Providers often find themselves tied to ineffective care-delivery systems that are focused on serving populations from numerous payers both with fee-for-service and value-based arrangements. Being one of many stakeholders makes it difficult to achieve the goals payers look to achieve: improved outcomes for the populations they serve, a unique member experience, and, ultimately, long-term control of the total cost of care.
If these challenges resonate with you, we’d like to propose a counterintuitive solution: making an investment in care delivery through an advanced primary care (APC) model.
How can an investment in care delivery reduce the total cost of care?
It’s a smart question in a healthcare marketplace known for sentiments such as, “You get what you pay for.” The answer can be found in the value-based nature of the APC model.
APC is a value-based care model that replaces antiquated reimbursement models by linking payment arrangements to health outcomes. In doing so, it shifts the focus away from production-based billing to providing the care patients truly need. In the APC model, that means increasing utilization in the right part of the healthcare system: primary care.
Payers who integrate APC with a proven partner like Vera can provide for 80-90% of all patient needs in a cost-controlled primary care setting.
This looks like expanded access for underserved populations, increased appointment lengths to allow providers more time to determine the underlying health issues members face, clinically integrated health coaching to achieve behavior change, the inclusion of services like behavioral health and physical therapy, and much more.
When you invest in primary care and focus on prevention, utilization across other parts of the healthcare system decreases, reducing claims for more expensive services such as:
High-cost specialty care
Complex care needs
For next-level needs, APC provides care coordination that ensures members are referred to appropriate specialists when needed. Follow-up is then provided within the primary care setting.
While claims for primary care will climb as utilization increases, APC reduces overall healthcare costs and creates a more streamlined experience for patients and providers.
As scrutiny increases and public policy (and public opinion) changes, APC will help payers stay relevant and agile to drive market share. And they’ll do all this while controlling the total cost of care, while increasing the perceived value and the overall outcomes for their members.