Likewise, employers are also worried about the rising costs of their benefits offerings, and health benefits stick out among the costliest this open enrollment season.
Employers are scrambling for outside-the-box solutions to tackle costs while keeping their employees healthy and at work.
But the answer is much closer than most would think: The answer is more, and better, primary care.
Primary care is the only kind of health care where more of it leads to lower costs and better outcomes.
So how do employers design benefit strategies that emphasize primary care?
In my role as chief strategy and development officer of Premise Health, I work with large employers every day who want to use primary care to keep their population healthy and avoid costly specialty health services.
When speaking with these organizations, I suggest starting with these three things.
1. Make primary care available.
It might seem obvious, but Americans today are having more and more trouble getting an appointment to see a physician.
This is a significant barrier to care and one I expect to continue to be exacerbated by provider shortages and the recent closures of many retail health operations.
Employers need to emphasize strategies that make primary care accessible.
A Kaiser Family Foundation poll earlier this year indicates that about half of U.S. adults say it’s difficult to afford health care costs — and I believe this is probably on the conservative side. This is true even for those covered by employer-sponsored health insurance.
To offset the costs and make seeking health care easier, employers should look to offer health plans with lower deductibles or coinsurance.
Many employers are also turning to onsite wellness centers to address the issues of access and affordability. Onsite clinics offer a way for employees to establish a primary care relationship in a location that is convenient to them.
Rather than requiring additional transportation time, employees can walk just down the hall and see a provider.
Incentivizing employees to use these clinics by offering discounts or making them free or low-cost also encourages engagement with primary care.
Making virtual care a part of the conversation is equally as important. Health care in the COVID-era leaned heavily on telehealth options to encourage patients to seek care, but I’d caution employers to take a hybrid approach by offering virtual care to support traditional in-person services.
You can’t argue with the idea that virtual care offers more access points for the member — especially for employers with remote or hybrid workforces – but it shouldn’t be relied on for all health care needs.
2. Focus on advanced primary care.
Many organizations I work with benefit from implementing advanced primary care and integrating additional services like behavioral health and care management.
Advanced primary care builds on the traditional primary care foundation to provide whole-person, coordinated care, drives better health outcomes and improves member experience and value. It’s a win-win for everyone.
As an employer or benefits advisor, you may be concerned about the prevalence of chronic conditions among a plan’s population.
Advanced primary care looks at a plan member’s physical, mental and social health needs and emphasizes preventive health, allowing for earlier detection of chronic conditions.
Using comprehensive chronic condition management and care navigation programs to help identify serious health conditions earlier can open the door for more, and often better, options for treatment.
With 6 in 10 Americans living with at least one chronic condition, and 4 in 10 having two or more, these programs can improve health outcomes and decrease out-of-pocket costs, missed time at work and lost productivity.
True chronic condition management looks at lifestyle factors and social determinants of health, along with medical history, to identify high-risk members.
Condition management strategies can be tailored to a specific employer’s population and can include necessary navigation to fair-cost, high-quality specialists or centers of excellence in a specific employer’s community.
Proactive engagement with those members creates a supportive partnership throughout a member’s health journey to guide them to positive health outcomes, rather than focusing solely on episodic care.
3. Consider alternative health plans.
Conversation around the idea of alternative health plans is beginning to grow.
This model allows employees to augment traditional health plans with a less expensive plan option focused on member experience and reducing overall health care costs through a focus on prevention and high-value primary care.
Members benefit from low or no-cost primary care.
Employers benefit from lower claims and administrative expenses, driven by better risk management.
Are alternative health plans the new “disruptor” of health care? We won’t see the idea take over immediately, but we expect to see them exist alongside traditional PPOs and HDHPs as the movement gains traction.
Their future depends on the open-mindedness of employers and employees looking for a new solution.
Keep moving forward.
You have the opportunity to make a real impact on the health of the employee population while simultaneously managing costs for the organization.
I’ve highlighted why I believe a focus on primary care is the right path, and there’s even more to be found with advanced primary care, or APC.
APC takes primary care to the next level by using digital tools and data to integrate traditional primary care, behavioral health, and pharmacy solutions to better serve plan members
Derek Brochu is the chief strategy and development officer at Premise Health, an advanced primary care company.
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