Maryland-Based Payer Launches Virtual Primary Care Practice

The new virtual primary care practice, CloseKnit, offers a full range of primary care services along with behavioral health care.

Telehealth has expanded exponentially during the coronavirus pandemic. Healthcare organizations have launched telehealth offerings in a wide range of specialties, including primary care, behavioral health, cardiology, oncology, and neurology.

Among those organizations include Baltimore-based CareFirst, which recently launched a virtual primary care practice.

CareFirst is a not-for-profit healthcare company that offers a comprehensive portfolio of health insurance products and administrative services to 3.5 million individuals and employers in Maryland, the District of Columbia, and Northern Virginia. In early September, CareFirst opened its CloseKnit subsidiary, which is a virtual primary care practice available to commercial health plan members.

"CloseKnit is a primary care practice [that] offers a full range of primary care services, including sick care, well care, and preventive care. It also has behavioral health integrated, so it has behavioral health specialists. It has insurance navigation and care coordination—those are nonclinical functions in the sense that they are not involved in the delivery of care, it is more supporting people in getting and receiving care. These are dedicated teams that work on behalf patients," says Mary Jane Favazza, MBA, CEO of CloseKnit.

CloseKnit patients will have a clinician who serves as their primary care provider. In addition, they will have a full complement of professionals who work with the PCP to help with care, including physician assistants, nurse practitioners, insurance navigators, care coordinators, and mental health specialists.

CloseKnit is designed to be patient-centric, Favazza says.

"We are trying to build true longitudinal relationships with patients by putting them at the center of care. We do a lot of research on patients, particularly with those who are not engaging in primary care. We want to know the kinds of things that are causing patients not to engage in primary care—what are the obstacles and barriers that get in their way. They talk about things such as unavailability of appointments on a timely basis, or the wrong time of day relative to their work schedules, or the difficulty of getting their mental health professional and their physical health professional on the same page working together. Patients end up having to do a lot of legwork to make that kind of coordination happen," she says.

The virtual primary care practice offers telehealth visits on a 24/7/365 basis.

"One of the top reasons that people told us it was hard to find a primary care provider who worked for them was because of the lack of evening and weekend availability. If a patient is working certain shifts, they may not have the typical 9-to-5 availability that others do. So, it was an important feature for us to create access for patients who have significant barriers to accessing primary care," Favazza says.

To be able to offer visits around the clock throughout the year, CloseKnit has hired a full-time staff of clinicians, she says.

"It is a full-time staff of MDs, DOs, physician assistants, and nurse practitioners. We do not employ a model that many others use, where we allow clinicians to sign up for available space in the system. We have dedicated, full-time employees who work for CloseKnit. We just think that works better for our model—we want to build relationships with patients, so they can see the same provider all the time. To do that, we need to have providers who are working full-time for CloseKnit—not just working at times when they have availability."

Insurance navigation and care coordination

Insurance navigation is an important service for CloseKnit patients, Favazza says. "Insurance navigation is there to support patients. For example, insurance navigators can say what the benefit allows patients to do in terms of steps that they might have to take such as whether a referral is required and who are the specialists beyond primary care that are in network who are close to the patient."

Care coordination is equally important, she says. "Care coordination includes getting appointments, getting the scheduling done, and if patients need to see someone else, that gets followed through. Care coordinators make sure that records get back to primary care—we work hard to reduce care fragmentation and make sure the PCP can know where you are in the healthcare system."

Price transparency

CloseKnit is committed to price transparency, Favazza says.

"As any provider does, we have access to information about how much a patient's set of responsibility is for any given service. We are choosing to promote the fact that we work with patients to make that responsibility visible to them, talk with them about their options, and we do that in a way that does not require a visit. Patients can chat with a navigator and say, 'What would this cost? What would the difference be if I did the service here versus there?' We are hoping that moving that conversation upfront and before things happen gives people the support that they need to make good choices and fully understand what is going to happen."

Patients have a couple of options to have conversations about the cost of services, she says. "You can ask to speak to someone straight away and you can chat asynchronously. We are trying to make ourselves as available as possible to people based on their preferences for communication."

Virtual visits versus in-person visits

At CloseKnit, whether a patient needs a virtual visit or an in-person visit is up to the discretion of the CloseKnit clinicians, Favazza says.

"Often, the providers reach a point in the conversation where a visit needs to be done physically. Some of those are easy to tell upfront such as if a patient needs a women's health exam that requires a Pap smear or pelvic examination. We know there are limits to things that can be done virtually. Then there are situations that may start as a virtual visit—there can be questions about a rash or about abdominal pain and the provider can go through the care process. If they feel that the patient needs to be seen in-person, they just make that decision and transfer the patient to in-person care."

When an in-person visit is required, CloseKnit can refer patients to clinicians who are in CareFirst's network of providers, she says. "We work with the patients to say, 'What is important to you? Is it better to be closer to home? Is it better to be closer to work?' We ask whether the patient has preferences about the type of in-person specialist that they might need to see. It can be about gender or training, whatever the case may be. We do our best to find somebody who fits the patient's immediate need."

Related: How to Use Telemedicine With Your Older Patients