Managed care was first created with the best of intentions: to consolidate patient healthcare to one convenient network. The idea was that this would drive better outcomes while controlling total costs. Unfortunately, that goal was never quite realized.
Managed care resulted in primary care providers acting as filters for specialist care and patients frustrated and anxious about the high costs and lack of access. Worse, this reactive sick-care system that was focused on treating symptoms instead of whole patient health wasn’t leading to better health outcomes or lower costs.
But that doesn’t mean managed care can’t be what it was intended. With primary care at its center, managed care is an effective and powerful model for improving health, guiding behavior change, and driving down costs.
In 2015, the City of Kirkland was facing skyrocketing healthcare costs. Their $10 million budget was rising by 11% each year, leaving them to find another million each year just to make up the difference. They had 15% per member per month annual claims growth and a looming Cadillac tax of $1.5 million.
The situation was alarming, but they were unwilling to compromise on their employees’ benefits or increase costs. They needed a solution.
Managed care through a near-site care center
To improve employee benefits in the face of escalating medical claims costs, they opted for a near-site care center with primary and acute care, health coaching, and health council services.
Employees gained improved access to primary care providers and health coaches, along with full care coordination for their specialist referrals, and personalized health plans that improved their physical, psychosocial, and emotional well-being.
The City of Kirkland paid for members’ monthly fees in addition to their benefits plan and, once the care center was opened, offered a $600 incentive for each employee who completed an Annual Whole Health Evaluation.
In the first year alone, the City of Kirkland saw incredible results:
$1.6 million gross savings
$137.20 lower costs PMPM
23% increase in primary care engagement
17% claims reduction
The City of Kirkland’s success demonstrated how a patient-centric, managed care approach improves health outcomes and lowers cost.
Primary care services, with time-rich appointments and empathetic listening, drove up patient engagement. That meant healthier employees, fewer claims, fewer expensive trips to the ER, and a more proactive, robust culture of health throughout the workforce and their families.