If you’ve been paying attention to the healthcare debate at all, you’ve heard a lot about high-risk patients. Insurance companies say they’re the ones that make health insurance coverage unaffordable for everyone else.
Some propose creating high-risk pools that will move the riskiest patients into alternative buying groups so they won’t impact everyone else’s premiums. But such a move does nothing to solve the underlying problem that is driving costs higher every day: high-risk patients need support, not penalties.
Even worse, our system creates more high-risk patients every day. With more and more people forced into high deductible insurance plans, the more people there are who wait until they have a major issue before they visit the doctor. They’re not getting the routine care they need to become and remain healthy, and therefore become riskier patients every day.
We constantly talk about fixing healthcare, but we lie to ourselves about what’s driving our system’s flaws. The result is that our self-deception prevents us from seeing what’s really going on, and guarantees we’ll keep making the same mistakes. In this white paper, we take on seven of those mistakes and the lies that are driving them.
The current healthcare system is disjointed. Providers and payers are working toward different goals, creating a lack of alignment that can be detrimental to high-risk members. These members have complex health needs. Rather than receiving most of their care from one location, they are frequently shuttled to different specialists, driving up costs and reducing the efficacy of care.
Vera’s Advanced Primary Care (APC) model helps to control costs by moving away from the fee-for-service model to one of value-based care. The majority of care, 80 to 90%, is delivered from a primary care setting. Whether that be through talking by phone or video or bringing someone in who has an urgent need, the Vera APC model reduces the need for most of the costly referrals to specialists. This cost-saving care is achieved by creating a medical home where members receive better care coordination between themselves, providers, and any specialist care they need.
With the majority of care happening in the primary care center, members’ care journeys become shorter and more efficient. This creates a better member experience, particularly for high-risk members who are often forced to wade through a sea of referrals.
It’s time to stop leaving high-risk members to figure out their care on their own. Adding the Vera APC model includes sophisticated care coordination. This allows providers to efficiently manage their care and reduce unnecessary, costly specialty care.