The fee-for-service model that dominates much of the healthcare landscape defies any attempts to make it more efficient and cost-effective. In the traditional settings, primary care providers act as gatekeepers who refer patients to specialists, driving up costs as a part of normal practice. This is simply not sustainable.
Advanced primary care (APC) realigns the incentives between payers, providers, and patients, allowing everyone to prioritize health outcomes over reimbursement. The end result is a model that proven to help payers improve outcomes along with HEDIS quality scores or Star ratings for Medicare Advantage populations. Let's explore how APC achieves those outcomes.
The APC Difference
APC builds on the foundation of true primary care, at the core of which is the provider-patient relationship. In the APC model, just like the in true primary care, this relationship is nurtured through time-rich appointments and empathic listening. But that's only the beginning.
APC moves beyond true primary care by:
Leveraging informatics and data to meet the needs of a specific population: Data sets from claims, EMR data, user-generated surveys inform how the APC model should be tailored for a specific population. These data sets serve as the foundation of the population health management strategy and influence both care delivery and member outreach.
Providing 80-90% of care in the primary care setting, and coordinating care when specialty care is appropriate: In the APC model, care centers provide a medical home for members where they can receive the vast majority of care. The care team also coordinates specialty care, including follow-up and integration into the member’s care plan back at the care center. This type of coordination prevents gaps in communication and treatment. It’s especially beneficial to Medicare Advantage populations who are often managing multiple chronic conditions.
Embedding health coaches within each care team: Professional health coaches who use the transtheoretical change model to help patients take ownership of their health, make positive behavior changes, and achieve life goals.
Payers face big challenges as they seek to increase the quality of care, improve satisfaction, and provide a differentiated member experience. APC supports each of these goals. Its ability to serve any population using insights from advanced informatics creates a system that can drive true outcomes.