Employers Are Driving Innovations in Primary Care

February 24th, 2022
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Employers know that primary care is essential for a healthy workforce and employees’ access to a high-value health care system. Evidence shows that improved primary care translates into healthier, happier patients and lower overall health care costs:

Large employers are increasingly working with existing direct contracting partners and new vendors to enhance primary care, which includes the integration of behavioral health care among other things.

Four approaches reflect the ways large employers are currently working to improve primary care for their employees:

1. Developing a common set of advanced primary care standards to enable employers to speak with one voice. The development of the advanced primary care model is as much about streamlining the practice of primary care as it is about improving outcomes, enhancing the patient experience and reducing costs. Simple and consistent definitions of optimized primary care across all payer contracts would reduce, if not eliminate, the bewildering array of sometimes-conflicting value-based requirements contained in multiple payer contracts. That fact could mitigate clinician burnout by easing the administrative burden while allowing more time for the actual provision of care.

It is, therefore, essential that employers send a common signal to the market. For that reason, PBGH worked last year with members through an employer-led initiative to create a Common Purchasing Agreement. This enables employers to communicate their priorities and engage payers and providers to make changes to care delivery and payment that meet their priorities.

2. Integrating behavioral health into primary care. Behavioral health integration is an integral part of advanced primary care and a key feature of the Common Purchasing Agreement mentioned above. Nearly seven in 10 patients in need of behavioral health treatment seek care via primary care practices. Evidence shows that integrating behavioral health services into primary care can enhance mental health care access and coordination, improve outcomes and reduce costs. Behavioral health integration, a feature of advanced primary care, allows patients to access mental health care screening, services and treatments through their primary care provider, just like any other specialty care. Employers are highly focused on these efforts, which address an issue that has reached crisis level in this country.

3. Requiring members to choose a primary care provider. Patients benefit from an ongoing primary care relationship with improved care access, greater care continuity and better health outcomes. This in turn reduces employee absenteeism, enhances productivity and lowers overall health care spending for employers. That’s why some employers are taking additional steps to ensure their members are connected to a primary care practice. Methods to do so include mandating that members select a primary care physician and/or team, using benefit design incentives to support the use of primary care over specialty care (when appropriate) and increase education about the importance of having a primary care provider.

4. Helping employees identify and use only the highest quality primary care providers. Using quality measures, such as the PBGH advanced primary care measure set, purchasers and health plans can identify high-performing provider practices. Once those practices have been identified, employers can drive plan members to providers able to demonstrate that they provide high-value care, or the providers identified can be rewarded for their superior performance.

Employers understand better than anyone that the quality of health care their employees can access has a profound impact on their work, lives and productivity. The last few years working through the unprecedented challenges brought about by the pandemic have only reinforced the importance of continuing to strive to reduce disparities in health care and increase access to high-quality and more affordable services.

The same principles of aligning payment incentives and employer voices in primary care provides a model for other care verticals, including maternity care, oncology and musculoskeletal disorders, to name a few. Employers will increasingly work with organizations able to help design and implement the standards necessary to ensure they’re buying the best health care services available for the millions of employees, consumers and families throughout the nation who rely on their employers for health benefits.

A Little Less Conversation, A Little More Action

November 18th, 2021
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“We’ve talked long enough. It’s long past time to take action. Our goal is to foster meaningful, widespread change in health care within three years.” – Elizabeth Mitchell, CEO of PBGH

Large employers and health care purchasers have increasingly begun to take actionable steps to strengthen primary care, the critical precursor to a high-quality, cost-effective health care system.

Extensive research and pilot programs over multiple decades have repeatedly shown that a robust, integrated and accountable approach to primary care—characteristics collectively defined as advanced primary care—can significantly reduce overall health care costs while improving patient outcomes and experience.

Efforts by the nation’s largest employers to transform health care reached a major inflection point this fall when nearly 200 employers gathered with their health plans and health care provider partners from across the country at the PBGH Primary Care Payment Reform Summit. The event created a platform during which employers collectively conveyed their readiness to implement tools designed to induce payers and providers to deliver the same levels of value and quality they routinely expect from other vendors, and their commitment to investing in advanced primary care with integrated behavioral health and a commitment to equity.

Here are 5 key takeaways from the summit about what large employers and purchasers want from their health care vendors:

1. Employers have long accepted poor value for their health care dollars in ways they never would for any other product or service.

Employer-sponsored health plans routinely pay 200-600% times the rates charged to Medicare and effectively provide most of the profit margin for both health plans and providers without visibility into the quality of care their employees receive. Years of provider and insurer consolidation means even the largest employers tend to lack enough employees in any market to exercise adequate leverage to compel greater transparency and accountability.

2. Purchasers feel they’ve given health care stakeholders ample opportunity to reform the care payment and delivery system.

