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Many Medicare Advantage members face limited access to primary care providers while managing multiple chronic health issues. As a result, they’re forced to forego necessary primary care and navigate the complexities of the healthcare system without support.
This experience is frustrating and poses health risks to members. Any payer that solves this access issue will attract and retain more Medicare Advantage members while improving their health outcomes.
It’s difficult for payers to solve the access issue because care delivery for their members is often out of their hands. Their ability to earn four- or five-star ratings for their plans is dependent on providers in networks that they do not control.
There is an out-of-the-box solution to this problem: integrating primary care into Medicare Advantage plans. This solution is advantageous to both payers and their members because it solves the access issue while allowing payers to design their care delivery model to meet the unique needs of their population. The result is a unique competitive advantage that will improve both member acquisition and retention metrics.
An integrated primary care offering, like Vera’s Advanced Primary Care (APC) model, creates a medical home for Medicare Advantage members. 80-90% of care is delivered in the primary care setting.
Sophisticated care coordination ensures that the complex needs of these members are either addressed in the primary care center or with specialists when necessary. And, every time a member visits a specialist their follow-up occurs in the primary care center.
Here’s how APC improves the experience for Medicare Advantage members:
Time-rich appointments allow members to be heard and providers to understand them beyond their symptoms. This gives members the opportunity to talk through health concerns with a provider who has a deep understanding of their issues.
Empathetic listening goes beyond prescriptive medicine, building connections and understanding of a member’s whole health.
Coordination of complicated specialist referrals ensures that the process is easy, efficient, cost-effective, and coordinated.
Professional Vera whole health coaches use the Transtheoretical Model of Change to determine where members are in their health journey, and from this, help patients improve their lifestyles and achieve life goals.
The experience we’ve outlined provides payers with a differentiated product that will allow them to acquire and retain more Medicare Advantage members while also increasing the health outcomes of their population.
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