ON THE COVER
Building Partnerships to Support Advanced Primary Care Models Authors Duke-Margolis Center for Health Policy Mark Japinga Mark McClellan, MD, PhD Robert Saunders, PhD Michael Zhu Morgan Health Dan Mendelson Brooke Thurston Dawn Alley
Across public and private programs, a growing array of efforts aims to strengthen primary care as a foundation for addressing the ongoing cost, quality, and access challenges that Americans face in navigating our fragmented healthcare system. Fee-for-service payment, particularly prevalent in employer-sponsored insurance, has helped these challenges persist. Encouraging volume over value makes it easy to overutilize high-cost, procedure-focused care and difficult to invest in preventive services. Advanced primary care models aim to use a different financial approach that better supports nimble, innovative care delivery. Capitated, per-member permonth payments or direct contracting arrangements offer flexibility through a more predictable funding stream. Additional performance bonuses are tied to meeting quality goals and improving outcomes. Leading primary care practices use these arrangements to invest in and develop a range of capabilities that allow for more convenient, personalized, and affordable care, including: • Integration of nurses, pharmacists, and other health professionals • Coordination with behavioral health and specialists • Advanced data analytics to anticipate individual needs
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An employer purchasing reform strategy can add a valuable dimension to provider efforts to advance primary care.”
• Home-based and virtual care • A culturally competent approach focusing on what matters to patients and on building relationships with community organizations Today, the vast majority of Americans do not have access to providers with these capabilities. Many practices want to expand these capabilities and do more, while others are interested but lack the resources to start on their own. In both cases, organizations can benefit from additional capital and technical support to help them advance, especially if Medicare or Medicaid contracts alone cannot provide it.
PARTNERING WITH EMPLOYERS To continue building momentum, providers should consider partnering with the growing set of employers implementing advanced primary care purchasing initiatives.
Employers face particularly acute financial pressures and are growing increasingly frustrated with their inability to support employee health at a reasonable cost. The average annual family premium for employer-sponsored health insurance has now eclipsed $21,000.1 Money spent on healthcare is money not spent on wages or other employee benefits, and inefficient or inaccessible healthcare can reduce employee well-being, job satisfaction, and productivity. Many existing initiatives have not produced the desired results. Individual employers typically lack sufficient market power to manage rising costs by negotiating much lower fee-for-service rates. Blunt approaches to tighten benefits, such as higher deductibles and copays, have caused employees to cut back on both necessary and unnecessary care. Investing in targeted initiatives designed to improve quality while reducing costs—onsite clinics, centers of excellence, workplace wellness initiatives, support for care navigation, and others—can be helpful, but have generally only
18 l JOURNAL OF AMERICA’S PHYSICIAN GROUPS
Fall/Winter 2021
