National Alliance Report Details Factors That Drive Advanced Primary Care

As the coronavirus disease 2019 (COVID-19) pandemic causes employers nationwide to implement strategies to efficiently operate amid potential revenue loss, the National Alliance of Healthcare Purchaser Coalitions (National Alliance) released a comprehensive report to assist employers and plan sponsors to optimize the delivery of advanced primary care (APC).

“While employers have always sought value for their health benefit dollars, the unprecedented revenue loss and business disruption for so many due to COVID-19 adds an even greater urgency to maximize the return on investment for their healthcare spend,” said Michael Thompson, president and chief executive officer of National Alliance.

The report, Achieving Value Through Advanced Primary Care, highlights the significance of an APC strategy, which, when properly structured and reimbursed, can be critical in lowering healthcare costs and improving health, the organization said in a statement. As indicated in the report, 80% of patients with common chronic conditions, such as diabetes and hypertension, access primary care, but the lack of behavioral health (BH), misaligned reimbursement incentives, and technology issues may inhibit healthcare quality and raise costs for employers.

National Alliance researchers said 7 factors are key to building and implementing an optimal APC:

1. Enhanced access for patients
2. More time with patients
3. Organizational infrastructure backbone
4. BH integration
5. Disciplined focus on health improvement
6. Referral management
7. Realigned payment methods

The first 6, aimed at delivering both high value and high quality, are vital during the COVID-19 pandemic, the report said.

In detailing how employers can use an APC strategy to deliver value to their workforce, the report emphasized appropriate infrastructure and focus, where care is patient centered and population focused, using a data-driven approach.

Additionally, the integration of BH was also touted; nationally, less than 2% of all ambulatory visits included screening for alcohol misuse or substance use disorder, and only 4.4% included screening for depression. This could prove vital as nearly 7 in 10 employees indicated in a prior survey that the COVID-19 pandemic is the most stressful time of their entire professional career. As the rise in new prescriptions for mental health medications coincide with these findings, employers must develop an optimal pathway for accessibility to these BH services. Researchers said that to incorporate BH, whether virtual or co-located, a systematic approach to screening is vital, characterized by consultation and follow-up.

To support these services, researchers stressed the last point—align payment by increasing investment into the APC model. By rewarding performance as opposed to volume through fee-for-service, employers may decrease total cost of care and form an efficient mechanism to get the best value from their healthcare spending.

“Optimally, advanced primary care programs can save employers as much as 15% of their overall healthcare costs while also providing a steady source of income to these critically important providers,” said Thompson.

The report was developed in collaboration with 5 primary care organizations, Catalyst Health Network, Premise Health, R-Health, Optum, and WeCare TLC. Findings and recommendations were based on the National Alliance’s eValue8 assessment process, a benchmark mechanism used to define, measure, and evaluate health plan performance.