In the last couple of years, we’ve tried to drive home a couple key points about the routine medical care of your employees:
First, even though annual “check-ups” may not be that important, steady access to a primary care provider is essential. Access to primary care increases the life expectancy of a community. Primary care visits are declining, being crowded out by visits to retail clinics, urgent care centers, emergency rooms, and specialist visits.
Second, primary care is the most cost-effective form of health care, and to avoid unnecessary costs, most of your care should be coordinated through a primary care provider. American adults who have a primary care physician may have healthcare costs as much one-third lower than the costs of their peers who lack a PCP. Almost two-thirds of Medicare claims for wasteful or unnecessary care are by physicians with no relationship to the patient’s primary care practitioner.
But it’s possible that even with those assertions we’re thinking too small. KBGH is a member of the National Alliance of Healthcare Purchaser Coalitions (say that three times fast), and they have adopted the provocative stance that simple access to primary care isn’t enough. The Alliance has begun advocating for “Advanced Primary Care.”
If you’re a provider, you might cringe at the name. Isn’t the “advanced” part insulting to a seasoned, experienced, competent doctor who does “regular” primary care? Names are tricky. But the name isn’t meant to connote the achievement of a certain score on board exams or the possession of a special skill set. Instead, Advanced Primary Care, as defined by the National Alliance, describes a philosophy and commitment to seven key, sometimes overlapping, attributes in the clinic:
Enhanced access. Many patients end up in the emergency department simply because they could not access their primary care practitioner during normal business hours or they got frustrated by the time it takes to schedule and complete a visit. Primary care practitioners who offer available appointments on nights or weekends can reduce emergency room utilization.
Increased time with patients. The average fee-for-service primary care physician carries a patient panel of roughly 2,200 patients. In models in which the physician or practice directly contracts with employers, this number may be more like 400-600 patients. This allows additional time with each patient to encourage better engagement, to better identify social determinants of health, and to relationship-build to ensure continuity of care over time.
Realigned payment methods. Much of the current fee-for-service model perversely incentivizes increased care or increased volume without increased quality of outcomes. Advanced primary care, which operates more frequently on a salaried or subscription model, seeks instead to incentivize patient activation, case and care coordination, accountability for health outcomes, and judicious use of downstream referrals.
Organizational and infrastructural “backbone” to support patient-centered leadership, additional training for staff when needed, and commitment to quality improvement over time. This may mean changes in the practice’s staffing and use of information technology.
Behavioral health integration in order to deliver “whole person health,” not just physical health. This can be in the form of a social worker, therapist, or psychologist on site or coordinated via telemedicine.
A disciplined focus on health improvement, not just reactive care, with a deep understanding of population risk factors and a strategy to focus resources within that population to where they will drive the greatest overall improvements. Advanced primary care seeks to anticipate problems like seasonal influenza, not just respond to crises that arise from those predictable problems.
A process of referral management to other providers or services, like specialist physicians, labs, radiology departments, and allied health, that explicitly seeks to maximize quality while moderating downstream cost.
The National Alliance has a good infographic on Advanced Primary Care below. If you’re interested in exploring direct contracting with primary care providers for your employee benefit package, please let us at KBGH know. We would love to help out.
As the Medical Director of the Kansas Business Group on Health I’m sometimes asked to weigh in on hot topics that might affect employers or employees. This is a reprint of a blog post from KBGH.
