April 08, 2020
To deliver on primary care that satisfies the “Principles for an Optimal Primary Care Experience,” here is what employers are asking from the market to make it happen. When vendors, including primary care providers themselves, pitch their services to employers, they need to incorporate these elements in order for their offering to resonate and be viewed as compelling.
Make Access Easy and On-Demand
Multiple avenues for people to get care when they need it and where they want it should be present, including bricks-and-mortar practices, virtual, chatting and other options. Vendors selling technology to create additional avenues to interact with primary care, such as “smart” symptom checkers, should be integrated into the patient’s primary care ecosystem to support optimal coordination.
Reimbursements to providers and systems should move away from fee-for-service or discard it altogether. Optimal primary care does not drive revenue through utilization, but innovation surrounding population health management is only possible when providers are not hamstrung by fee-for-service incentives, instead sharing and benefiting from shared financial risk.
Integrate Mental Health
A strong integration of mental health care services into primary care interactions should be present. The brain is a part of the body – arguably the most “primary” part – and it needs to be addressed in primary care.
Engage People Before They Become Patients
Effective primary care must engage patients when they need care for an immediate health concern, but also throughout the year. Effective regular communication helps engage patients to get their preventive screenings and reminds them to go to primary care first when an issue arises. Population health management will require people to think first of primary care when they have a non-emergent health need, but also to engage with their PCP when they’re healthy.
Make Smart Referrals to Expand the Impact of Primary Care
Referring patients to specialty care based on data, including cost and quality, is a must.
Change Workflows to Improve the Patient and Provider Experience
Patients shouldn’t have to fight for what they need. Cost, quality and clinical appropriateness information on referrals and prescribing should be integrated into the primary care provider or program’s workflow to make doing the right thing, the easy thing for both providers and their patients.
Focus on Continuous Quality Improvement and Report on it
Tracking outcomes, quality metrics and patient experience scores is necessary for continuous process improvements. This should be reported back to employers regularly.
Help Patients Navigate the System
An optimal primary care provider group or vendor provides a concierge-like experience for patients, with coaching and navigation support throughout the health care system.
Communicate Your Value
Across all of these capabilities, primary care vendors providing optimal care must be able to articulate how their approach is differentiated for the patient and for the employer. The best primary care experience or tool available does no good if no one knows about it or cares to use it.
Examples of High-Performing Primary Care Models
So what are these primary care models that are making progress toward primary care nirvana? Of course, no one has perfected the practice of medicine and population health management, but several groups in these models are improving health outcomes and keeping total costs of care lower than their market competitors. Every one of these models has to use smart referrals to steer patients to high quality, efficient specialty care to drive total cost of care reductions.
Primary Care Focused Accountable Care Organizations (ACOs)
ACOs led by primary care groups have seen greater success in controlling total cost of care in Medicare compared to their counterparts that are run by hospitals. Hospital-led ACOs still generate most of their revenue through inpatient admissions reimbursed through fee-for-service, whereas a primary care group operating under a risk contract can increase their revenue by keeping people healthy and out of the hospital.
Direct Primary Care (DPC)
Practices in the DPC model do not accept fee-for-service payments. In fact, they make no additional revenue each time they see a patient, but instead are paid a per attributed member per month fee to manage the health of their total population. Many other systems have salaried doctors who don’t make money off individual patient visits, but neither the physicians nor the DPC practices in them make money for driving utilization. This gives providers the freedom to innovate in how they address population health, because when they keep people healthy and out of more expensive settings of care, everyone “wins” financially.
Enhanced Onsite or Nearsite Clinics with Primary Care
No longer limited to occupational health, many employers are working with provider partners to increase the scope of services offered in their onsite and nearsite clinics, including holistic primary care, pharmacy, and mental health. The convenience of making a full suite of primary care services on the worksite saves employees time and increases access to services like mental health care and preventive tests, which are often under-utilized. This affords employers a greater ability to drive utilization of high performing specialty care through virtual referral networks.
Virtual-First Primary Care?
Many bricks-and-mortar primary care groups are succeeding in improving access, convenience and reducing costs by encouraging patients to access them remotely before stepping into the office. But what if you took it a step further and eliminated bricks-and-mortar entirely as your primary care “home”? Several established and new players in the telemedicine market are introducing models that migrate the “front door” to primary care to a virtual interaction, with services requiring in person meetings scheduled separately. These new models are unproven at the moment, but there are substantial opportunities to increase access, convenience, and facilitate efficient referrals to downstream care.