Catalyst for Payment Reform

Primary Care: An Amazonian-sized Effort

Primary Care: An Amazonian-sized Effort

Like so many others in the industry, CPR staff are monitoring the buzz about Amazon/Berkshire Hathaway/ JP Morgan Chase’s Haven Healthcare. We noticed that the role of primary care is a theme that looms large in the newly released website, in addition to other coverage of the organization. As the designated entry point into a well-functioning health system, primary care is key to keeping employees and their families healthy, but, alarmingly, health care spending in this area actually decreased in 2017 due to lower utilization of outpatient visits by patients.

Amazon is far from alone in this recognizing the barrier to primary care faced by many employees, especially those employees who are struggling to pay for health care in the face of increasing deductibles. Other employers have already taken steps to address this challenge. PepsiCo made headlines in December of last year when the Dallas News reported that the company will waive all premiums and even give it’s Dallas-Fort Worth employees a $100 gift card for seeing a primary care doctor with one of three specified physician groups. When describing the bold solution, PepsiCo Director of Benefits, Betsy Harrison, recognizes what this financial incentive can signify for the population she works to cover, noting “That’s a big deal, especially for our hourly employees.”

CPR’s Employer Case Studies have profiled other firms taking on this issue through unique solutions. For Rockford, Illinois- based AirCraft Gear Corp, increasing access meant the creation of a near-site clinic. They made sure to not replicate the failures of the status-quo by requiring the primary care providers to be salaried, instead of receiving their compensation through a fee-for-service arrangement. Meanwhile, FedEx delivered primary care access through a Health Reimbursement Account (HRA) strategy that allowed them to bring a broader array of preventive services pre-deductible. Finally, CHG Healthcare adopted a telehealth strategy to increase primary care utilization and decrease unnecessary Emergency Room visits. Since 2012, CHG Healthcare has waived co-pays for primary care and dermatology services through telehealth, and their population used the services almost 2,000 times in 2016.

One by one -or three by three- employers are rolling out fixes to increase primary care access. Simultaneously, policy makers are finding other avenues for creating sea change. Since 2010, Rhode Island has required commercial health insurers to increase spending in primary care through the promotion of primary care centric delivery models, like the Patient-Centered Medical Home (PCMH). A recent evaluation found that the state has saved significantly on health care costs through their multi-faceted approach, including reducing consumer out of pocket spending. Some stakeholders advocate for a different route to increase access through a movement known as “Direct Primary Care.”  According to the Direct Primary Care Coalition website, Direct Primary Care provides a membership-based benefit of unlimited access to primary care providers who are paid a flat-fee to provide patient-centered services.

The direct primary care concept, which faces several legal hurdles in its attempts to scale, is similar to Rhode Island in its promotion of non-fee-for-service payments. Many experts partly blame the widespread fee-for-service payment structure for dampening the supply of primary care, causing the U.S. health care system to be heavy on specialist care since the 1960s. Payment reform – like the shared savings, shared risk, or partial capitation arrangements that are in place with many primary care centric ACOs or medical homes – is a necessary component toward financing investments in primary care sustainably.

Whether through sweeping policy initiatives or unique health benefits programs, tweaking the fee schedule or overhauling the delivery system through a PCMH, increasing primary care access represents a sea change in U.S. health care. The fact that this area is reaching Amazonian size this year is cause for celebration. Yet, even before Haven Healthcare unveiled its vision, there has a growing army of change agents responding to a 2005 call to action to put primary care at the forefront of reforming the health care delivery system, and, as usual, employers can be found leading the way.

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