One of the best ways to control the total cost of care and improve health outcomes is by integrating an advanced primary care solution into your benefit strategy to complement a high-deductible health plan. Whether you’re a payer or an employer, choosing the right vendor can be challenging. And when results don't materialize, you’re faced with rising costs and a hit to your reputation.
You have every right to understand the true impact of a vendor’s APC model.
By equipping yourself with specific questions and seeking clearer information, you'll be prepared to vet vendors and their models — and make the smartest choice for your workforce.
Consider the following five questions to make sure you select a vendor and primary care model that delivers.
There's a lot of noise in the marketplace about APC these days. Anyone can use the right words, but very few vendors deliver the results to back up their promises about meaningful health outcomes, total cost of care savings, and high member satisfaction.
It's important to ask a vendor, “How do you define APC, and how is your APC model different from typical primary care?” Listen for whether they truly understand the difference between APC, “old-school” primary care (fee-for-service), or true primary care (primary care plus time-rich appointments, providers well-trained in empathetic listening, and care coordination).
Real, effective APC is true primary care—plus an informatics platform that proactively identifies health risk opportunities and provides actionable insight into reducing costs. An effective informatics approach provides the care team a 360 degree view of each member to improve utilization, address care gaps, focus on population health, and customize member outreach.
Finally, proven APC models deliver outcomes any vendor will be eager to share with you, including verification of their methodology by a 3rd party. If a vendor hesitates to provide insight into improved health outcomes or significant cost savings, it’s an alert worth paying attention to.
2. Is the vendor trying to sell you something that won’t ultimately fit your workforce, benefit strategy, or organizational bandwidth?
A vendor should tell you about their approach. Are they focused on value-based arrangements or are they looking for a traditional, transactional, fee-for-service healthcare relationship? Because if it's more of the latter, a lot of their decision-making is going to be cost driven instead of a clear-eyed focus on quality and population health cost outcomes.
This potential disconnect is the root cause of a lot of headaches for payers and employers alike.
Proven APC models create a culture of health through three types of core services: preventive and planned healthcare such as annual whole health evaluations and immunizations and unplanned health care including rapid treatment for serious or urgent needs. They should be built around integrated care teams with nationally certified health coaches and support for mental health needs.
3. What are the unique things the vendor does that makes it successful in delivering positive health outcomes for its clients?
We’ve found that having varied expertise in a care team really makes a difference in improving health outcomes — whether it’s a provider, doctor, or a specialized practitioner (such as a physical therapist or a behavioral health specialist). Varied expertise provides members with more holistic insights and greater internal support to reduce gaps in communication and treatment.
A vendor’s APC model should be able to demonstrate results stemming from services that truly make a difference, like smart scheduling, care coordination, time-rich appointments built around empathetic listening, clinically-integrated health coaches, and robust informatics.
4. Is the vendor aligned with your company’s values?
APC is a value-based approach that relies on a tight alignment of philosophy between you, your organization, and key members of your APC partner.
A vendor should be able to articulate their goals and operating approach in light of your partnership. Ask yourself if their answers and model align with your current values (as well as values you anticipate in the future). After all, you and your team can’t achieve meaningful success if the partners you hire aren’t aligned with your core beliefs.
5. Does the APC vendor try to cover up cracks in their model to make it seem stronger than it really is? And are there any additional gimmicks added to a deal that may not make a significant impact in the stated outcomes?
Vendors often talk about things like integrated teams, health coaching, and population health, but far too many haven't really adapted their approach or actually brought the necessary providers on board. And an overly-aspirational advanced care model doesn’t help anyone.
Watch out for elements that have the appearance of value but don’t actually provide outcomes or a measurable return. Be sure to look underneath the hood of any vendor’s APC model to see how it impacts members from a health and well-being standpoint (more than just an accumulation of disconnected services that admittedly look good on paper).
Also be wary of a vendor’s focus on clinics designed to impress members with appearance but not with results. Aesthetics can certainly impact a member’s peace of mind—and they do need to feel attended to throughout their care—but if clinics aren’t providing high levels of service, improving health outcomes, or managing the total cost of care, modern flourishes are nothing more than a disservice to members and an unnecessary expense to you.
How we set our APC model apart from the pack
When it comes to any partnership, we ask ourselves, “What is this client trying to achieve from an alignment perspective, and how well have we delivered that in the past?" This helps us play an effective and active role in achieving the goals of payers and employers.
We place empathy at the center of a patient/provider relationship, and we extend that to our relationship with clients. We’ve learned over time that empathy creates a unique opportunity to advance health outcomes even further, because everybody feels valued when they’re working towards important goals verbalized in safe and trusting relationships.
We’re also clear about our expectations. Our APC model builds healthier populations, identifies risks and opportunities for patients, and drives down costs to payers and employers.
Unlike other APC models that specialize in serving one particular population, we don’t limit our results and success to a specific market.
Our APC model services multiple populations at once from a single care center. We’ve made it a priority to improve outcomes across every population and we’re dedicated to delivering results for self-insured employers, commercial payers, Medicare Advantage, and individual exchange populations.
APC that aligns with your goals
Though urgent care companies and traditional service providers may deliver great clinical care, many vendors run into challenges as they try to move operationally and financially towards value-based APC. And a value-based APC model is exactly what you need.
We hope these questions will help you find the vendor to deliver results on your terms.
Learn more about APC — the front line of a healthcare revolution— by downloading our free eBook.