Building Partnerships to Support Advanced Primary Care Models

Across public and private programs, a growing array of efforts aims to strengthen primary care as a foundation for addressing the ongoing cost, quality, and access challenges that Americans face in navigating our fragmented healthcare system. Fee-for-service payment, particularly prevalent in employer-sponsored insurance, has helped these challenges persist. Encouraging volume over value makes it easy to overutilize high-cost, procedure-focused care and difficult to invest in preventive services.

Advanced primary care models aim to use a different financial approach that better supports nimble, innovative care delivery. Capitated, per-member per-month payments or direct contracting arrangements offer flexibility through a more predictable funding stream. Additional performance bonuses are tied to meeting quality goals and improving outcomes. Leading primary care practices use these arrangements to invest in and develop a range of capabilities that allow for more convenient, personalized, and affordable care, including:

• Integration of nurses, pharmacists, and other health professionals

• Coordination with behavioral health and specialists

• Advanced data analytics to anticipate individual needs

• Home-based and virtual care

• A culturally competent approach focusing on what matters to patients and on building relationships with community organizations

Today, the vast majority of Americans do not have access to providers with these capabilities. Many practices want to expand these capabilities and do more, while others are interested but lack the resources to start on their own. In both cases, organizations can benefit from additional capital and technical support to help them advance, especially if Medicare or Medicaid contracts alone cannot provide it.

PARTNERING WITH EMPLOYERS

To continue building momentum, providers should consider partnering with the growing set of employers implementing advanced primary care purchasing initiatives.

An employer purchasing reform strategy can add a valuable dimension to provider efforts to advance primary care.

Employers face particularly acute financial pressures and are growing increasingly frustrated with their inability to support employee health at a reasonable cost. The average annual family premium for employer-sponsored health insurance has now eclipsed $21,000.1 Money spent on healthcare is money not spent on wages or other employee benefits, and inefficient or inaccessible healthcare can reduce employee well-being, job satisfaction, and productivity.

Many existing initiatives have not produced the desired results. Individual employers typically lack sufficient market power to manage rising costs by negotiating much lower fee-for-service rates. Blunt approaches to tighten benefits, such as higher deductibles and copays, have caused employees to cut back on both necessary and unnecessary care.

Investing in targeted initiatives designed to improve quality while reducing costs—onsite clinics, centers of excellence, workplace wellness initiatives, support for care navigation, and others—can be helpful, but have generally only produced limited results to date.2 Because the programs only made modest changes and affected only small components of beneficiary health, they have not fostered more comprehensive change.

In a sense, employers and primary care innovators face complementary challenges: Both strive to implement new, transformative models of care, and both would benefit from more comprehensive support to do it. The opportunities appear to be improving.

About 51% of large employers have said they are planning to implement at least one advanced primary care strategy in the next year.3 Organizations like the Purchaser Business Group on Health are supporting members in defining attributes of advanced primary care and creating an aligned set of accountability measures to use in future contracts.

A MORE DYNAMIC PRIMARY CARE SYSTEM

Growing momentum through employer partnerships can help providers make even more progress in adopting new care models. One example of what a partnership could look like is JPMorgan Chase’s efforts through Morgan Health, its new healthcare innovation business unit.

Morgan Health has made a $50 million investment in Vera Whole Health, whose model aims to help organizations build diverse provider teams and offer comprehensive services through person-level payments. In addition to financial support, JPMorgan Chase’s benefits team is finalizing details of a commercial deal to offer Vera’s services to employees in Central Ohio.

Vera works directly with local, independent primary care practices to help implement a broad-based infrastructure that integrates behavioral health, care coordination, population health analytics, and non-hospital-based interventions. These tools and resources are some of the key missing pieces many organizations need to better manage an attributed member population. Vera also seeks to include performance guarantees structured on a provider’s ability to deliver on improving metrics related to health equity, ensuring all enrollees can benefit.

The model provides a glimpse of what a more dynamic, responsive primary care system could look like within a particular geographic region. For Morgan Health and Vera, Central Ohio Primary Care is an anchor partner for its region—a collaboration that could easily be replicated in other metro areas. Building successful relationships with employers could be combined with value-based partnerships with other payers (which include traditional Medicare payment reforms, Medicare Advantage, Medicaid plans, and others). These relationships could also leverage delivery reforms like accountable care organizations to help organizations become less dependent on volume-based payments and able to more fully innovate within new care models.

More broadly, the Centers for Medicare & Medicaid Services (CMS) announced a new strategic vision in October that aims to give all beneficiaries access to advanced, accountable primary care by 2030.4 Complementary steps that strive to better align Medicare payment reforms directionally with similar employer and state multi-payer reform initiatives can make it easier for all types and sizes of primary care practices and employers to participate.

Significant work will still be needed to implement new models successfully. For example, effective employee engagement may require more robust efforts to educate employees about new options and enhanced services. Primary care providers need tools to identify and engage with high-value specialists and support patients, as well as clarity on how new models will impact their revenue and workflow.

Employers and providers alike will need more reliable and timely data to identify and act on opportunities for improvement, supported by better data sharing (with interoperable electronic health records) and potentially supported by third parties, such as Vera, to provide infrastructure, advance integration, and foster relationships.

By identifying, prioritizing, and developing employer partnerships now, providers can support their own delivery reform efforts and help drive progress toward advanced primary care in their markets. With the commercial market still insuring the majority of Americans, and with CMS taking new steps to facilitate progress alongside employer reforms, an employer purchasing reform strategy can add a valuable dimension to provider efforts to advance primary care, improve health and health equity, and make healthcare coverage more affordable and effective. o

This article is part of a broader collaboration between the Duke-Margolis Center for Health Policy and Morgan Health and was based on the organizations’ joint September 2021 white paper: “A Pathway for Coordinated, Affordable Employer-Sponsored Health Care.”

Authors

Duke-Margolis Center for Health Policy: Mark Japinga; Mark McClellan, MD, PhD; Robert Saunders, PhD; and Michael Zhu

Morgan Health: Dan Mendelson; Brooke Thurston; and Dawn Alley

References:

1 Kaiser Family Foundation. 2020 Employer Health Benefits Survey. Published October 8, 2020. https://www.kff.org/health-costs/ report/2020-employer-health-benefits-survey/

2 Japinga, M, et al. Duke Margolis Center for Health Policy. A Pathway for Coordinated, Affordable Employer-Sponsored Health Care. Published September 20, 2021. https://healthpolicy.duke.edu/sites/default/ files/2021-09/Pathway%20for%20Coordinated%2C%20Affordable%20 Employer-Sponsored%20Health%20Care..pdf

3 Premise Health. BGH Survey Identifies Top Healthcare Trends for Large Employers in 2021. Published September 3, 2020. https://www. premisehealth.com/resources/news/nbgh-survey-identifies-top-healthcaretrends-for-large-employers-in-2021/

4 Centers for Medicare & Medicaid Services. Innovation Center Strategy Refresh. Published October 20, 2021. https://innovation.cms.gov/strategicdirection-whitepaper