Healthcare costs in the United States continue to climb, but that higher spending does not ensure better health outcomes than those in other high-income countries. In some key areas, such as life expectancy and unmanaged diabetes, the U.S. has actually fallen behind. Value-based care models (such as our advanced primary care (APC) model) realign the incentives between payers, providers, and patients, allowing everyone to prioritize health outcomes over reimbursement.
It’s an effective approach that gives payers the ability to improve and sustain quality of care and member satisfaction.
Achieving value through consistency
APC helps payers achieve strong Healthcare Effectiveness Data and Information Set (HEDIS) quality scores and notably higher Star Ratings from Medicare Advantage populations. This is accomplished four specific ways:
APC addresses the needs of each population, supporting continuous innovation: APC creates a single provider network that can quickly adopt new technologies or pilot new care delivery approaches without waiting for the rest of the healthcare system to catch up.
A single partner with aligned incentives creates broader alignment: Alignment on goals and financial incentives between those providing care and payers means everyone agrees on the best way to serve member panels.
Adaptability allows for quick responses to emergent needs in a crisis: In situations like the COVID-19 pandemic, quick pivots to virtual solutions are supported, because the revenue model isn’t dependent on members coming into care centers.
The member experience exceeds expectations because of the strength of the provider-member relationship: When providers focus on members’ social, mental, and physical well-being, it contributes to excellent member experiences. Patients consistently report they have never felt so heard or motivated to take ownership of their own health goals. This is a direct result of a care delivery approach built around empathetic listening and longer appointment times.
The APC model allows payers to construct member experiences built around the specific needs of their populations—ensuring improved health outcomes, reduced total cost of care, and significantly higher scores across the board.
Leveraging data to meet the needs of your population
Driving improved outcomes requires a deep level of data, as well as the ability to put that data into action in ways that will be impactful for members. That’s one of the reasons why Vera and Castlight Health have combined. Together, we will further extend the power of data.
Data serves as the foundation of a population health management strategy and, when managed effectively and proactively, improves the quality of care and overall member satisfaction.
Improving the member experience for specific patient panels
Different approaches are necessary to improve the health outcomes of diverse populations. The APC model provides payers with control over experiences within care centers, ensuring each population’s specific needs are met. Here are a few specific ways this happens in the APC model:
Customized care for customized needs: Whether implementing an occupational health program, offering vaccinations, or emphasizing a specific preventive screening, APC allows you to customize care to each population’s specific needs.
Increasing member access without increasing cost: Payers can solve the primary care shortage in their regions by embedding dedicated primary care access into existing health plans. With little to no cost to members, payers remove barriers (physical, financial, and even cultural) that previously kept members away from primary care centers.
Many solutions under one roof: Members benefit from the breadth of APC’s services administered by physicians, nurse practitioners, physical therapists, behavioral health clinicians, and multilingual care teams.
Longer appointments address underlying issues: Because APC is built around improving health outcomes rather than volume or claims, members benefit from longer appointments with their providers — giving them the time to get at the root of their health issues.
Digital technology meets members where they are: Virtual care improves continuity of care and blends seamlessly with in-person services when needed — adapting to meet members wherever their busy lives take them. Castlight’s digital navigation technology further improves the ease with which members find and access care.
It’s simple: When members’ needs are met, their experience improves.
APC improves population health
Population health management is complex. Payers face big challenges as they seek to increase the quality of care, improve satisfaction, and enhance the member experience.
Together, Vera and Castlight support each of these goals. Our ability to serve any population using data-driven insights creates a system that can drive true outcomes. When all-population care is combined with aligned incentives, it ensures care is delivered exactly as needed by your population.
Editor's Note: This is an updated version of the original post published on August 19, 2021.