By now, this is not breaking news: Primary care has the power to improve patient outcomes and lower costs. Providers, payers, employers and the healthcare community have agreed on the facts for years – increased primary care spend is associated with less downstream care as well as fewer emergency department visits and total hospitalizations. A recent California study showed larger investments in primary care were also associated with better quality, improved patient experience and a lower total cost of care.
Yet today, primary care spending is at an alarming low in the United States – less than 5% across commercial payers. The average number of primary care visits made by employer-insured employees per year has been declining, and nearly a quarter of privately insured Americans don’t even have a usual source of primary care.
So why aren’t patients taking advantage of the health benefits and cost-saving power of primary care? Part of the problem may be the price tag – which sounds like more of yesterday’s news. Yes, healthcare costs continue to rise. But what should raise an eyebrow is that many of the patients avoiding care because of costs are not uninsured.
For many, having employer-sponsored health coverage doesn’t mean they can afford to use it, even for routine primary care. This is especially true with high-deductible health plans, where most primary care visits end up covered out of pocket. As a result, employees avoid getting care, even for annual physicals or screenings. And that’s a risky game that can lead to much more urgent, expensive care down the road.
Primary care can make a difference – but patients need the affordability and accessibility to get the right care at the right time and in the right place. Because most traditional plan models don’t do this, they haven’t been able to fully realize the promise of primary care to impact outcomes and lower costs – as much as $13 downstream savings for every $1 invested in primary care.
But change is happening. As described in a recent issue of Managed Healthcare Executive, alternative health plans, like Centivo, are making healthcare more accessible by building high-value networks with primary care at the center. Our recently announced 2022 results prove that by incentivizing primary care visits, which increased 30 percent with Centivo’s Partnership Plan, patients had fewer emergency room visits (-15 percent) and inpatient admits (-13 percent). That led to lower costs for employers and reduced out-of-pocket expenses for employees.
Another fast-growing innovation in primary care accessibility is virtual primary care. It meets patients where (and when) they are, eliminating geographic and scheduling barriers to care. Centivo’s Virtual Primary Care practice – one of the very first virtual primary care practices to receive Patient-Centered Medical Home (PCMH) Recognition by the National Committee for Quality Assurance (NCQA) – is fully integrated into our core health plan. This allows primary care physicians to coordinate all care, including specialty care, within the network. Additionally, Centivo’s hallmark Partnership Plan offers free primary care for all visits whether virtual or in person.
Centivo’s results are part of a growing body of evidence suggesting that if employers invest more in primary care up front — specifically advanced primary care from high-quality, value-based providers — they and their employees could see significant overall cost savings, not just in year one, but sustained savings over time.
Want to hear more about how Centivo can save your organization 21-33% on employee healthcare benefits? Sign up for one of our upcoming educational (no-pressure) group demos.