Advanced primary care: Employees see doctors regularly, without driving up costs

Health care in America is at a tipping point. Although COVID-19 created a dip in primary care visits, total primary care volume has finally returned to its pre-pandemic levels. The current health care system faces a number of challenges — there’s a drastic provider shortage with provider availability plummeting, and primary care capacity is worsened by expensive hospital-system based or other non-independently practicing primary care. Meanwhile, health care costs are expected to rise another 7% in 2024.

This combination of rising costs and limited providers is finally taking its toll — Americans are not going to primary care for routine visits as much as they used to, or they are opting for televirtual visits within a fragmented system. Health care is in desperate need of an approach that makes it easier for people to see their providers regularly without driving costs up. Standing apart from a gamut of lackluster care options, there’s one approach that allows employers to drive increased utilization of routine care while driving costs down.

Defining advanced primary care

Advanced primary care is an innovative approach to health care that blends payment reforms with timely member access to a dedicated, quality-oriented, data-informed, and comprehensive primary care team that manages an expansive array of acute and chronic needs with dedicated provider-member time. Traditional fee-for-service primary care models in the U.S. are broken and difficult to navigate, driven by the volume and speed of care rather than the quality of care given. In this type of setting, financial incentives are not aligned between the providers, patients, and employers for the best patient outcomes. Providers have limited time to meet and engage with patients, which can lead to a fragmented experience that sometimes involves referrals to more specialty care before it’s necessary.  As a result, patients often get lost in the system, don’t get the holistic care they need, and providers burn out because they are incentivized by seeing a higher volume of patients instead of the quality of health outcomes.

With employers ditching traditional fee-for-service payments, they’re now opting to pay a flat monthly rate per employee that is directly paid to a primary care provider. Rather than being siloed, these providers are part of a core team that includes doctors, advanced care practitioners, care advocates, mental health experts, wellness coaches, nutrition educators and more who can ensure comprehensive care delivery. These collaborative providers — who are already integrated into a care team — can reduce unnecessary downstream care by bringing these services into primary care first. This model embraces and incorporates televirtual care as a means to secure engagement of members directly to physical care centers directly on-site at the workplace or to a convenient location. This streamlined, employee-centric approach allows for more comprehensive, on-demand care at a lower cost.

In an advanced primary care setting, patients can get about 80% of all their health care needs from a single location and be seen by the same dedicated care team. This team doesn’t just include providers, but individuals who can help to navigate care, and are there to help employees find the health resources they need.

How does this really help?

Advanced primary care is designed to improve access to high quality care, while also engaging members with their health care and ultimately reducing costs. It helps take the burden off employees by creating a more cohesive care plan for all their health needs, starting with primary care. From an engagement standpoint, it also enables providers to communicate with patients and their family members via apps and their employer’s digital ecosystem so that they can schedule additional or follow-up appointments with ease when care is needed. Employees get access to member advocates who can navigate them through the system before and after visits with a provider in the form of chat, text, and portal communication. This improves the quality of care they receive, and helps employees build long-term relationships with their integrated care team. Ultimately members leave far more satisfied with their care, while reaping the benefits of convenience and higher quality of service.  Employers then benefit from a healthier, more engaged, more productive, and dedicated workforce.

This model lowers the cost of care by making preventive care easier to access. When members are able to more easily schedule routine appointments, their providers are able to catch and manage chronic conditions earlier, and improve health outcomes down the line. By maintaining same or next day access for acute care, plus incorporating services like on-site medication dispensing, members reduce the need for visits to unnecessary urgent care or acute hospitalizations.

What benefits managers should look for

So — what should benefits managers look for in advanced primary care?

The first thing to look for is a model where the employer only pays for primary care services used, to help reduce unnecessary or wasted costs. Second, that the model actually results in strong member outcomes (clinical, satisfaction, and productivity) backed by data rather than simple engagement metrics, which are not enough.  Third, that services included in the model address the needs of their population (behavioral health, pharmacy, etc.).

Lastly, benefits managers should prioritize advanced primary care options that incorporate televirtual and integrated digital solutions that the employer has already purchased. Today’s employees value their flexibility, can live in geographically dispersed areas, and need a comprehensive platform that encourages employees to use their plan. Moreover, a platform that also allows providers to more effectively engage patients through digital channels where they can check-in, share timely updates, or help schedule a future appointment. These touchpoints all promote a more proactive, engaged experience overall for the member.

New models are now backed by clinical data that clearly shows which plans support whole-person health, often meaning the plan includes screenings for diseases like breast and colon cancer as part of a regular visit. The proof is in the data, and engagement is not enough if care teams don’t provide potentially life-saving care during routine visits.

According to Brian Marcotte, principal at BJMarcotte Consulting LLC and the former President and CEO of Business Group on Health, “If the employer strategy is to simplify the employee experience, having all health and wellbeing resources and all point solutions sit behind a single navigation engagement platform would streamline communications and simplify messaging.”

In short, employers get a win-win by offering primary care as a benefits differentiator—and are able to attract and retain more talent given the high costs of care. These dedicated primary care models also save time as employees no longer have to waste time searching for a provider, waiting for an appointment, or traveling far distances and losing time from work. The average wait time to see a doctor in the U.S. is 26 days, whereas an advanced primary care provider can usually be seen the same day or next day.  Depending on the genre of employment, for in-person jobs ranging from firefighter to teacher, this can result in increased employee productivity and reduced downtime. On top of this all, many of these primary care providers are also leading the nation in clinical quality, an output of more dedicated time and relationships with members.

Related: How to close the primary care provider gap? It’s complicated

Today, the rising cost of health care is coupled with a provider shortage and generally limited access to providers for employees. There’s an opportunity for employers to prioritize employee health and also save money. Advanced primary care has the potential to help employers close the post-COVID gaps in care, and ultimately make employees happier, healthier, and less likely to require hospitalization down the line. In the past, the economic incentive may not have been present for employers to update their model. Now, we must leverage advanced primary care to meet the needs of the modern workforce.

Kevin Wang, M.D., is Chief Medical Officer at apree health.