It realigns the incentives between payers, providers, and patients, allowing everyone to prioritize health outcomes over reimbursement. This approach is effective, allowing payers to improve member satisfaction and achieve excellent HEDIS quality scores or star ratings for Medicare Advantage populations.
APC equips payers to maintain high quality scores and member satisfaction in 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 alignment: Alignment on goals and financial incentives between those providing the care and the payer means everyone agrees on the best way to serve member panels.
Adaptability allows quick responses to emergent needs in a crisis: In situations like the COVID-19 pandemic, the model can quickly pivot to solutions like video and phone appointments because the revenue model isn’t dependent on members coming into the care center.
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, patients consistently provide the feedback that they have never felt so heard or motivated to own their health. This is a direct result of dramatically more time with providers and a care delivery approach built around empathetic listening.
Leveraging informatics and data to meet the needs of your specific population
Any care model must be built on a foundation of informatics and data. Data sets from claims, electronic medical record (EMR) data, and 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.
Serving high-impact segments first: An informatics platform segments the population by risk so that we can provide care to the highest risk segments of the population first.
Conducting customized outreach: The next step is to contact members using relevant messaging that speaks to their specific health situations and encourages them to visit care centers.
Closing care gaps: When data indicates that members are missing out on vital care, the model should be adjusted to fill that gap.
Improving the member experience for specific patient panels
Different approaches are required to improve the health outcomes of different populations. APC provides payers with control over the experience within care centers to ensure that each population’s specific needs are met. When needs are met, experience is improved. Here are two specific ways this happens in the APC model:
Customized care for customized needs: Whether it be implementing an occupational health program, offering travel vaccinations, or emphasizing a specific preventive screening, APC allows you to customize care to your population’s specific needs.
Improving access to care without increasing cost: By implementing a value-based care model, APC can increase access to care (like Medicare Advantage) without driving up costs for populations that need more time with their primary care providers.
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.
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. That, combined with aligned incentives, ensures that care can be delivered exactly as it needs to be for your population.