A Better Choice for Your Clients: Navigating Advanced Primary Care for Health Plan Consultants and Brokers

Facing a constantly shifting healthcare landscape, benefits leaders are asking harder questions about how to control their healthcare cost, access, and outcomes – and they expect their consultants and brokers to have the answers.

Rising specialty drug spend, provider shortages, and growing chronic disease burden are making it difficult to choose a health plan that improves member health while ensuring long-term affordability and convenience. As a benefits consultant, you want to bring your clients strategies that work for their people’s health needs and improve the bottom line.

That’s where advanced primary care comes in.

What is advanced primary care?

Advanced primary care delivers primary care, behavioral health, pharmacy, care management, and care navigation as part of a single, coordinated care model. The goal: To increase access to care, improve outcomes, and reduce total healthcare spend.

Need a refresher on the basics of advanced primary care? Check out our guide here.

Why do health plans need advanced primary care?

Limited Access to Care

The best benefit designs don’t mean much if members can’t make or attend an appointment. Nearly a quarter of employees live in areas facing economic instability, food insecurity, and poor access to healthcare services. The problem is only expected to get worse with a predicted shortage of 100,000 healthcare workers by 2028. All of this creates an enormous barrier when it comes to members accessing healthcare.

When members and their dependents can reliably access healthcare, they can proactively address health challenges or manage chronic conditions and avoid expensive emergency room and specialist visits billed to their plan.

Escalating Healthcare Costs

Pharmacy and behavioral health are two of the biggest drivers of medical spend. While 30% of plan participants had a mental health related claim in 2024, 21% of insurers expect substantial increases of 15% or more in pharmacy costs, driven by the advancement of medications like specialty drugs and biosimilars.

For consultants and brokers, that means that there’s an urgent need to find solutions that tale a whole-person approach to preventive care, addressing serious mental and physical health concerns proactively and reducing spend on costly medications.

Workforce Health Trends

Earlier-onset cancer, heart disease driven by chronic conditions like obesity and high blood pressure, and mental illness are all expanding the number and cost of claims across member populations. For employers, this means more missed workdays, higher rates of absenteeism, and continually increasing spending.

Brokers and consultants looking to find a comprehensive solution for their clients must see coordinated, preventive care as more than just a wellness perk. Instead, it’s a financial necessity, a crucial part of improving organizations’ satisfaction with their benefits, and a simple way to provide convenient health solutions for members.

Advanced primary care is the solution

Better Access

Advanced primary care improves access by embedding low- or no-cost healthcare in the communities where members live and work. Because it’s exclusive to members, they’re not competing for appointments, and can even access care virtually via phone or video. This empowers them to get proactive treatment for health challenges before they impact outcomes or require more expensive downstream care.

Integrated Care

Advanced primary care brings primary care, behavioral health, and pharmacy support together under a single care team and shared medical records.

For brokers and consultants, this means comprehensive care that doesn’t require employers to finance or manage disparate point solutions. This can be especially impactful for members on high-cost medications like GLP-1s where a lifestyle change support program that integrates providers across the care team maximizes return on investment for organizations.

Meaningful Engagement

Helping employees and their families stay on top of their preventive care through data-driven member engagement programs makes managing chronic conditions easier and reduces the need for high-cost interventions. When health plans not only make wellness centers available to their clients’ members, but actively help promote them, they’re boosting the likelihood of successfully improving health and supporting a better care experience for their people.

Member Satisfaction

Advanced primary care centers member satisfaction by making appointments with their own care team more convenient. As provider shortages become more prevalent, wait times increase and the chances of being able to quickly schedule and see a provider in the community decrease. When members have access to exclusive care that is tailored to their needs, schedules, and location, they can bypass scheduling stress and spend less time in the waiting room. The result: Happier, healthier members who are more satisfied with their benefits, too.

Finding the right advanced primary care partner

When you’re looking for the right primary care partner for your clients, you want to find a solution that’s able to address all of their most pressing concerns, provide ongoing support, and share the administrative burden of making sure people are getting the care they need. When evaluating advanced primary care partners, brokers and consultants should keep an eye out for:

• Value beyond “sick care”: Demonstrated ability to provide long-term support for chronic conditions, manage specialty pharmacy utilization, and integrate behavioral health as part of a single solution
• Data and reporting: Clear strategic reporting on cost trends, utilization, savings, engagement, and outcomes that supports client goals
• Accountability: Willingness to stand behind performance with measurable KPIs and continuous improvement
• Operational simplicity: A comprehensive model that reduces the cost and administrative burden of juggling multiple point solutions
• Member engagement support: Comprehensive plans for bringing members into the wellness center, keeping them coming back, and encouraging them to bring others

An advanced primary care partner that goes the distance

For brokers and consultants exploring advanced primary care solutions, the right partnership is a key opportunity to strengthen relationships with employers and help them make more confident benefits decisions.

At Premise Health, we partner with both health plans and employers to deliver onsite and nearsite advanced primary care that meets members with they are, improves outcomes, and reduces healthcare spend. And it really works: On average, organizations that work with Premise Health save 30% on their total healthcare costs, and members get same- or next-day scheduling with providers they can trust.

Learn how advanced primary care can help you deliver measurable value to your clients. Contact us today to learn more.

Frequently asked questions

Q: What is advanced primary care?

A: Advanced primary care is a healthcare model that expands traditional primary care by integrating services such as behavioral health, pharmacy support, care management, and health navigation into a coordinated care system. Instead of treating health issues in isolation, advanced primary care focuses on prevention, chronic condition management, and whole-person care to improve outcomes and reduce total healthcare costs for employers and health plans.

Q: Why are employers investing in advanced primary care?

A: Employers are increasingly investing in advanced primary care to address rising healthcare costs, limited access to providers, and the growing prevalence of chronic conditions and mental health needs. By improving access to preventive care and coordinating services like behavioral health and pharmacy support, advanced primary care helps organizations reduce emergency room visits, better manage chronic conditions, and improve workforce health outcomes.

Q: What should brokers and consultants look for in an advanced primary care vendor?

A: When evaluating an advanced primary care partner, brokers should prioritize vendors that demonstrate measurable outcomes that include cost, quality and member satisfaction, strong data analytics capabilities, integrated care delivery, and a strong member marketing strategy. The most effective partners proactively manage chronic conditions, coordinate pharmacy and behavioral health services, and provide transparent reporting so brokers and health plans can track improvements in healthcare costs, utilization, and member health even when the members need to be seen outside the Premise ecosystem.