How to Build Successful Virtual Primary Care Services

The essential elements of providing primary care to patients via telemedicine include an affordable financial model and exceptional patient experience.

A San Francisco­–based telehealth provider is on a mission to transform primary care services for patients and their physicians.

The coronavirus disease 2019 (COVID-19) pandemic has accelerated adoption of telehealth services at health systems, hospitals, and physician practices. Many payers, including the Centers for Medicare & Medicaid Services, have expanded coverage of telemedicine.

PlushCare has been providing primary care telehealth services to patients since its founding five years ago.

"Our median patient age is 40 years old. We are at parity with what a typical primary care provider can do. We deal with urgent care visits, preventative care, and we also take care of patients with chronic conditions such as high blood pressure, asthma, depression, anxiety, and high cholesterol. We have treated more than 3,500 unique diagnoses," says Ryan McQuaid, co-founder and CEO of PlushCare.

PlushCare, which has a nationwide patient population of more than 200,000, employs more than 100 physicians. The COVID-19 pandemic has boosted demand for PlushCare's services, with a 400% increase in telehealth visit volume, McQuaid says.

The business model at PlushCare features five elements.

1. Financing mechanism

The financial model at PlushCare includes a monthly patient membership fee set at $14.99. "The membership fee is for all of the benefits that our patients are getting that are not billable through insurance. When you compare Plushcare to people paying $10,000 a year for a concierge doctor, it is extremely reasonable," McQuaid says.

In addition, there are payment mechanisms for virtual visits, he says. "Patients can pay cash or use their flexible spending account or health savings account. We also are contracted with most of the major health plans. For patients with health insurance, they pay the primary care copay that they would typically pay for a bricks-and-mortar primary care practice visit."

2. Patient experience

An exceptional patient experience is a foundational aspect of PlushCare, McQuaid says. "We have seen that providing what we consider a 'wow' patient experience is incredibly valuable for people getting excited and telling their friends and family members about us. Our net promoter score has consistently been at 90, and the average primary care physician office across the United States is about 3, which is according to the Advisory Board. Our focus on the patient experience is huge."

PlushCare offers patients 24/7 access to a physician.

"From a patient perspective, the way we work is you can go on our website or download our app, then book a video visit with your physician. Patients select a dedicated primary care provider with whom they have an ongoing relationship. Our clinicians do not work 24 hours a day, seven days a week; so if a patient has an urgent need on the weekend and their primary care physician typically works Monday through Friday, the patient can see one of his or her colleagues to get immediate help," he says.

PlushCare employs more than 40 care coordinators to help patients with a range of issues, McQuaid says. "Patients can use in-app messaging to talk with their care coordinators. So, if a patient's prescription did not show up at a pharmacy, or if a patient needs help finding a specialist who is in-network and highly rated, our care coordinators can help patients figure that out. It is a concierge-like service."

There are also registered nurses available to help patients, he says. "If patients have a question that does not necessarily need contact with their dedicated primary care providers, they can contact a registered nurse who can respond to any questions."

From a technology perspective, PlushCare has a world-class patient app, McQuaid says. "When you think of healthcare, technology, and apps, you often do not think of great consumer experiences. We hired some of the best product folks, designers, and engineers who came from consumer-focused companies such as Amazon. They focused on building an amazing consumer experience."

3. Physician experience

A crucial element of providing a good patient experience is promoting a positive physician experience, he says. "We feel it is important for physicians to feel happy and not to be burdened by bureaucracy or imputing information into an electronic health record. We use technology to make functioning as a physician seamless."

PlushCare developed a physician-friendly electronic health record, McQuaid says. "We built our own electronic health record because a virtual primary care EHR did not exist when we founded PlushCare. Similar to the consumer side, we got amazing designers, engineers, and product specialists who had built fantastic consumer experiences to build our electronic health record, which our physicians love."

For example, PlushCare's EHR is designed specifically for primary care, so it is not bloated to support many specialties. The EHR also is configured to decrease paperwork for physicians, with forms and coding completed behind the scenes by a tech-enabled administrative team.

In addition to building an innovative EHR for physicians, PlushCare's billing processes reduce the administrative burden on clinicians, he says. "We have removed physicians from the billing process as much as we possibly can. The goal is to remove everything that is distracting our physicians from building a relationship with their patients and taking care of their patients."

PlushCare's company culture includes making sure physicians feel they are part of a community, McQuaid says. "When you talk with our doctors, one thing they love is the community we have established—they are able to share information absolutely seamlessly. It may not be what you would think because everybody is working virtually, but our management team has done an awesome job at creating a community for our physicians."

4. Top-notch physicians

Employing high-quality physicians has been one of the keys to success at PlushCare, he says. "All of our physicians are recruited from the Top 50 medical institutions in the country and, on average, they have 15 years of experience."

Building a team of excellent physicians has appealed to patients, McQuaid says. "When you think of professional services—whether you want a lawyer, or a physician, or a management consultant, or an investment banker—everybody wants the best. By having high-quality doctors, we instill trust in patients that they are going to get an amazing doctor at PlushCare."

5. Physician-patient relationship

PlushCare has focused on building relationships between patients and their primary care physicians, he says. "To optimize the physician-patient relationship in telehealth, it really is a longitudinal primary care experience, in which the patient sees the same physician over time and builds a relationship with the physician on an ongoing basis."