Industry efforts to transform health care have largely failed due to a lack of shared alignment and goals, a fragmented care system, the continued reliance on fee-for-service and the industry’s resistance to change. Now purchasers are collectively taking action to improve value and quality. Read more about what purchasers are doing right now in the full report.

3. Point solutions are making fragmentation worse and threaten to further increase costs.

To better serve members and reduce costs, many employers are turning to third-party vendors for singular, or point, solutions that address specific care functions or services. While many of these new, often digital capabilities are useful in isolation, they’re collectively making worse the already substantial problem of fragmentation and complexity across the care continuum. Many are also backed by venture capital firms seeking maximum profit potential and hence have little incentive to reduce the overall cost of care.

4. Integrating behavioral health into primary care is vital.

Mental health has been a top priority for employers for many years, and the urgency has only increased during the pandemic. Mental health care is hard to access and of variable quality, but mental health care is primary care and needs to be part of advanced primary care practice. Evidence shows that integrating behavioral health services into primary care can enhance mental health care access and coordination, improve outcomes and reduce overall costs.

5. Achieving lasting change will require that purchasers pull together to achieve critical mass.

Employers today have an opportunity to leverage their immense buying power to promote fundamental change in how health care is accessed, purchased and delivered. But even the biggest purchasers in the country lack leverage in most markets. Change on this scale cannot occur unless purchasers work in concert in every region in the country. Only by collectively setting high standards and demanding change can employers hope to overcome the existing system’s enormous inertia.

The Time to Act is Now

Employers want to buy the best health care benefits on behalf of their employees. But they understand better than most how costly and dysfunctional our health care system has become. They provide the critical lifeline of health insurance to about half of Americans, and they grapple every day with ways to keep coverage affordable.

Read the full report A Little Less Conversation, A Little More Action: 5 Takeaways from the PBGH Primary Care Payment Reform Summit here.

See more about the PBGH Primary Care Payment Reform Summit here.

Using Primary Care’s Potential to Improve Health Outcomes

October 4th, 2021
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For over a decade, revitalizing primary care has been a top priority for the Purchaser Business Group on Health (PBGH). Through successive initiatives and in collaboration with a diverse group of committed stakeholders, PBGH has spearheaded efforts to create a blueprint for “Advanced Primary Care.”

What Is Advanced Primary Care?

Advanced Primary Care places patients at the center of every interaction and prioritizes access to high-quality primary care to prevent higher acuity, costlier care and making for a healthier California.

Building off a statewide practice transformation initiative funded by the Centers for Medicare and Medicaid (CMS), PBGH’s California Quality Collaborative (CQC) began crafting definitions for ‘exemplar’ primary care practices with the goal of identifying, celebrating and learning from high-performing organizations within the program’s network. This led to a definition of “Advanced Primary Care.”

CQC defined Advanced Primary Care by high-performance attributes and a set of results-oriented measures that focus on how the care process is, or should be, experienced from the patient perspective. This set of measures is based on existing outcome measures widely in use by California and national payers that if collectively applied would enable medical practices to deliver Advanced Primary Care.

Why Is Primary Care So Important?

Primary care—long underfunded and woefully underutilized—remains the foundation upon which a high-performance, cost-effective health care system must be built.

Evidence shows that improved primary care translates into healthier, happier patients and lower overall health care costs:

It is important to note that the development of the Advanced Primary Care model is as much about streamlining the practice of primary care as it is about improving outcomes, enhancing the patient experience and reducing costs. Simple and consistent definitions of optimized primary care across all payer contracts would reduce, if not eliminate, the bewildering array of sometimes-conflicting value-based requirements contained in multiple payer contracts.

Why Doesn’t Primary Care Work Better?

Funding arguably is the greatest hurdle to more effective primary care. Despite 55% of office visits taking place in primary care clinics, only 4-7% of health care dollars go toward primary care.

But misaligned financial incentives, infrastructure and technology barriers and poor integration with other elements of care all play a role in compromising quality and driving up costs.

Advanced Primary Care in Practice

One initiative that has come out of the primary care groundwork laid by CQC is a measurement pilot with Covered California and CalPERS. Both organizations agreed to pursue a pilot program starting January 2022 to test statewide practice-level measurement using CQC’s 11 Advanced Primary Care measures.

Covered California contracts with 11 health plans to provide coverage for 1.6 million Californians, and CalPERS manages pension and health benefits for more than 1.6 million California public employees, retirees and their families.

The goal of the pilot is to create the basis for extending the Advanced Primary Care criteria across PBGH’s membership and to other payers nationwide.

On September 30, 2021, more than 175 employers, public purchasers, health plans, providers and other stakeholders from across the country came together for a summit to discuss implementation of a common purchasing agreement based on CQC’s definition of Advanced Primary Care. Going forward, CQC plans to continue pursuing solutions to barriers that inhibit broader implementation of Advanced Primary Care.

For more about the journey to Advanced Primary Care, click here.