Table 2 Major themes and representative quotes from high-performing practices

Telehealth

For people that are working, now they don’t have to take off all this time. They’d need 30 min to drive to the appointment. Then they’d have to wait there for 15 min. Then, they’d have their 15-min appointment and a 15-min check-out. Then, they would have to drive back. They’d miss a whole half-day of work. Now, they can just keep working, and we can call them at different times, and they can just take a quick break to get their med checks and stuff that my staff does ahead of time. When they call into me for an appointment, they are just taking a break for a few minutes, we go through what we need to do, they hang up, and they’re back to work. So, I think it’s just easy for those factors. It’s technology that we’ve had for years. We should have been utilizing it. It’s efficiency. It’s quality of care from the patient standpoint, I think, or at least satisfaction from their standpoint. (Physician)

Chronic disease management

Our RN [registered nurse] care coordinators have been running patient lists. We’re continuing to follow diabetes. We’re continuing to follow hypertension. A lot of those things our care coordinators are routinely holding televisits with folks to do their, you know, diabetes plan, diabetes education, that type of thing. (Director of Quality)

Screening and preventive care

Yeah, so that was essentially shut down. So, as far as screening colonoscopies or mammograms, all the preventive health was down to zero; that was essentially shut down. I would say probably now in the last […] maybe two to four weeks is when we’re starting to reopen those types of pathways with our local hospital here. (Medical Director)

Access to care and equity

I think our biggest struggle with that was some of the older population that don’t, I mean, we still have patients that have flip phones. They’re like, “I can’t do that telehealth stuff. I don’t even have a smartphone.” So that was a challenge for some of those older patients. Then, trying to get a family member to help them or something. But then, nobody wanted to be there; they needed to keep their distance. So, it wasn’t easy to just get a family member. If they lived with somebody or their child or somebody was taking care of them, we were able to work something out that way. But there were a lot of patients that didn’t have the capability. And, if they did, we had a struggle walking them through it because we were on the phone trying to tell them how to do it. (Office Manager)

Primary care after COVID-19

I’ve shared this term before, but I think it’s Pandora’s box. I think it got opened. The insurance companies, Medicare and Medicaid were dragging their feet on reimbursement for it [telehealth visits], and now that that box has been opened, I think that patients are certainly going to create a fuss when they’re told they have to go back [to in-person visits]. Because many of these visits, especially in chronic care management, don’t require a physical exam, or require minimal physical exam. Most of it’s really with history and monitoring, and those kinds of things very easily can be handled remotely, with the exception of things like the vital signs and weight. But if you can come up with a solution for that, yeah, I think that it would be very hard to go back to requiring all visits to be in-person. (Physician)