How Inboxologists are Transforming Primary Care with Dr. Priya Dixit-Patel and Mary Goshert

You need a prescription refill or have a quick question for your primary care provider. So you send a message through your patient portal, expecting your doctor will read it between appointments.

To make sure every patient gets timely, thoughtful care, primary care is no longer a solo effort. Today, doctors are supported by a full care team. And the newest member might surprise you: the Inboxologist.

In this episode, we take a closer look at how modern primary care is evolving with Dr. Priya Dixit-Patel, physician executive of primary care at ChristianaCare, and Mary Goshert, a nurse practitioner at ChristianaCare's MAP2 primary care practice who serves in this innovative Inboxologist role.

Mary explains what inbox management really involves - covering multiple providers, triaging urgent concerns, and reviewing charts to spot gaps in care. Dr. Dixit-Patel shares what sets ChristianaCare's model apart: experienced advanced practice clinicians dedicated to "desktop medicine," helping reduce cognitive load for physicians and speed up responses for patients.

From the idea that sparked this role to real-world examples of its impact, you'll hear how Inboxologists are reshaping primary care - and improving the experience for both patients and providers, one message at a time.

Priya Dixit-Patel, M.D., is the physician executive for core and advanced primary care at ChristianaCare. In this role, she oversees ChristianaCare's primary care providers and focuses on their strategic and operational success. Dr. Dixit-Patel is a family medicine physician with over two decades of experience.

Links:

• ChristianCare Primary Care
• ChristianaCare Patient Portal

Thanks for listening and subscribing! Follow us on Facebook, Instagram, X and LinkedIn.

Transcript

A Teaser About Inboxologists

SPEAKER_01 0:01

I think it's been one of the most powerful roles that we've implemented, and that's what our clinicians are telling us as well.

SPEAKER_00 0:10

You're listening to For the Love of Health, a podcast about delivering care and creating health, brought to you by Christiana Care. Hello everyone, I'm Jason Tekarski.

SPEAKER_02 0:20

And I'm Megan McGerman. Welcome to For the Love of Health, brought to you by Christiana Care.

SPEAKER_00 0:25

When's the last time you sent a portal message to your primary care provider? Yesterday, last week, last month, or am I currently reminding you that you actually need to send in a prescription refill?

Delaware’s Primary Care Access Crunch

SPEAKER_02 0:35

Uh I think you're reminding me I have a few on my to-do list I've been meaning to send, but who is responding to your messages when you send it to your primary care provider? Is it an inboxologist? Do you have any idea what an inboxologist is? Well, they are a vital part of care teams now in a few primary care practices here at Christiana Care. And to tell us more about the role of inboxologists, we're joined by physician executive of primary care, Dr. Priya Dixipatel, and nurse practitioner and inboxologist Mary Goshard. Priya and Mary, thank you so much for being here today. Thank you for having us. Happy to be here. Priya, there's a lot of different directions we could take this conversation. But start by explaining the current landscape of primary care in the region.

SPEAKER_01 1:19

So we have seen a lot of growth in the state in the last five years. Many of you have heard that Delaware is in the top 10 for fastest growing states, as well as the top 10 for the highest aging population. At the same time, we've seen a lot of uh independent practices go into a concierge model. You know, they're seeing less patients. And so this has displaced a lot of our Delawareans to not have a PCP. It's created a very big access challenge. So we knew that, you know, in order to improve access for our communities, we not only have to recruit more clinicians to come here, but also retain the workforce that we have here. And in that moment of hardship, we really thought of a lot of innovative ways to improve access for our communities and have found, I think, transformative processes, people to help us achieve that.

SPEAKER_02 2:16

Mary is certainly one of those transformative people, but before we dive into what she is doing in primary care, talk to us about a few of these transformative models that you're implementing right now.

