The current state of healthcare is disjointed. The key players involved — the payers, the health systems, the providers, and other companies providing services — are all trying to achieve different goals. What we’re left with is a misaligned system lacking cohesion. This results in stalled health outcomes and a less than optimal experience for members, payers, and providers.
Our experience has been that payers and their clients are frustrated with the breakdowns in the system — the high utilization, the escalating costs, and the types of care being delivered are all points of contention. It’s not working for anyone, and they’re looking for meaningful change.
How advanced primary care (APC) allows payers to meet complex client and member needs
APC solves the major issues of the disjointed system when a payer chooses to implement their own care center:
80-90% of care is provided at the primary care level.
While utilization is increased at the primary care level, it’s decreased throughout the rest of the system, lowering total costs.
Aligned incentives allow the care teams to focus on the right kind of care that produce better health outcomes for a population.
APC allows payers to provide an innovated solution to commercial clients
APC is a highly differentiated and valuable solution. In the commercial space, APC provides the ability to retain clients and grow their businesses.
The APC model follows the methods below to make this successful:
Time-rich appointments Allows members to be heard and providers to understand them beyond their symptoms.
Accessibility Facilitates access to more providers, low to no cost visits, convenient locations, no wait times, and smart scheduling.
Informatics platform Identifies health risk opportunities and provides actionable insight into utilization.
Integrated health coaching Enables coaches to use the Transtheoretical Model of Change to help members improve their lifestyles and achieve life goals.
Care coordination Prevents gaps in communication and treatment when specialty care is appropriate. This includes follow-up and integration into the member’s care plan.
Primary care providers who have the time, support, and staff Ensures providers can handle most of a member’s care, including care that in today’s system is being outsourced to specialists.
Empathetic listening Goes beyond prescriptive medicine, building connections and a deep understanding of a member’s whole health.
Culture change Encourages members to see their care team as an extension of their family and friends and to come to the powerful realization that they are in control of their own health.
By providing this type of care with aligned incentives, payers are able to provide solutions that meet the needs of commercial clients.
Medicare Advantage, APC, and payers: a guide to navigate complex health needs
APC is also a solution that allows payers to attract and retain more Medicare Advantage members. Medicare Advantage members have complex needs, and they’re frustrated when they can’t get in to see their primary care providers. They’re swimming in a sea of referrals to specialists.
The members need care coordination and a medical home that can help ensure adherence to a care plan. However, this is difficult to achieve when payers lack control over the member experience or the ways in which providers and systems are incentivized to provide care.
APC will allow payers to guide Medicare Advantage members through their care, making the process more effective and less frustrating. This allows them to retain members as well as attract more new ones.