Improving Primary Care with Innovative Solutions
Utilizing primary care improves health outcomes for patients and lowers the total healthcare spend for employers and employees.
What is Primary Care?
Primary care is the care delivered by clinicians who are trained in family medicine, internal medicine, and pediatrics. These doctors, nurses, and other primary care staff represent the frontline of medicine by focusing on preventative care. They are in the best position to help patients maintain and improve their health by detecting and treating problems early and managing chronic conditions. Primary care providers also act as a quarterback, coordinating care and referring patients to the right specialists when needed.
Primary care has a significant impact on patients’ health and the cost of their healthcare. That impact can vary based on how much time doctors and other caregivers are able to spend with patients, what kind of services they deliver at the primary care office, and where they send people for additional care. Since primary care is typically where an individual’s healthcare journey begins, it’s an effective place to improve the value of healthcare.
What is Direct Primary Care?
Direct Primary Care can increase the value of primary care for patients and employers. Direct Primary Care is a type of primary care that’s provided directly to employers or individuals independently of a larger hospital system. This type of care utilizes an alternate payment method, most often capitated, meaning employers or patients pay a flat monthly fee for unlimited access to care. This greatly improves access to care and helps manage healthcare costs. Direct Primary Care is usually accessed through an on-site, near-site, or shared-site clinic.
The Alliance’s Direct Primary Care Partnerships
The Alliance helps employers increase access to primary care for their employees by incorporating Direct Primary Care into their benefit plans. We have vetted and partnered with Direct Primary Care providers that deliver good care at lower costs. We also share our list of Preferred-Value Providers with our Direct Primary Care partners so they can refer patients to high-value healthcare options when specialty services are needed.
What are the Benefits of our
Direct Primary Care Partnerships?
Employer Benefits
Lowers overall healthcare costs by referring to Preferred-Value Providers for specialty services only when care can’t be provided at the clinic – resulting in fewer referrals, tests, and procedures.
Creates a predictable payment schedule based on per-member-per-month fees.
Improves employee health and satisfaction through comprehensive, personalized, and more convenient care.
Employee Benefits
Lower out-of-pocket costs because care is covered by a flat monthly fee per employee—usually paid by the employer—and more services are handled directly at the clinic, reducing the need for expensive specialist referrals.
Convenient access for employees with clinics located on-site or near their employer, offering same-day appointments and extended hours beyond the typical workday.
High-quality, personalized care focused on the whole person, not just the illness.
Direct Primary Care strengthens the patient-doctor relationship by allowing for longer appointments and more frequent visits. This ensures there is enough time to treat the whole person, not just the symptoms that prompted them to seek care.
The Alliance’s Direct Primary Care Partners Meets the Following Benchmarks:
Enhanced Access for Patients
More physician-patient time to allow sufficient time to treat the whole patient. A greater range of services, including close collaboration with other practitioners like behavioral health and physical therapy. It can also include access to x-rays, labs, and prescriptions. Timely access to care, including same-day appointments, and availability outside of typical clinic operation hours.
Risk-Stratified Care Management
Patient risk is assessed, and a care plan is developed based on their unique needs, such as extended office visits, care management guidance, monitoring and tracking, phone check-ups, etc.
Care Navigation and Referral Management
A careful selection of Preferred-Value Providers for tests and procedures that can’t be provided at the clinic. The clinic team remains in constant contact with this specific list of trusted clinicians as treatment plans develop.
Behavioral Health Integration
Care teams use patient records to identify those who may need outreach and assess behavioral health needs through multiple methods of connection.
Evidence-Based Medicine
Care teams provide tests and treatments based on scientific evidence, avoiding unnecessary care. Clinicians use standing orders and protocols for patients with chronic diseases to ensure evidence-based care is reliably delivered.
Care Coordination
A primary care team that engages in outreach, including chronic condition management, coordination of care, and ensuring patient understanding of medications, orders, adherence expectations, etc.
Organizational Infrastructure
Analytical and reporting capabilities to allow employers and providers access to data for informed decision-making, as well as continuous staff improvement and training.
Balanced Compensation
Rewarding care management teams based on quality of care, meaning care quality, patient experience, resource use and referrals – not volume of care. This global payment methodology differs from traditional primary care, which uses fee-for-service payments and a third-party payor.
