Catalyst for Payment Reform

Why many employers have primary care on their mind

Why many employers have primary care on their mind

Last year, Amazon/Berkshire Hathaway/ JP Morgan Chase’s Haven Healthcare made a splash across the health care industry, not only for the big names associated with the effort, but also for its focus on increasing access to primary care. As the designated entry point into a well-functioning health system, primary care is essential to keeping employees and their families healthy.

Amazon is far from alone as an employer interested in rolling out a primary care strategy for their plan members. In December of 2018, PepsiCo made headlines when the Dallas News reported that the company will waive all premiums and even give its 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, recognized what this financial incentive can signify for the population she works to cover, noting “That’s a big deal, especially for our hourly employees.”

But does the evidence support a one-size-fits-all strategy of increasing primary care utilization among all plan members? What if the costs of annual exams outweigh the benefits for certain demographics? Are there other approaches that deliver better quality of life for patients with a lower price tag for the employers sponsoring the health coverage?

These questions are being asked among benefit managers nationwide, and recent regulatory changes make the questions even more pressing. In 2019, the IRS expanded the list of preventive services covered pre-deductible for Health Savings Account (HSA)- eligible high-deductible health plans (HDHPs).  These welcome changes remove financial barriers to care for plan participants with certain chronic conditions, but they also mean new territory for employers to navigate in 2020.

CPR is here to help employer-purchasers understand the latest evidence on high-value primary care and the dynamic primary care marketplace.

The purpose isn’t to reinvent the wheel. CPR will focus on building off of the momentum and strategies to date, helping align purchaser needs to send a consistent signal to the marketplace. We draw from CPR’s Employer Case Studies that have profiled firms taking on this issue through unique solutions. For Rockford, Illinois- based AirCraft Gear Corp, increasing primary care 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 offer a broader array of preventive services pre-deductible to plan enrollees. 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. Finally, the Covered California Health Exchange provided insights into their primary care focus during a webinar in Fall of 2019.

There is 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.  As usual, benefit managers (and vendors trying to win employer business) can be found at the cutting edge.

This blog was adapted from a previously published version.

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