Common Sticking Points When Designing An APC Solution With A Vendor

Let’s be honest: Costs matter and investing in primary care doesn’t make a lot of sense unless it creates solutions that payers, employers, and members actually need. So it’s no surprise that sticking points emerge whenever the unique needs of an organization run up against a vendor’s distinct advanced primary care (APC) model.

To help payers and employers craft an APC solution that aligns with their realities, we’re addressing three common (and reasonable) questions that any vendor should be able to answer and substantiate.

Question 1: Do I really need to invest in APC? And does it truly save me money?

The answer may initially sound counterintuitive, but reallocating healthcare funds within your benefit strategy to APC can improve health outcomes and drive down overall costs. When members engage more in APC, it will more effectively manage their overall health, which in turn lowers overall costs.

The City of Kirkland, Washington provides a great example of the return on investment:

When Vera first met with the City of Kirkland, their 10 million dollar healthcare budget was growing 11 percent each year — an untenable trajectory — until they made the decision to reallocate spending into an APC model from Vera. The City of Kirkland also launched an incentive program to drive care center utilization. How big of an incentive? Employees who visited the onsite care center for their 60-minute Annual Whole Health Evaluation would receive a $600 bonus in their HSA — a savings account.

The City of Kirkland saw a night-and-day difference in results. Primary care utilization at the Vera care center as 83 percent sustained engagement over two years. In total, the City of Kirkland saved $1.6 million in their first year with the APC model.

Read more about the City of Kirkland’s success in our free white paper, Benefit Strategy Design: Solving An Impossible Task.

An investment in APC yields multifaceted gains.

Beyond the savings in overall costs seen in examples like the City of Kirkland, Vera’s APC model successfully translates into everyday benefits including a significant reduction in workforce sick days and absenteeism, increased workforce productivity, healthier employees, and a valuable recruitment tool.

Question 2: How do I know members will use their new APC benefits?

Most people want to live healthier lives and would like to utilize their healthcare as a support system — provided their healthcare doesn’t hinder their time or their finances. Unfortunately, traditional fee-for-service healthcare has too often trained members to stay away from the help they need. Overwhelmed by confusing and inconvenient network benefits or significant out-of-pocket costs, members disengage from the kind of preventive, primary care that significantly improves health outcomes. Pretty soon, even those apparently healthy members can take an unwelcome bite out of your balance sheet once they develop more acute symptoms requiring expensive services (like an ER visit).

This all-too-common problem can be remedied by working with a vendor to design an APC model that fits with your population. It’s equally important that a vendor be willing to listen and fine-tune a model’s services to meet members where they are. It might sound like learning the hard way, but we consider it part of being a collaborative partner.

For example, shortly after the Vera onsite care center launched at the world-famous hospital, Seattle Children’s, Vera representatives were curious about the portion of employees who were not taking advantage of the care center or its services. The Whole Health Council — made up of Seattle Children’s staff from multiple departments and administrative levels — knew the answer: The care center’s hours were limiting utilization to those staff who worked swing and evening shifts. The care center’s operating hours were promptly changed, and utilization improved across all demographics of employees.

Patients embrace APC when plans are structured to accommodate their everyday lives and remove hurdles to services rather than creating new ones.

Question 3: My workforce is dispersed. Can APC effectively serve them and their dependents?

The answer is yes. Any vendor should be willing to work with your organization to come up with a solution that ensures your employees and their families have convenient access to their healthcare.

We understand now more than ever that workforces are dispersed, and care models must function across a much larger area. These common and increasing needs make a great deal of sense to us, so we’re happy to work with the realities of your organization to place care centers in locations that will be the most convenient and accessible for your team and any enrolled dependents.

Vera’s APC model treats primary care as the central hub in the patient’s care journey. As a result, Vera members enjoy enhanced access and continuity of care thanks to our network of care centers and virtual care services. Our robust data network ensures members and providers don’t miss a step when it comes to health coaching or keeping track of symptoms. At the same time, our EMR-integrated care teams follow the same strategy everywhere, so members know they have a proactive advocate whenever they visit a care center.

Learn more about the real-world benefits of care coordination in this Q&A with Vera’s Chief Medical Officer Kevin Wang.

While Vera care centers provide a home for ongoing patient-provider relationships — patients deserve care features that can meet them wherever they may be. Geographical concerns are further addressed by our virtual care, a service with benefits that have become particularly clear during the COVID-19 pandemic. Virtual care is offered within the APC plan to supplement access and improve the member experience regardless of their place on the map.

Learn how virtual care is solving modern challenges in this post from Sarat Raman, M.D..

Proven Performance

Any APC vendor worth their salt should be able to provide assurances about the performance of their APC model or it’s not worth reallocating a portion of your healthcare spend. We’re willing to work with you to build a financial structure that will accommodate the needs of your organization.

Learn how advanced primary care can solve your long-term healthcare headaches by visiting our APC resource.