Fostering Primary Care Use May Hold Key to Value and Quality

Speakers on a panel at the 2023 Greater Philadelphia Business Coalition on Health described the ways their organizations are promoting access to primary care in hopes that it can be part of the progress toward achieving the Quadruple Aim.

Each of the components of the Quadruple Aim—lower costs, better outcomes, patient experience, and clinician experience—can be furthered by a robust primary care system that enables the right care for the right patient at the right time, the panelists said, tying their organizations’ missions to this goal.

Larry Boress, CEO of the National Association of Worksite Health Centers, provided an overview of how worksite health services reduce the barriers to preventive care, particularly for employees who don’t have a personal primary care physician (PCP) or who face barriers to reaching a traditional care site. The improved access and convenience stemming from the worksite care model can boost employee engagement and retention, and the per-member per-month contracting model makes it attractive to employers since there is no incentive for clinicians to order unnecessary services.

Worksite clinics also enable better care coordination, Boress said, as the practitioner can take more time to learn about the patient in front of them and link them to an employee assistance program or services like smoking cessation or chronic disease management—all adding up to “an integrated, holistic, advanced care approach.”

Next, Kevin Fosnocht, MD, chief medical officer of Tandigm Health, discussed Tandigm’s role as a population health management company that works with PCPs and payers to enable high-value care delivery. By providing a refined set of informatics and analytics, Tandigm aims to give clinicians the data they need to move to a proactive, preventive care model that allows them to identify who their patients are and what care they need. Care management extends the PCP’s reach into the home, community, or skilled nursing facility in a way that is coordinated and integrated.

That alone is not enough, Fosnocht said: It also needs to be tied to a value-based payment model that offers incentives for clinicians to focus on high-value activities and drive the desired change. By treating the Quadruple Aim as a north star, the focus shifts from just cutting costs or meeting quality measures to delivering on better outcomes and experiences for patients and clinicians.

He noted an earlier speaker’s observation that patients can be activated with an incentive but they will not keep going without friction being reduced, and he said the same applies to clinicians, so his team works at “making it easy to make high-value decisions and enabling them to provide high-value care.”

Finally, Dave Osterndorf, chief actuary at Centivo, provided insight from the perspective of a health plan committed to a primary care–centric model. Centivo’s approach centers on a combination of alignment and accountability, as providers take accountability for patient outcomes, employers equip them with the tools to make that happen, and beneficiaries agree to take part in a trusting and coordinated relationship with a PCP. By investing more spending in primary care, the payer is confident the return will be realized through reduced downstream care.

Indeed, Osterndorf presented Centivo’s 2022 data showing primary care visits were 30% above the benchmark whereas inpatient admissions and emergency department visits were 13% and 15% below benchmark, respectively.

“A strong primary care relationship does that,” he said. “Do things that really structure health care differently, and you’ll get some really important outcomes.”

In discussions after the presentations, the panelists agreed on the importance of engaging patients in their primary care. The first step is to ensure each member has a PCP, Fosnocht said, but employees also need to know what good primary care looks like, meaning a trusting relationship where the PCP provides continuous care and has insight into all care utilization by that patient. Coordination also is crucial for ensuring providers know what resources and benefits are available to patients so they can link them to these programs seamlessly, Boress added.

The importance of strong primary care has also been heightened by the shift toward a hybrid or remote workforce in many companies, the speakers concurred. Fosnocht noted that successful practices are those that can provide off-hours care appointments and have member calls answered by someone who knows their health records. Osterndorf added that the emerging virtual care world is creating huge opportunities, not just among the tech-savvy young adults whom plans might picture accessing telehealth, but also for members with a disability or needing an organ transplant. Virtual care “can be a real-life primary care relationship,” he said.

“Don’t be an employer that just sits back and waits,” Boress told the audience. “You have to get your own shop in order; you have to focus on your data, your population, your culture, your strategy, creating a culture of health and finding the best partners you can who share your vision, share your objectives, and then make them accountable.”