Employers look to advanced primary care for improved value, care and health
There is a serious business case to address the challenges with the “old” primary care standard and move it toward something new.
Primary care is a cornerstone of any purchaser’s health care strategy. Based on the numbers alone, it presents a great opportunity to initiate early treatments and establish a continuous relationship with patients before, during and after a medical need or in managing chronic conditions. But over the years, its overall effectiveness and impact have suffered due to misaligned reimbursement, lack of care coordination, and infrastructure limitations. These flaws have compromised the ability to support people with increased health needs and, particularly, to treat the whole person, rather than just the presenting condition.
As a primary care physician for more than 34 years, I have experienced firsthand the traditional fee-for-service primary care model where health care providers may be expected to see 25+ patients/day, leading to insufficient time for engagement, a tendency to refer, and high frustration levels for all.
Related: Pandemic hastening drive for payment reform in primary care
Despite these challenges, there is a growing body of research showing better health outcomes and lower health care costs are strongly linked to the use and availability of primary care physicians. Because of this, there is a serious business case to address the challenges with the “old” primary care standard and move it toward a “new” model that delivers high-quality care to patients and allows physicians to obtain better performance and outcomes. In fact, several providers and provider organizations including my own practice are doing just that — providing “advanced primary care” — with clear benefits accruing to patients, health plans, and employers/purchasers.
Advanced primary care is defined as primary health care structured to deliver increased value for both patients and purchasers. This model can be explored in depth in a recent report from the National Alliance of Healthcare Purchaser Coalitions that outlines the following key attributes for this model of care:
Enhanced access for patients
Access to primary care is a critical first step to establishing a pathway for ongoing, coordinated, high-value care and reducing the chance of unnecessary visits to emergency care facilities. For patients, enhanced access to primary care includes care when they need it such as outside of normal business hours or over the weekend or technology-based access such as telemedicine.
More time with patients
Enabling physicians to spend more time with individuals encourages better patient engagement and improves continuity of care over time.
Realigned payment methods
Practices must focus on the metrics by which they will be paid to stay in business. If employee health is the incentive important to the company and primary care providers, as opposed to submitting billing codes in a fee-for-service model, then the practice and the employer should align on what matters for improved quality and reduced cost. Direct primary care based on these metrics — which is prepaid advanced primary care — is a model that is emerging and worthy of consideration. Real changes will only occur when employers insist as health plans, specialists and hospital systems will resist these changes.
Adequate organizational and infrastructure
Organizational infrastructure is the backbone of a primary care practice and the overarching driver of advanced primary care and patient satisfaction. This requires data and advanced data. Purchasers with their health plan professionals, who are evaluating a contract with an advanced primary care practice, can expect this high level of organizational support.
Behavioral health integration
In general, primary care clinicians, rather than mental health or substance use specialists, have traditionally provided the majority of behavioral health care, yet studies have shown that treatment of behavioral health conditions in primary care settings falls short of minimal best-practice standards as much as 85% of the time. Incorporating professional behavioral health integration through trained staff is an essential ingredient to the success of this model.
Disciplined focus on health improvement
Understanding of population risk factors and a strategy to focus resources where they will drive the greatest improvements can have the greatest impact on patients.
Referral management
The process of referring appropriate patients to another health care provider or service — hospital, specialist, lab, imaging center, physical therapist — is a critical step in the influence of primary care on the cost and quality of downstream medical care.
A recent comparative effectiveness research study funded by Patient Centered-Outcomes Research Institute (PCORI) found that providing integration of behavioral health services through a community social worker lens within a primary care setting improves the outcomes that matter to patients, health care delivery systems, and purchasers. The result is fewer days in the hospital, improved patient-reported quality of care, and increased patient activation, likely leading to lower health care costs and improved patient-centered outcomes.
Primary care practices are implementing the most impactful elements of advanced primary care and moving toward a model that reflects the current and future needs of our people. Success for this movement requires the support of employers and their health plans to align and implement patient quality and service-focused care.
With improved primary care, other stakeholders in the system lose when less money is spent on things like imaging, specialist care, inpatient care, and prescription drugs. That’s why it’s important for employers and other health care purchasers to advocate for advanced primary care to improve value and ensure the best possible lifelong health for employees and their families.
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