Self Funding Partner General Changing the Way...
Changing the Way Employees Get Health Care
By Melina Kambitsi, Ph.D., Vice President, Business Development and Member Services

What if you could reduce the total cost of health care for your company by as much as 15 to 30 percent and help your employees get high-value health care at the same time?

It all starts with changing the way your employees access primary care.

Primary Care Makes the Difference
Primary care is where many patients start their health care experience. Primary care is usually defined as the essential basic services provided by family physicians, internal medicine physicians and pediatricians.

Dr. Michael L. Tuggy is a family practice physician who is vice chair of the board for Family Medicine for America’s Health, which is working to improve the health care system and demonstrate the value of “true primary care.” 

The Alliance recently held webinars featuring Tuggy to share his insights on the value of offering “comprehensive” or “high value” primary care. The Alliance is a cooperative of employers who self-fund their health benefits.

Offering Comprehensive Primary Care
Tuggy said high-value primary care puts the focus on patients by breaking free from the fee-for-service model, where delivering more care generates more revenue.  

Instead, comprehensive primary care clinics are typically paid on a per-patient, per-month basis to meet all the patient’s primary care needs. That might mean:
  • Managing chronic conditions;
  • Using email and telephone for some patient visits;
  • Changing how and when patients are steered to specialists, which includes doing some routine outpatient procedures at the primary care office
  • Being available to answer patients’ questions 24 hours a day, seven days a week.
Patients see the difference because appointments can last 30 minutes or more when needed, compared to a typical eight-to-15 minute appointment in fee-for-service settings. Patients also get access to same-day care when needed, which helps them avoid using urgent care or emergency services.

Switching the Payment Flow
Comprehensive primary care also changes where money flows for care. More funds are spent on high-value primary care, with less money spent on high-cost specialty care.

In a typical fee-for-service model, Tuggy said 4 to 7 percent of the total cost of care is spent on primary care services. But in a comprehensive primary care model, 10 to 15 percent of the total cost of care is allocated to primary care.

When a comprehensive primary care model is used in place of a fee-for-service model, Tuggy said the total cost of care typically drops 15 to 30 percent. For example, Tuggy worked at a family practice clinic that trained medical residents using a comprehensive primary care approach, resulting in 20 percent savings in health costs.

In as little as 12 to 18 months, employers who guide employees to comprehensive primary care find that savings add up as more care is provided in a primary care setting; more patients are guided to high-value specialists; and the primary care team oversees more of the patients’ care.

The Employers’ Role in Offering Comprehensive Care
Self-funding gives employers the freedom to explore new ways to offer primary care. Employers typically have chosen to pursue high-value primary care in two ways:
  1. By guiding employees to a primary care clinic that has developed a high-value practice. In this arrangement, the employer pays for care with a per-employee per-month fee.
  2. By participating in the creation or operation of a primary care clinic for employees. This may mean working with a vendor who operates high-value clinics or developing an onsite or near-site clinic that brings care to the worksite. Some employers also offer “shared-site” clinics, where multiple employers share the cost of a primary care clinic.
Whether the care is onsite, near-site or provided at a physician clinic, the goal is to add value by delivering the kind of primary care that patients – and employers – need and want.
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