All primary care is not created equally. Employers need a strategy to determine what value they are getting for the dollars they spend. The National Alliance of Healthcare Purchaser Coalitions published this playbook on advanced primary care.
Five tenets distinguish advanced primary care from ordinary on-demand “sickness-based” care:
Access: Personalized, readily available, flexible; providing adequate time during visits; after-hours access; medically appropriate alternatives to in-person visits such as telemedicine.
Data: To assess quality and value of care provided on an individual member basis and for the entire population of covered members
Care Management: Resources to provide the level of care appropriate to each individual’s health risks; coordination of care among specialists; referral management to assure engagement of high-value specialists and top-quality hospitals
Integration of behavioral health and awareness of social determinants of health: Recognition and treatment of such problems as depression, stress and anxiety that are pervasive, especially in persons with chronic illnesses; identifying financial, mobility, environmental barriers to care; identification of substance abuse including alcohol.
An aligned payment model: A practice that pays providers on the number of patients seen, regardless of the quality of care, will not have the incentives to achieve best results.
Are you getting the level of primary care you want? Try this experiment: identify which medical group provides the most primary care to your members. Ask them to give you this de-identified data on your covered members treated by that group:
- what percentage of my members with hypertension have documentation of adequate blood pressure control?
- what percentage of members with diabetes meet comprehensive diabetes care guidelines for control of blood sugar, blood pressure and monitoring for eye and kidney complications?
- what percentage of women members have had mammograms at the appropriate age and appropriate time?
- what percentage of your primary care provider compensation is based on other than volume of patients seen or “RVUs”?
There are many other measures of high-quality primary care but these are easy for a practice to measure. If you can’t get that data, you can’t be certain you are buying high-value primary care.
Remember this: Beware of bargains in parachutes, fire extinguishers, bear sprays and primary care. Cheap primary care isn’t cheap in the long run.