Benefits advisor’s guide to value-based primary care: the antidote for rising health care costs

Rising health care costs are an omnipresent headache for employers across the nation. According to a recent survey, the average health care expenditure per worker surged to approximately $17,200 in 2023. Furthermore, projections from WTW’s Global Medical Trends Survey indicate an anticipated 8.9% increase in medical benefits costs for 2024.

Employers are also grappling with labor shortages, burnout, and the pressure to stay compliant with federal laws like the Consolidated Appropriation Act. They need to find a way to slash health care costs while still offering attractive benefits that make their employees feel valued.

Once billed as a panacea, high-deductible health plans (HDHPs) cut down on premiums but also saddled employees with hefty out-of-pocket expenses, potentially deterring them from seeking essential medical care. Now, employers are on the hunt for better options — and innovative companies are moving to value-based primary care models that not only save money, but prioritize their employees’ well-being and recognize their health as a valuable investment.

The value-based alternative

Nearly a third of Americans lack access to primary care, missing out on vital routine checkups, while a staggering 40% forgo or delay care due to financial constraints. Incorporating value-based primary care into benefits packages acts as a potent catalyst, not only for bolstering employee satisfaction and retention, but also for elevating care standards on a wide scale, impacting millions positively. Moreover, employers stand to reap significant savings by transitioning to a value-based primary care model.

In a world cluttered with subpar health care plans, value-based primary care represents a paradigm shift, blending quality, accessibility, and affordability to redefine the health care experience for employers and employees. These models, which include advanced primary care (APC) and direct primary care (DPC), depart from traditional fee-for-service structures, prioritizing a patient-centric approach focused on preventive care and holistic wellbeing.

When it comes to implementing a value-based primary care model, some employers forge direct partnerships with local clinics or health care networks, while others collaborate with specialized firms offering on-site health care solutions. However, many opt to contract directly with providers to establish and staff local health centers under an advanced primary care framework.

Under this delivery model, employers typically pay a fixed monthly fee for employees to access high-quality, comprehensive primary care and other services, eliminating the need for copays and deductibles. Patients benefit from holistic, ongoing treatment and preventive care, building trust and rapport with their care teams. The focus on keeping people healthier overall reduces the likelihood — and costs — associated with expensive procedures, drugs and surgeries. This connected, people-first approach to care cuts employers’ overall health care benefit costs by as much as 30%, according to The Validation Institute).

The advisor’s role: advocating for better benefits

As a benefits advisor, you play a crucial role in advocating for improved health care benefits that meet the changing needs of your clients and their employees.

Incorporating value-based primary care models into your portfolio isn’t just about expanding your offerings; it’s about solidifying your role as a trusted advisor and helping your clients build innovative benefits packages that reflect their businesses — smart, efficient, and genuinely caring about their people.

That doesn’t mean you won’t meet some resistance, usually stemming from a lack of understanding or skepticism. Educate, reassure and guide your clients through this evolution, showing them the tangible benefits of prioritizing value-based care over traditional models and leading the charge towards a brighter, healthier future.

Here are some strategies you can use to advocate for modern health care benefits:

• Educate employers about the advantages: Clearly and comprehensively articulate the advantages of value-based primary care models, addressing common misconceptions and concerns. Patients experience tailored care, shorter wait times, and decreased overall health care expenses by removing copays and emphasizing preventive care. Employers realize reduced insurance costs and a healthier workforce. Leverage these as key selling points, using real-life examples and case studies to illustrate the cost benefits and the enhanced patient experience.

• Alleviate any concerns: Despite the compelling benefits, employers may have apprehensions regarding services and implementation logistics. While routine primary care is typically encompassed, patients may still require a traditional health plan for comprehensive needs like hospital stays or specialty care. And the delivery model will depend on factors such as the client’s location and number of employees. Your role is to navigate these concerns, evaluate all factors, and recommend the most suitable model for their needs.

• Conduct a cost-savings analysis: Analyze historical health care utilization data to demonstrate potential cost savings and improved health outcomes associated with moving to a value-based care model.

• Drive employee awareness & adoption: Once a client decides to add value-based care to their benefits package, help them develop communication strategies to effectively convey the perks to employees. By driving awareness and encouraging employee participation, you’ll enhance cost savings for employers even further.

• Offer continuous support: Provide ongoing support and guidance to employers throughout the implementation process, addressing any challenges or uncertainties that arise. By serving as a trusted advisor, you’ll instill confidence in employers’ decisions to embrace value-based care models, ultimately driving positive health outcomes and cost savings for all involved.

Everybody wins

Value-based primary care is a win-win-win solution for benefits advisors, employers, and most importantly, employees. As health care costs skyrocket and accessibility issues persist, the demand for change grows louder. The transition to value-based primary care presents an opportunity to address these challenges while enhancing employee satisfaction and wellbeing.

As an advisor, advocating for value-based primary care means more than just expanding your offerings — it also solidifies your role as a trusted advisor. By educating clients about innovative approaches to health care benefits, you can drive adoption of value-based care, ultimately facilitating positive health outcomes and cost savings for all involved.

Jordan Taradash is the founder and CEO of PeopleOne Health.