Advanced Primary Care: Upgrading Employee Benefits

In an era of marketing a new generation of primary care services, employers and benefits teams are inundated with pitches around “advanced” primary care. For some in employee benefits, the lingo may come off as a distinction without a difference. But for many patients, the experience with advanced primary care can be revolutionary in how they are cared for and supported in navigating the health system. And the improvement in their health is the proof that advanced primary care can meaningfully improve the trajectory of health outcomes overall.

So what is advanced primary care and how should employers look to incorporate this approach?

Advanced primary care is a health care delivery model that prioritizes strong relationships between patients and their doctors with additional support from data, analytics and coordinated care.

The power of advanced primary care is front and center for patients navigating the complexity of health care. In an advanced primary care setting, patients have a natural advocate with an established care team of doctors, nurses and specialists who integrate primary care, mental and behavioral health services into one clinical program. Patients also can access same day or next day in-person or virtual care support when they need it, addressing one of the persistent access barriers facing employees and Americans more broadly.

Two of the clearest distinctions of advanced primary care versus traditional primary care in practice are how a group manages specialty referrals and clinical follow-ups, like making sure patients are sticking with their prescriptions. If and when a patient requires specialty care – for example, a consult with a dermatologist or an MRI – the care team goes beyond just identifying the ideal provider and writing a referral or order. They help manage and coordinate appointments, follow-up on any relevant action items or clinical information that should be considered as part of the patient’s future health considerations, and ultimately, make sure that the patient received appropriate care. Similarly, with prescription medications, an advanced primary care team will check in with a patient if the prescription is still pending at the pharmacy and make sure they are able to follow the treatment regimen without any issues.

While many specialists may tout their ability to provide this type of care coordination, the reality is that many fall short.

This disconnect is largely a result of the commercial insurance market still relying on fee-for-service, a payment scheme that rewards the number of office visits instead of improvements in health outcomes. According to the latest market data, fewer than 13 percent of commercial insurance payments in 2021 were tied to two-sided financial risk for improvements in health outcomes, compared to more than 35 percent of payments in Medicare Advantage and 24 percent in traditional Medicare. These perverse incentives undermine employers’ ability to offer accessible, high-quality primary and accountable care programs, and ultimately contribute to pervasive gaps in health outcomes among employees.

Advanced primary care is only possible through a value-based care model, one that is specifically accountable for improvement in patients’ health outcomes – such as reductions in unnecessary hospitalizations and improvements in specific health measures, such as for diabetes, heart disease and obesity. Because the payment models incentivize whole person care – practically translated into longer primary care visits if needed, proactive wellness screenings, virtual and in-person follow-ups on appointments, referrals and health status – providers know that they are accountable for the overall health improvement of the patients they serve.

This approach is the cornerstone of our innovation efforts in Columbus, Ohio, where JPMorgan Chase
JPM
and Vera Whole Health, part of apree health, launched on-site and near-site advanced primary care centers for 30,000 JPMorgan Chase employees and family members. At the care centers, employees have access to comprehensive wellness exams, behavioral health screenings, health coaching sessions, and chronic disease management. While still in its early stages, we expect measurable improvements in health outcomes for employees, particularly related to reductions in hospitalizations and ER visits, progress with diabetes prevention and management, and reduction in the severity of other chronic conditions and risk factors.

It’s important to acknowledge that not all primary care providers are equipped or able to take on the technological capabilities and infrastructure of an advanced care model. Our partner in Ohio, Central Ohio Primary Care, is an outstanding group highly experienced in this model. Employers will need to choose their partners wisely.

However, the growing burnout among primary care clinicians – driven by a multitude of factors, including ongoing administrative burden, strain from ongoing pandemic demands, and job satisfaction – illustrates the urgent need to shift to a care model that is more responsive to physician and patient concerns. Advanced primary care can play a fundamental role in transitioning from a siloed approach to care delivery to one where physicians and patients are supported collectively.

For employers, integrating advanced primary care into a benefits package starts with engaging health plan partners and other primary care partners on key goals around health outcomes and realigned payment models that incentivize early prevention, outreach and accountability for health improvement. Groups like the National Alliance of Healthcare Purchasers are one of the many organizations that have outlined principles and recommendations for employers that are ready to embrace the benefits of advanced primary care programs and services.

We stand ready to support employers and providers in the transition to advanced primary care. Incentivizing care quality – rather than quantity – aligns the interests of all parties to support better health for patients.