Early versions of managed care meant well. They were created to centralize care and achieve better health outcomes while controlling costs — but things didn’t go as planned. Instead of controlling costs, managed care controlled access to care and fueled a cycle of wasteful spending.
Advanced primary care (APC) delivers on the promise of managed care and much more, with a model focused on members’ health outcomes rather than the volume of care transitions and related claims. Keep reading to learn how APC answers where previous versions of managed care could not.
Correcting the limitations of managed care
While managed care never worked as intended, the model had good intentions: to manage care more proactively. It was designed to provide coordinated care and to help guide members through their care journey.
To be truly effective for both employers’ bottom line and health and wellness, managed care must be about more than a centralized member experience.
To be successful, managed care must put care first and center the care in primary care. This should include:
A “medical home” model with improved accessibility for members and employees
Health engagement for all members and employees, which improves the risk stratification for the entire population
Relationship-based integrated care, including health coaches and behavioral health clinicians
Real-time data analytics for improved care coordination
Organization-wide behavior change to support health and wellness
Care coordination corrects the misalignment of outdated managed care models by making PCPs and their care teams the focal point of the care experience — rather than restricting primary care teams by facilitating referrals tor specialists.
Effective care coordination includes the following benefits:
Maximizing the amount of care within the amply equipped, fixed-cost environment of primary care
Controlling costs by referring employees out to appropriate high-quality, low-cost specialty networks only when necessary
Improving communication and anticipating member and employee needs
Care coordination means primary care teams work proactively to identify when a member or employee needs specialty care and to ensure their return visit to a primary care center. This improves the member experience and reduces gaps in care that were all too common in earlier versions of managed care.
And it’s especially important for at-risk populations in their 60s, 70s, and 80s who tend to have more than one condition (like high blood pressure and diabetes) and are more likely to fall behind on screenings. “This situation requires strong care coordination,” says Dr. Kevin Wang, Vera’s Chief Medical Officer. “You have to have a model in which primary care is the hub that drives the right referrals when needed but also quarterbacks the patient's care.”
APC: A coordinated care hub
APC establishes primary care centers as the hub (rather than a brief pitstop) where 80-90 percent of all care-related needs can be achieved. The entire APC model is driven by data to determine, plan, and staff a care center team that can best meet the actual needs of the population they’re serving.
Care coordination is helped by APC’s services that work together to reduce overall costs and drive real, measurable improvements in health outcomes.
Virtual care increases access and convenience so that members can more readily achieve their health goals in trusting relationships with providers
Behavioral health clinicians provide support for mental health, addictive disorders, and more — contributing to mental and emotional well-being
Health coaches encourage members to improve lifestyle choices that otherwise account for 70% of all healthcare costs
APC and care coordination correct for the costly inefficiencies, care gaps, and underutilized PCPs of managed care. It’s no wonder reputable predictions about the future of healthcare look a lot like APC’s proactive, patient-centered model. At the end of the day, APC overcame what managed care could not — but cutting costs and increasing control are not enough. APC works because it prioritizes health outcomes, flattens costs, and improves the member experience — all at the same time.