While it’s easy to say healthcare needs solutions, we start any consulting conversation with a clear outline of where things are at today, and where we are trying to go in the future.

Some key facts about American healthcare:

• Deductibles are higher than the emergency savings of many Americans
• Wages have been fairly stagnant over the last few decades while healthcare expenses have doubled
• Disproportionate outcomes across racial lines e.g. 23 percent of Black compared to 8 percent of White cancer survivors on high deductible health plans skipped medications to save money
• Health insurance carriers have outperformed the market nearly 2 to 1 since the ACA was passed in 2010

Nearly 140 million Americans receive health insurance and health benefits from their employer. We work with employers to improve these benefits by reducing costs and improving outcomes.

And we believe quality primary care is a cornerstone healthcare strategy to accomplishing this dual objective.

“Everyone should have access to the ‘sustained relationships’ primary care offers.” – National Academies of Sciences, Engineering, and Medicine *

How Does Primary Care Work?

Primary care is the tip of the spear in health care. Your Primary Care Physician, or PCP, is your starting point when it comes to your health care.

Usually, a Primary Care Practice is not just a PCP but also includes other health professionals such as Nurse Practitioners, Nutrition Coaches, Physical Therapists, and more. This way, you can get directed to the right care when you present with a healthcare concern.

Primary care doctors can care for most diseases except for rare and unusual issues, counsel you on your health goals, and monitor your health towards lifestyle goals you cooperatively identify.

Primary care is differentiated by a focus on proactive healthcare. PCPs can work with the overweight person to better manage their health before they become obese; PCPs can help the prediabetic better understand nutrition and exercise before they become diabetic; and PCPs can help someone with some mobility issues who wants to play with their grandkids before they need a joint replacement.

What Are the Benefits of Primary Care?

Quality primary care is defined by coordinated care. When your primary care physician understands your needs and your goals, they can make quality referrals to the right specialists.

The results from findings with Intermountain Healthcare speak for themselves:

• 9 percent decrease in the total cost of care in a commercial population¹
• Increase in both patient and physician satisfaction²
• Increase in preventative screenings²

Primary care physicians are engaged with member’s total cost of care and seek to deliver quality outcomes without unnecessary spending.

Study after study has found high variations in healthcare costs with no correlation to quality.

While HDHPs were supposed to reduce spending on “shoppable” services, consumers are not equipped with the tools or knowledge to fully benefit from these plans. Rather, PCPs are well-positioned to make smart referrals to their members.

One study found that 51 percent of the price variation in MRIs can be explained by referrals, while reporting found that the cost of a hip or knee surgery performed at Sutter in San Francisco could range anywhere from $22,865 to $101,571.

And large employers such as Boeing, Disney, and Intel have taken matters into their own hands and invested in delivering quality care to their employees. These new kinds of purchasing models align all parties involved – members, their employer, and select, high-quality healthcare providers.

What Are the Advantages of Primary Care?

A better health care plan today is smart. What do we mean by that?

A smart health plan uses data to structure benefits, contract with select providers, preempt avoidable expenses, eliminate waste, and improve the plan over time.

Providers are put in the driver’s seat for their member’s care, meaning primary care teams are paid to care for people, not to deliver services.

The health plan puts primary care front and center as it drives towards affordability and quality. In many cases, cost-sharing is actually reduced for members. This means simple, no deductible, copay-only plans.

And technology enhances every aspect of these plans. Members and their providers use best-in-class tools to reinforce the aspects of coordinated care and increase transparency in plan spending and outcomes.

 

Yes, I want to know how my company can deliver high-quality primary care to members and reduce overall plan costs

 

1. “The impact of a regional patient-centered medical home initiative on cost of care among commercially insured population in the US” DovePress, May 2016.
2. The Patient-Centered Medical Home’s Impact on Cost and Quality: An Annual Update on the Evidence 2012-2013, Jan 2014

Posted by John Hansbrough in Behavioral Health, Business Strategies, Health Equity, Healthcare Innovation, Healthcare Spending