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High-Value Primary Care Changes Health Care Where It Starts

High-value primary care can save 15 to 30 percent of the total cost of care in as little as 12 to 18 months. At the same time, it gives patients a closer relationship to the primary care team through:

  • More time with caregivers.
  • More ways to access care, including telephone, email and telehealth services.
  • More services available at the primary care office.

Where do the savings come from?

Savings come from:

  • Making smart referrals for tests and specialty care. A high-value primary care clinic is more likely to refer patients who need an MRI to a free-standing clinic instead of a hospital, which can save thousands on a single test, for example.
  • Treating common or routine conditions at the primary care office, rather than referring them to high-cost specialty care. Primary care doctors operating as part of a typical health system often choose not to do minor procedures, even those which they have been trained to do, because of lack of time and equipment within their current system. Doing simple procedures at the primary care office produces major savings.
  • Helping patients get care when they need it, which means they are less likely to make unnecessary visits to the emergency room or urgent care centers.
  • Paying for care on the basis of a per member, per month fee, instead of paying a fee for every service. This removes the incentive to do more to patients — there’s no incentive for sending patients for more visits, more referrals or more procedures. Instead, the focus is on working toward better outcomes for patients.

What’s Special About High-Value Primary Care?

It’s Easy to Access

Your doctor and primary care team give you more time. Typical clinics rush through appointments in 15 minutes or less; a high-value clinic gives you 30 minutes or more when needed.

You can get an appointment quickly – often on the day you call or the next day, based on your needs.

Telemedicine, email or telephone visits are offered – sometimes all three!

High-value primary care improves patients’ health and lowers the total cost of health care.

Total Spend Goes Down

But primary care’s share increases. Cost savings typically begin in 12 to 18 months.

* Source: Dr. Michael Tuggy, “Cutting the Tie Between Primary Care and the Fee-for-Service Model,” The Alliance blog, www.the-alliance.org/blog.

Patients Who Need More Care Get More Time

time clock

  • 71 percent of all health care costs are due to patients who have heart disease, diabetes or another condition that needs ongoing care.*
  • 85 percent of doctors say they lack time during appointments to meet the needs of these patients.*
  • High-value primary care offers longer appointment times to meet patient needs.

* Source: Quest Diagnostics study, “Hidden Hazards: Closing the Care Gap Between Physicians and Patients with Multiple Chronic Conditions”

Doctors Help Patients Get the Right Care

High-value primary care doctors and staff:

Identify and reach out to high-risk patients.

Do more at the primary care clinic and less at high-cost specialty centers — when it’s right for patients.

Seek out high-value specialty care when a referral is needed.

Coordinate care for patients and stay connected even when patients are referred elsewhere for care.

Use evidence-based medicine, which means decisions are based on scientific proof instead of opinions.

Have processes in place that lead to better outcomes.

Patient Well-Being = Success

  • Monthly per-person fees replace a fee for each service.
  • Success is measured by patients’ health status instead of by revenue from extra visits and tests.
  • Patient well-being and satisfaction impact pay for doctors and staff.

Employers’ Role Changes

  • Some employers pay a monthly fee directly to a high-value primary care clinic.
  • Some employers pay to have primary care clinics at or near worksites with no copays or out-of-pocket costs for employees.

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