SPEAKER_01 2:27

Really proud of the work that we've done. We have really leveraged our telehealth platform, being able to meet people where they need us to meet them, being able to provide care in between an office shift that a patient has or if they have transportation issues. The telehealth platform has really allowed for us to reach more of our patients and reach them more frequently. In addition to that, we've done on-demand video visits that can be utilized on call when a patient, you know, so they don't have to go to the urgent care. The other things that we've done is really look at primary care as a whole. There have been many studies that have said that, you know, you need 27 hours in a day for a primary care physician or APC to provide guideline recommended treatment. We know that clinicians are seeing patients in the office, but for every one hour that you see, you know, a patient, there's two hours of work behind that, whether it's documenting in the chart, whether it's looking up a lab, whether it's answering a portal message. It's just not possible to do everything the way that we want to do with one person. And so that really led to thinking about different workflows. And the concept of the inboxologist was really looked at here and developed in a way that I think Christiana is doing it very differently. And we've learned so much, you know, in a short amount of time. I think it's been one of the most powerful roles that we've implemented, and that's what our clinicians are telling us as well.

What An Inboxologist Actually Does

SPEAKER_00 3:58

So let's focus on that idea of an inboxologist. I'm not gonna lie, before we started working on this episode, I hadn't heard the term before. And I'm sure there's quite a few people listening who are in that same boat. Mary, can you describe a little bit of what that means and what your typical day looks like?

SPEAKER_03 4:14

Sure. So we are kind of the behind-the-scenes person helping to manage your care and keep the workflow going for the provider that's in the office, seeing the patients, you know, filling up the forms and the paperwork. The way my day is structured, I start my day, I communicate with the office who I am providing support for, and I cover up to eight providers who are either in the office or out on PTO or leave or what have you. And then the way my day goes from there, I just prioritize the messages as they come in. You know, I look for urgent messages first thing in the morning, things that need to be addressed right away, and then just prioritizing and reprioritizing anything that comes in, medication refills, communicating with other members of the team, uh, lab results, imaging results, what have you, and kind of go through that throughout the day and just help support in any way that we can.

SPEAKER_01 5:06

They've all really spent a lot of time getting to know uh the PCPs in the practice. As you can imagine, everybody has their own style, their own way of doing things, and that's the beauty of this model. Mary has been able to go into a practice that has 23 PCPs. 23. It's our largest practice, and she's been able to, you know, understand how do you want me to manage this? Do you want me to take care of it? Do you want me to let you know? Do you want me to make a visit for this? And uh that's a real talent and uh very compassionate care, I think, you know, to be able to customize it to the way where the PCP feels comfortable, empowered, and also they understand that PCP's patient panel needs as well. So that's one of the, I think the best parts of it. It truly is a collaboration uh and extension of a PCP.

Why ChristianaCare Built It Differently

SPEAKER_00 6:00

Priya, you said that the inboxologist is something that is happening nationwide, but Christiana is doing it a little bit differently. Can you go into a little bit about where this idea started and what that difference is that Christiana Care is bringing to the table on that front?

Faster Answers And Less Clinician Stress

SPEAKER_01 6:14

Aaron Powell For any health system, any community to be successful, you need a strong primary care workforce to be able to provide that care. Many studies have been done. We know that we can improve clinical outcomes, reduce the cost of care by having a strong primary care presence. I think in the past, it was felt that the PCP had to do it all. And maybe a few years ago that was possible. But in the modern day of medicine where we have, you know, in our organization, 35,000 patient-initiated portal messages for primary care alone every month, where we have patients knowing more about their own health and having questions and appropriately wanting to, you know, have a conversation with their PCPs, where we have older patients that have more complicated needs. We need to think about how we provide this access. We had the opportunity to hire six inboxologists last year. With our inboxologists, we knew that we wanted to dedicate their time fully to the desktop. Some models will use where there will be a clinician that sees patients for half the day and does inbox work for the other half. Some models use RNs only, some use MAs, some use AI technology. We decided to lean on our experienced APCs. We looked for candidates that had primary care experience and were very savvy with being able to manage a lot of volume of messages and a wide variety of physician and APC clinician style. And so they dedicate their time fully to the desktop work, which is unique. A lot of other health institutions are using alternative ways. And I think that allowing them to focus on the desktop only one improves efficiency, improves patient experience, improves, you know, the experience for our clinicians. And also I think their own experience where they're not toggling back and forth. The more that you are with a practice doing this work, the better that you become at it, just like anything else.

SPEAKER_02 8:26

And what kind of victories are you both seeing since this implementation of the inboxologist?

