia Health. Privia Health is a technology-driven, national physician enablement company that collaborates with medical groups, health plans, and health systems to optimize physician practices, improve patient experiences, and reward doctors for delivering high-value care in both in-person and virtual settings. The company’s platform is led by top industry talent and exceptional physician leadership, and consists of scalable operations and end-to-end, cloud-based technology that reduces unnecessary healthcare costs, achieves better outcomes, and improves the health of patients and the well-being of providers.
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Keith Fernandez, MD, is the Chief Clinical Officer of Privia Health.