Centivo’s latest eBook “How healthy is your health plan?” offers a seven-point checkup for evaluating affordability, access and quality. For those of us demoralized by the torrent of research demonstrating just how broken so many aspects of the US health system are, this checkup is a reminder that there are ‘cures’ in the marketplace today that can help dramatically ease the pain for both employer plan sponsors and their employee members.
For me, affordability is at the center of our ailing industry. As Head of Provider Analytics for Centivo, I am, however, a big believer that offering a health plan built to support the primary care relationship, featuring high-performing networks and user-friendly plan design while rewarding the practice of evidence-based medicine, can dramatically reduce health plan costs.
What’s the headline cure? Investing more in primary care upfront leads to a better managed patient population and lower total cost of care. An ounce of prevention is indeed worth a pound of cure.
Here are the numbers:
What do these numbers tell us? Total medical cost in 2021 for Centivo’s Partnership Plan – our signature plan anchored around value-based, advanced primary care – was 14% lower than the Milliman moderately managed plan benchmark*, an industry standard for comparing similar health plans. This delta highlights a compelling tradeoff for health plan purchasers. While spending an incremental $7 dollars per member per month in primary care, our clients accrued $62 in savings relative to benchmark. The results affirm what many of us already believe: that benefit design with primary care at the center leads to greater healthcare affordability.
We saw similar, promising results across rates of service utilization, or how often members receive care relative to the population. In 2021, Centivo members visited their primary care providers more frequently (12% above benchmark) and made fewer trips to the emergency room (25% below benchmark). Specialty visits were on par with benchmark, suggesting that plan design did not interfere with members’ ability to access needed care. In summary, Centivo members received more proactive, preventive care from primary care providers and less reactive care in the ER, all the while maintaining access to specialty care when necessary.
Achieving healthcare affordability does not require a magic formula or ‘miracle’ cure. But it demands an organizational commitment to what works. The following core tenets of the Centivo model result in substantial savings without jeopardizing access to quality care:
- Build networks featuring only those providers who are leading providers of value-based care in their market; plus
- Empower the primacy of advanced primary care by requiring members to select an in-network primary care provider (virtual or in-person); plus
- Coordinate all specialty care via the primary care provider; plus
- Offer a health plan with no deductibles or coinsurance, free primary care (all of it, not just wellness screenings and tests) and simple and predictable copays for everything else.
Bring these factors together, and the numbers really start to add up to a cure for what ails the affordability of our healthcare system.
Ready to take the checkup to see how you can ease the pain of your health plan? Enter your information below to receive your copy.
*Compared to Milliman’s loosely managed plan benchmark, total medical cost under Centivo’s Partnership plan was lower by 27%.