The economics of primary care in today’s fee-for-service medical system don’t work. As Stephen Schimpff, MD, MACP, unpacked in his Medical Economics article called Why primary care is in crisis-and how to fix it, this model has led to “...an insidious misunderstanding of primary care…” that has driven a shortage of primary care providers (PCPs) that will plague the healthcare industry for years.
Schimpff clearly diagnoses the cause of the economic travails of primary care: a reimbursement model that forces PCPs to maintain an unsustainable practice size and focus on output rather than outcomes.
As a result, PCPs provide “less comprehensive care, more referrals to specialists, inadequate coordination of care, more tests, more ER visits and far less satisfaction.” All this while trying to pay the bills. A situation that has been aggravated by the severe disruption to primary care provided by COVID-19.
Schimpff goes on to argue that value-based models that allow providers to reduce the patient panel they serve from 2,500-3,000 patients to 400-800 will be a key part of the solution.
We couldn’t agree more, and we believe that large employers and payers have a unique opportunity to lead this transition at scale by investing in advanced primary care (APC).
Seattle Children’s Demonstrates The Efficacy Of The APC Economic Model
Five years after implementing APC via a near-site care center for their 6,000-plus employees, Seattle Children’s is reaping the benefits of an approach similar to what Schimpff recommends.
They have saved an estimated $16 million over that time while dramatically expanding their employee’s access to primary care. This is money that has been invested back into their employees through benefits like free prescription refills at the care center dispensary, an added 9-12 days PTO, and an additional 80 hours of maternal/paternal bonding time for new parents.
These savings were made possible by the APC model. It builds on the foundation of true primary care, including longer appointments and strong provider-patient relationships by incorporating the following elements:
Empathetic listening that goes beyond prescriptive medicine, building connections and understanding of a person’s whole health in order to unlock the door to behavior change: the key to better health outcomes.
Care coordination for any necessary specialist visits (including follow-up and integration of any new treatment or medication into the patient’s health plan), which closes any gaps in care or communication.
An advanced informatics platform to help identify and manage health risks for groups of patients most vulnerable to certain illnesses and infirmities.
Clinically integrated health coaching by rigorously trained Whole Health Coaches who work as an embedded part of the primary care team to guide patients through each step of behavior change so they can take control of their own health.
The model not only saved money, it improved employee health and satisfaction. Seattle Children’s saw an 80% drop in hospital stays, as well as a 10% drop in prescriptions. After five years, the care center maintains a 4.6 out of 5 patient satisfaction rating.
Employee engagement based on increased access to care was a key contributor to these outcomes. Our data shows that increased access to care was a driver for savings. Even a one-time use of the care center resulted in a significant decrease in associated costs and medical claims. That cost decrease became more significant as more employees engaged with care center providers and services.
The Right Type Of Utilization
How did a model that provides significantly more access to care drive down costs? It’s all about increasing the right kind of utilization.
The APC model increases utilization of primary care using a value-based economic model. Patients get the majority — about 80% — of all healthcare needs from one convenient location from a dedicated care team. Care is delivered by a team rather than a single provider, so professionals with different skill sets are available to meet the patient’s bio, psycho, and social needs. It provides a hub and network of care when referrals to specialists are required.
At the same time, utilization of costly specialty, emergency, and inpatient care falls. As a result, total costs drop, creating results like the $16 million that Seattle Children’s savings Seattle Children’s achieved.
As he closes out the article, Stephen Schimpff closes out the conversation by discussing a number of models that could be the future of primary care. The results achieved by APC by both large employers and payers demonstrate that it should be added to Schimpff’s list. It will be a leading contributor to the long-term revolution in primary care.