Primary care has traditionally been the “front door” to the American healthcare system. For employers, it also presents a prime opportunity to elevate both patient experience and health outcomes while keeping costs in check, especially at a time of overall high healthcare cost trends.
Employers are leveraging opportunities to address these concerns by offering access to “advanced primary care,” a model that goes beyond treating medical problems as they arise to emphasize continuous health management, proactive intervention and coordinated care.
Although definitions of advanced primary care vary, common characteristics include 24/7 access to in-person and virtual care; more time with clinicians; proactive outreach to encourage prevention; multidisciplinary care teams able to address a broader set of patient needs; and data-driven referrals to appropriate providers. Business Group on Health has outlined key principles in its framework for an optimal primary care experience.
A Holistic Approach
As patient needs become more complex and as a primary care physician shortage looms, innovation and investment in primary care are essential.
The growth of advanced primary care models, expanded virtual access and advances in artificial intelligence offer new opportunities to address persistent barriers to primary care. For employers, these developments underscore the importance of partnering with vendors that take a more holistic and accessible approach. This also means considering how these vendors can support other aspects of the care journey, including navigation and ongoing chronic condition management, and how new solutions can be integrated into a coordinated benefits and engagement strategy.
Employers have always prioritized primary care, and they have more options than ever for expanding its utilization. Advanced primary care has been one of the most significant ways in which employers have embraced broader concepts of value-based care and direct contracting. Many have also chosen to add advanced primary care offerings to their onsite and near-site clinics. Alternative plan designs offer another avenue, with primary-care-first offerings among the options for employers to consider.
Accessible, Advanced, Affordable, Accountable
For primary care to be an effective and foundational health experience, and help mitigate costs, it should be advanced, accessible, affordable and accountable.
- Advanced: To meet growing patient needs, advanced primary care should embrace leading-edge innovations such as AI-enabled tools that improve access, care coordination and the patient experience. For instance, AI-augmented technology can extend the capacity of primary care teams and has demonstrated benefits in patient outreach, care coordination and patient experience.
- Accessible: Expanding access to advanced primary care means offering multiple convenient options, including in-person and virtual care, onsite and near-site clinics, and partnerships with community providers and pharmacies. Employers have a responsibility to help connect employees to comprehensive, ongoing primary care as their health needs evolve. Globally, access to this care will vary by location due to workforce shortages, infrastructure and funding, and employers should tailor their strategies appropriately.
- Affordable: Out-of-pocket costs, particularly for those in high-deductible plans, present a considerable access barrier, and lost time at work can compound affordability concerns, especially for hourly workers. However, employers can help offset financial challenges that may limit primary care access. These approaches include reduced or waived out-of-pocket costs for primary care visits and more predictable out-of-pocket costs for virtual visits. Many employers also offer virtual care with reduced or waived cost sharing.
- Accountable: The fee-for-service model often falls short for primary care providers, patients and employers. Employers should consider value-based reimbursement that holds providers accountable for health outcomes, patient experience, access and quality. This approach can also provide high-performing providers and clinical teams with a more sustainable financial foundation to support virtual care, new technology and the data capabilities needed for modern practice.
Positives Outweigh Limitations
Advanced primary care is not designed to solve all cost challenges and may have limited influence on addressing the high costs of certain complex medical treatments.
Still, by investing in models that are advanced, accessible, affordable and accountable, employers can strengthen a core component of their health and well-being strategies, boost patient outcomes and improve experience with this core aspect of care.
