When payers first decide to get into the business of primary care delivery, they’re faced with a big question. Will they build the care delivery system from scratch, or will they buy it by working with an experienced partner?
The right answer isn’t always obvious, as each choice comes with its own challenges. In deciding the correct approach, payers must appraise their own capabilities, as well as the speed at which they wish to launch a primary care solution to their members. The following four questions should be important considerations in this process.
1. Do we have the infrastructure needed to build and operate a primary care system?
Building an integrated primary care model isn’t for the faint of heart. It’s a significant undertaking that strains even the most sophisticated organizations. In many cases, it requires building completely new capabilities that do not exist within your organization. Vera Whole Health recommends creating a detailed plan that outlines the people, resources, and processes that will be required to both build and then operate the primary care solution. Thus, you can:
Determine if the project is feasible
Establish whether it can be accomplished in a reasonable amount of time
Another key consideration is how much you will separate the effort to build and operate the primary care model from your core plan administration business model. The best option for efficiency and reduced disruption is to completely separate the two operationally, requiring you to effectively run two separate businesses.
2. Do we have the budget to develop a care delivery system?
Developing a care delivery system requires significant time and budget. Once you have an understanding of your existing infrastructure and processes available to support the effort, we recommend creating a detailed financial projection to determine if you have the financial capacity to complete the project.
Any projections should be compared against the cost to work with an experienced partner implementing primary care solutions. While there is no guarantee that a built solution will perform, many partners guarantee their models will achieve certain HEDIS quality scores or Star Ratings if you work with Medicare Advantage populations. These guarantees significantly reduce the risk to the payer.
An experienced and forward-thinking partner can also help you avoid the pitfalls of old-fashioned approaches, inefficient systems, and doctor shortages. According to Christopher Kerns and Dave Willis writing for the Harvard Review, “Analyses estimating shortages base them on an inefficient system: on the care models, labor practices, sites of care, and process inefficiencies that exist today.”
3. What level of control do we need? And can that be achieved with a partner?
Different primary care partners are going to offer different levels of control. You need to decide what level of control and customization your organization needs. If you’re willing to cede some control, a payer can likely find efficiencies with a partner, as well as the level of customization needed.
The best partners balance the needs of payers to customize their care delivery without sacrificing proven best practices that allow them to improve member experience and quality of care.
4. If a partner could effectively serve the needs of our population, would we still build?
There is no doubt that building a primary care solution is more expensive, takes longer, and causes more disruption to a payer’s existing business model. However, payers sometimes argue that they know their member panels better than anyone else, therefore they should be able to build the model that serves them best.
But what if this wasn’t true?
Experienced primary care partners can create a model that serves the specific needs of your population without the significant effort required to build. For example, Vera’s advanced primary care model:
Addresses the needs of each population and supports continuous innovation
The partner’s model should create a single provider network, one that can adopt new technologies quickly or pilot new care delivery approaches without waiting for the rest of the healthcare system to catch up.
Alignment on goals and financial incentives between those providing the care and the payer will allow everyone to collaborate on the best ways to serve member panels.
Allows for quick responses to emergent needs in a crisis
In scenarios like the one created by COVID-19, a primary care model should be capable of quickly pivoting to solutions like video and phone appointments, because the revenue model isn’t dependent on members coming into the care center.
Exceeds member expectations because of the strength of the provider-member relationship
It’s important for providers to focus on members’ social, mental, and physical well-being. When this occurs, it results in consistent, positive feedback from patients that they’ve never felt so heard or motivated to own their own health.
Are you ready to work with an experienced partner?
Developing and building a primary care system is challenging. Vera Whole Health’s advanced primary care model is the ideal solution for payers. It has the ability to serve any population, using insights from advanced informatics and creating a system able to drive true outcomes. When combined with aligned incentives, you receive the confidence that comes from knowing all care is focused on improving outcomes for your populations.