February 20, 2023
Employers are increasingly giving attention to primary care, which influences nearly 90% of overall cost and quality of health care through specialty referrals, prescribing, testing, procedures and hospitalizations. Primary care is the “front door” to the health care system for most people, so the opportunity to greatly improve the patient experience, outcomes and costs is tremendous.
As employers consider their approach to innovative vendor partnerships, plan design strategy and employee engagement with primary care, they face unique challenges, as shown below.
Employees are confused about how to navigate their benefits and find high quality primary care providers.
With each new innovative vendor an employer partners with, a new employee communication strategy, data-sharing process and evaluation strategy is required.
Benefit teams are tapped out with the number of vendors they can handle.
In some cases, large employer benefit teams are managing a dozen or more vendors in their benefit plan, many of which impact some aspect of primary care.
It’s not all doom and gloom, however. Many organizations are driving great value in the health care system through optimizing the primary care experience. As large employers consider who to partner with in the primary care arena, they should keep the following principles in mind, as told from the patient’s point of view.
The Patient's Perspective: Principles for an Optimal Primary Care Experience
- 1 | I should be able to get care when and where is best for me through a channel that meets my needs. Virtual health technology should be infused and integrated into my broader health care experience, so I don’t have to fight for basic things like scheduling an appointment, receiving care after regular business hours or wait times that keep me away from work and my family.
- 2 | My doctors should communicate with each other. Not just because I don't want to explain my medical history repeatedly, but because it's confusing, expensive and potentially dangerous if I'm being told to do conflicting things for my health.
- 3 | My treatment preferences should be understood and valued throughout my health care experience. My primary care team should understand my preferences and respect my input through shared decision-making.
- 4 | It should be easy for me to identify providers that are high quality and right for me. I should be able to get information on the quality and costs of care that a provider or care team deliver before I select one.
- 5 | My care team should understand my broader health experience, including in the home and at work. My care team should understand those aspects of my life, like transportation and housing, that have a large impact on my health, as well as the employer programs I have available to help me stay healthy and navigate the health care system.
- 6 | My primary care experience should be simple. My care team should be proactive in helping me get preventive care when I need it and be an oasis in the broader health care system that is often fragmented, confusing and costly.
- 7 | My care team should be a trusted resource for addressing my mental health needs. Primary care should integrate with mental health specialists to best address the health of my entire body, which includes the brain.
8 | The cost of my care should be transparent and predictable in advance. I shouldn’t have to worry about unexpected charges. Furthermore, primary care should be inexpensive, with limited or no out-of-pocket costs, given its tremendous value.
- 9 | When I need a referral, my primary care team should prioritize specialists who are high-quality and don’t cost more than I can afford. My provider should have data on quality and costs of physicians and facilities they refer me to that fit in with my insurance plan design.
- 10 | When I need specialty or hospital care, my primary care team should advocate on my behalf. Seeking intensive or specialty care can be scary and expensive; my primary care team knows me and should help guide me through the system.
These principles were created with input from leading large employers and innovative partners who participate in the Business Group’s Health Innovations Forum and Executive Committee on Value Purchasing. They represent a cross-industry, business-informed perspective on what patients need to have an optimal primary care experience. The Business Group encourages large employers to keep these principles in mind as they consider whether a particular strategy will help their plan members achieve an optimal primary care experience.