What Health Plans Need to Know About Direct Healthcare

High-quality healthcare and low costs aren’t oil and water. The two coexist under a model called advanced primary care – and it’s gaining major traction in the industry. The novel approach combines whole-person care, barrier-free access, and easy-to-use technology to deliver the healthcare experience your fully insured commercial members want. Easy access to care, exceptional experiences, and lower costs lead to happier and healthier members. When members are happy and healthy, all parties benefit. So, how does this approach work, and what does it mean for health plans?

What is advanced primary care?

Advanced primary care is an integrated healthcare model that combines comprehensive in-person care with digital care anytime and anywhere. Usually, the solution consists of several key components:

  • A network of wellness centers that offer primary care, behavioral health, and other services in strategically mapped locations in the community to serve the local or nearby membership.
  • Virtual care delivered through a centralized provider team to serve the entire population 24/7.
  • Data-driven, proactive care management and care navigation to identify and close gaps in care while supporting members with high-value referrals.

Advanced primary care solves many of the challenges health plans face.

Challenge: Solving for unique market and population needs

Health plans serve commercial members of all shapes, sizes, and geographies. These unique populations require customized solutions that the traditional healthcare model can’t deliver at scale. Health plans and members alike face challenges with fragmented care and a one-size-fits-all approach characteristic of the traditional healthcare model, instilling a lack of trust and personalization.

Solution: Personalized care and barrier-free access

With advanced primary care, dedicated providers spend more time with members to build trusted relationships and deliver quality, inclusive care for all, fostering a concierge experience, increased engagement, and meaningful connections.

Additionally, the combination of digital and in-person access points with top-tier care navigation makes care easily accessible and convenient for all. Members are provided with quality care, tools, and resources at their disposal, leading to lower financial risk while promoting the best health outcomes.

Challenge: Managing financial risk and population health

Medical loss ratio and total cost of care are top of mind for any organization taking on financial risk for the health of their people. When members are at higher health risk, often associated with multiple chronic conditions or comorbidities, healthcare costs go up for all. Quality healthcare solutions equate to healthier, lower-risk members, reducing overall costs. When organizations invest in better healthcare access, they see an average of 29% per member per year savings. Sounds simple, right? Unfortunately, primary care in the community often falls short.

Solution: Value-driven solutions that prioritize quality care and health outcomes

Advanced primary care focuses on value over volume to provide healthcare that aligns with your strategic goals and the culture of your member population. By driving engagement with members and delivering care that meets the highest quality standards, costs decrease and member satisfaction and health outcomes soar.

The numbers speak for themselves. In a Premise analysis, organizations who invested in high-quality primary care saw a 41% reduction in inpatient admissions, 24% reduction in outpatient and ambulatory services, and a 19% increase in routine and preventive office visits. It’s clear focusing on healthcare quality, access, and experience improves health outcomes and results in cost-effective healthcare thanks to healthier members with fewer chronic conditions.

The combination of concierge, end-to-end referral coordination capabilities with high-caliber data ensures members receive high-quality, cost-effective, in-network specialty care within their communities. Providers work to quarterback care throughout each member’s care journey, reflecting an integrated approach in which members receive the highest quality care in and outside of their provider’s hands while maintaining a single point of contact with their primary care provider. Additionally, because this model of care is incentivized by value, primary care providers can practice at the top of their license and engage in limited, appropriate, and high-quality referral practices.

Challenge: Member experience and engagement

The traditional healthcare model historically produces low member engagement and low or ineffective utilization of community resources. It’s not uncommon for members to lack trust in the healthcare system and feel confused, misunderstood, and defeated because of its complexity.

On the other hand, members who are engaged, complete routine checkups and regular screenings, and receive quality referrals and follow-ups benefit from improved care, member experience and engagement, and cost savings. Studies show adults who regularly see a primary care physician have 33% lower healthcare costs and 19% lower odds of dying prematurely than those who see only a specialist. In other words, a positive experience prompts increased engagement, which leads to better health outcomes, just as a negative experience contributes to the opposite.

Solution: A single, integrated healthcare partner

The advanced primary care model allows you to increase access and reach your member population in ways that were not previously possible. Members can build trusted relationships with their providers, improving their experience, increasing their engagement in their health journey, and ultimately achieving positive health outcomes. One partner that’s aligned with your vision and shares your goals is easier to manage, drive outcomes, and hold accountable than myriad vendors. With an integrated partner, members have access to a dedicated care team and network of physicians available in-person locally or digitally – meeting members where they are.

Advanced primary care gives fully-insured commercial member populations the most convenient, integrated, and comprehensive care that fits seamlessly into existing health plans – and it’s available to you. Take control of the healthcare experience; prioritize value over volume. Premise Health can work with you to provide this member-centered solution to your organizations. Get in touch today.

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