![The Value Of Primary Care Web](/Areas/CMS/assets/img/blank.gif)
简而言之: In search of value, payers want to redefine the role that PCPs play in patient care.
Primary care periodically enjoys 15 minutes of fame. 浮华的 头条新闻预示着最新的初级保健颠覆者的到来(Iora, Babylon, Carbon, etc.), the pundits go wild, and then…the excitement 消散. 亚马逊的 最近 acquisition of 一个Medical has restarted the hype cycle.
But in the background, 许多支付方已经在执行一种愿景,即将其运营模式从主要关注医疗支出转变为同时关注医疗bet8娱乐——从初级医疗开始. Despite Amazon being lionized as an industry disruptor, 支付方更有能力改变初级保健bet8娱乐的价值主张. 健康计划已经建立了规模和能力,以全面地观察病人的旅程和, 结果是, 他们对如何在交付系统中产生价值以及在何处产生价值有着深刻的理解.
To capture that value, payers are placing primary care at the center of their vision, 有着重新定义初级保健提供者(PCP)角色的远大抱负. 支付者将对pcp提出更高的期望,并将这些期望与驱动价值的激励相结合,同时推出支持pcp与患者互动的能力.
初级保健提供者为支付者和患者创造了巨大的价值 Populations They Serve
From the payer standpoint, primary care can be a source of 巨大的价值. 纳税人 are realizing that by making investments in primary 他们关心改善获取和促进更牢固的医患关系 能否减少不必要的开支,并将会员留在自己的网络中.
A Healthier Population
纳税人 want their patient populations to be as healthy as possible; investing in their members’ health leads to fewer high-cost claims. 为此, studies have shown primary care’s beneficial impact on preventive medicine, population health, and the quality of care. 进一步, 管理慢性病和防止其恶化的能力最好通过初级保健来实现.
A Positive PCP-Patient Relationship
使pcp能够与患者建立良好关系的支付方为改善和维持会员健康提供了最佳条件. 积极的经验是至关重要的,以确保会员留在目前的医疗保险公司, 良好的会员体验的核心是会员与PCP之间的关系和信任. 保持会员数量和减少流失率对于高绩效和财务状况良好的健康保险公司来说至关重要,这些保险公司旨在增加会员数量并提高其声誉. A mutually beneficial patient-provider relationship also helps to ensure fluid care coordination, which helps keep 病人 within payer networks.
更低的护理成本
Primary care is ideally positioned to lower total costs by 管理 一个病人’s journey through the delivery system. 患者接受护理的环境对质量和总成本都有重大影响. 一个 研究 显示在医院门诊部接受治疗的患者比在办公室就诊的患者索赔高21%,胸部x光检查的患者索赔高258%. pcp可以成为病人护理过程的主要负责人, 确保他们的病人尽可能在最合适的bet8娱乐地点寻求治疗, increasing positive health outcomes and lowering costs.
Primary care improves performance in other ways as well, such as referring 病人 only to high-performing, low-cost providers that are in network; using thorough documentation to accurately code 病人, thus impacting risk adjustment revenue; and preventing unnecessary visits to the emergency room, decreasing care delivery waste.
最终, 这些能力和策略在短期内减少了患者和健康计划的支付,并在长期内降低了保费.
![The Value of Primary Care from a Payer’s Perspective Image 1](/user_area/uploads/The-Value-of-Primary-Care-from-a-Payer’s-Perspective_-Image-1.png)
Payer Investments and Strategies to Create Alignment with PCPs
在很多方面, pcp共享并可以扩展健康计划的基本目标——改善护理和利用管理, achieving cost containment, and enhancing the overall member experience. 支付方认识到这一点,并不断投入时间和资源,以建立适当的护理协调,并确保bet8娱乐适当地针对pcp.
图1概述了付款人用于与初级保健实践bet8娱乐建立适当一致性的几种策略, ranging from tighter alignment (direct investment, vertical integration) to looser alignment (informal collaboration, improved patient experience) strategies.
FIGURE 1: Payer and PCP Alignment Strategies
![The Value of Primary Care from a Payer’s Perspective Table](/user_area/uploads/The-Value-of-Primary-Care-from-a-Payer’s-Perspective_Table.png)
Figure 2: PCP and Specialist Copays since 2006
![The Value of Primary Care from a Payer’s Perspective Image 2](/user_area/uploads/The-Value-of-Primary-Care-from-a-Payer’s-Perspective_Image-2.png)
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Opportunities for PCPs to partner and align with payers will 继续增长. The key for PCPs is to determine which form(s) of alignment make sense for their organization. Looking to be acquired may or may not be a 长期战略考虑,但扩大基于价值的护理合同,参与 in new products, and supporting community wellness initiatives are all pcp立即有机会与付款人保持一致,同时支持他们的bet8娱乐 病人.
Payer Obstacles in Primary Care
Despite the effort made by payers, obstacles that prevent members from seeing their PCPs remain.
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The first obstacle is the shortage of PCPs. The Association of American Medical Colleges estimates that by 2034, the healthcare system will be short between 17,800和48,000位初级护理医师. 一个 driver is the significant wage gap between PCPs and specialists. 2021年,专科bet8网站备用的平均收入比pcp高出约10万美元. With the median medical school debt for the class of 2021 being $200,000, it makes sense that students are seeking higher-salary positions. 纳税人 and products are increasingly emphasizing the use of primary care, 但是直到医学院的学生被激励去寻找初级保健的职业, access will continue to be a problem.
缺乏推荐
In addition to the growing shortage of PCPs, not all health plans require referrals, 这往往导致会员跳过初级保健访问,直接去找专家. If members don’t have a good relationship with their PCP, 在看专家之前,他们更不可能得到推荐或进行交谈. PCP与其他网络提供商的关系也可能成为障碍. If a provider is not well engaged in their network, members who do consult with their PCP might not get a quality referral.
消费者的选择
Aside from physician staffing and operational challenges, payers may also face obstacles in the form of consumer choice. 消费者(e.g., 雇主, members) change health plans frequently, so to the extent payers and providers move toward vertical integration, members may end up changing their PCP at that same frequency, which would marginalize each payer’s PCP value proposition. 考虑到这一点, 重要的是,支付方和PCP都要共同打造品牌,并营销他们的合作伙伴关系,这样消费者就能清楚地看到他们的健康计划和PCP之间的关系. 这也可以为双方创造额外的粘性,最终推动长期价值.
Developing a Successful Primary Care 策略
纳税人 want PCPs to be at the center of the patient’s care plan and overall member experience. Done correctly, a PCP’s unique relationship with 病人、健康计划和专家为所有人释放了巨大的价值 stakeholders in 一个病人’s journey.
However, payers are no longer passive stakeholders in primary 护理bet8娱乐,并积极寻求通过投资来增加其价值 他们的交货. Despite the obstacles facing primary care, payers have the size 并扩大规模以构建网络和设计满足消费者需求的产品 while minimizing the impact of physician shortages. Said more directly, payers can 改革初级保健市场,并将以提供者的成本为代价 the appropriate alignment strategies are not in place.
It is important for PCPs to proactively assess their 内部能力、能力与总体战略相协调 满足市场需求,否则就有可能被新的或扩展的bet8娱乐所取代 that can be offered by their payer partners. The payer-PCP alignment strategies 以上是pcp评估其护理的良好起点 模型,操作和付款伙伴关系,以最大限度地提高供应商的价值 group and health system.
了解心电图
创造互利的伙伴关系和对齐机会之间
支付方和pcp.
编辑: 马特杂粮面包
Published September 28, 2022