SPEAKER_01 8:32

I think if you think about one model that is addressing every standard that we're trying to achieve, it's the inboxologist. So first and foremost, the patient experience. Patients now get their issues addressed much quicker. We think about safety and quality, you know, in these interactions. If you think about a physician or APC that's seeing patients in the office, you know, they're they're going in and out of rooms and then they come back to their desk and see the in-box messages increasing. Can you imagine the stress and anxiety that they're feeling? It allows them not to focus on what's ahead of them. So we just think about multitasking is not something that is easy to do and probably not as safe. We're much more efficient when we carve out the work, when we're just focusing on the patient in front of us, or versus just focusing on the patient that's, you know, sending a message. And so from the patient experience, their issues are addressed, I think, in a more efficient, quicker, safer, comprehensive way. I think from the end of the clinicians, um, the cognitive load that is reduced, the stress that is reduced, that I'm seeing patients and I'm focusing my full attention on who's in front of me because I know that my colleague is doing an excellent job, you know, guarding the desktop, looking out for those urgent messages, looking out for that refill that needs to be done before five o'clock today, looking out for the patient that just needs some reassurance. They can just get their question answered. And so I just think that it's allowing us to give the best version of ourselves to the patient in front of us or to the patient that's calling into the office or sending a message.

A Friday Call That Avoided The ER

SPEAKER_03 10:14

Yeah, and I can speak further to that. We in this role, we're actually able to spend a little bit more time reviewing the patient chart to answer their questions. So we've been able to identify, you know, the patient that might be overdue for an office visit or a follow-up with their primary care provider, or they had labs ordered that weren't completed. So we're able to spend that time reviewing the chart, communicating appropriately with the care team to help ensure those things are in place for the patient. There was a provider who was out of the office for an extended period of time and I was providing coverage. It was late in the afternoon on a Friday, of course, because that's when a lot of things happen. Patient called in, he was concerned he was having a mild reaction to his blood pressure medication. Now, while it's not typical that we would make alterations to a patient's medication regimen without discussing with the primary care provider, certainly there's exceptions. So, this being a Friday afternoon, the patient was concerned that he should go to the emergency room. I was able to call the patient, kind of coordinate care, make some alterations, set him up with a very close follow-up with his primary care provider within the next week and saved him an emergency room visit. And everyone was happy. Are we seeing that happen frequently?

SPEAKER_01 11:32

Frequently. I mean, I've heard from many of the clinicians at MAP2 where Mary works. They have reached out to me and said, you know, I can take time off and not be worried that my patients aren't being taken care of because Mary's there. I've heard from patients that, you know, we love Mary. She's part of the care team. I have the benefit of having an inboxologist at my practice. And I remember Ashley saying to me, we are one. I'm an extension of you. You go on and do what you're doing, taking care of the person in front of you, and I'm going to cover the messages and take care of your patients the way that you know you are, which has really been just such a change in the way that we've doing things. We felt like we had to carry everything on our own. And truly now we have colleagues sort of helping us manage uh the challenges of taking care of care of patients and doing it in a very safe way.

SPEAKER_00 12:30

Aaron Powell With Delaware being on the leading edge of growth, as as you mentioned earlier in this episode, this primary care access issue is not something that's going to go away quickly or easily. So what do you see as the future of primary care and access and all of these concerns that we have, just in general about primary care and the future of inboxology as well?

SPEAKER_03 12:52

What is very exciting is that now we hear that other specialties are interested in this role. So specifically endocrinology and neurology have reached out and asked how they can start implementing inboxologist coverage for their teams, because certainly primary care isn't the only specialty that's overrun with messages and needs some assistance. So exciting things to come, hopefully.

Wrap Up And How To Follow

SPEAKER_01 13:14

There's going to be shortages in I mean, primary care for sure, but in all fields. So I think the more that we can do to work together to do medicine in a different way, having the inboxologist, having AI tools, having nursing teams and our pharmacists work with us, it's really exciting for me, having seen sort of challenges in medicine in the last few years. When I look at all of these things, it I can see a path forward, you know, which is really exciting.

SPEAKER_02 13:48

Thank you both so much for your time today. We look forward to having you back to discuss more of these changes in primary care. Thank you.

SPEAKER_00 13:57

Check out the show notes for this episode for more information on Christiana Care Primary Care.

SPEAKER_02 14:01

And make sure to follow us on social media, just search Christiana Care on your favorite platform.

SPEAKER_00 14:05

We'll be back in two weeks with another great conversation.

SPEAKER_02 14:08

Until then, thanks for joining us for the love of health.