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Advanced Primary Care May Be the 'Next Big Thing'

Doctors receive monthly fees per member instead of payment for services

A group of doctors standing next to each other.

In his 30 years of practicing medicine, Dr. James T. McDeavitt, executive vice president and dean of clinical affairs at Baylor College of Medicine in Houston, has seen a lot of "next big things" that haven't panned out. But he believes a new approach to primary care could be the real deal.

Baylor is among the first organizations in the country to embrace what may indeed be an influential shift in how employers deliver health care to workers and their families. The approach is called advanced primary care (APC), and it has the endorsement of some of the nation's largest employers and policy experts. McDeavitt is pleased with what he sees in action at Baylor, which launched its APC program last July.

"We're excited about it," he said. "This is one more weapon to try to re-imagine our health care system."

What Is Advanced Primary Care?

The Purchaser Business Group on Health in San Francisco, a nonprofit coalition representing employers, defines APC as a comprehensive care delivery model that combines several reforms rolled out in recent years. Employers contract directly with primary care providers, replacing fees for services with monthly per-member payments. The primary provider coordinates care with a patient-support team that includes mental health counselors and wellness coaches, and makes referrals to high-quality specialists. Other aspects of this coordinated care model can include access to telehealth services and clinics that are onsite at the workplace or nearby.

Although even APC's most enthusiastic backers say it's too early to present evidence of cost savings at scale, 2021 was the year that big corporate names put some big chips on the table. In May, JP Morgan Chase (JPMC) launched Morgan Health, starting with an investment of $250 million in "promising health care solutions and overall system improvements," both for its own employee benefits program and in partnership with other employers.

"The kinds of things we would like to leverage for our employees either don't exist today or don't exist at the scale that would be required for an employer like us," said Dawn Alley, Morgan Health's managing director of health care innovation. "Through that investment, we are looking at young companies that have the ability to help us with our mission around affordability, quality and equity."

One of those young companies is Seattle-based APC pioneer Vera Whole Health, into which Morgan Health invested $50 million last August. Vera is partnering with JPMC to deliver advanced primary care to JPMC employees in Columbus, Ohio, to test the concept for the rest of the company. Vera is also Baylor College of Medicine's partner in its APC venture.

Jumping In

Baylor is jumping into APC as both an employer and a provider network. The first Baylor-Vera APC clinic opened in July, with five planned for the Houston area by 2023.

Though McDeavitt said it was too early to have any definitive data on costs, one trend has proved promising in Baylor's rollout: "About half the visits are not to see a physician but for the wraparound services" such as wellness coaching, he noted.

Who Should Start, and When?

Bringing APC into the mainstream will take some time, but the commitment organizations like Morgan Health and Baylor have made indicates a willingness to stick to the new primary care model on a scale not seen yet.

There will, however, be challenges in making it ubiquitous, according to experts at the Duke-Margolis Center for Health Policy in Washington, D.C. Center researchers Mark Japinga and Robert Saunders, as well as Morgan Health's Alley, were among the co-authors of a recent comprehensive report that laid out possibilities and challenges for APC.

Right now, "we are talking about a small number of organizations that are trying these more comprehensive solutions, who have expertise in-house … and a large enough number of employees where they can change a local market," Saunders said. "It may be a little while until it's something all employers will be able to roll out."

Japinga said the success of efforts by large-sized pioneers who establish best practices will encourage third-party administrators to do some of the heavy lifting so smaller companies can launch APC plans of their own. Both Japinga and Saunders estimate it will take three to five years to see a return on investment, about the time it has taken models such as Medicare accountable care organizations to demonstrate their worth.

"Patience will be important, especially with primary care, which is much more focused on managing long-term chronic conditions where the big costs are five to 10 years down the road," Japinga said.

Changes in how care is delivered will have to be matched by a change in how it is purchased, McDeavitt added.

"As a purchaser of health care, it used to be adequate to say, 'Let's shop around and manage our spending,' " he said. "We need to start to push companies to say, 'I actually have invested in the health of my employees. I need to understand where they are getting screening exams. I need to understand issues of obesity and diabetes and high blood pressure.' As people are starting to negotiate their benefits suite, companies need to ask those questions of their insurers."

Alley said those in the vanguard are ready to change the relationship between providers and patients.

"We want to meet patients where they are and have team-based care that leverages nurses, social workers and pharmacists," she said, citing a 2021 report from the National Academies of Sciences, Engineering, and Medicine. Advanced primary care's staunchest advocates, she said, have learned from earlier attempts to reform care delivery: "We need to be paying teams to deliver care to people instead of paying doctors for visits."

Greg Goth is a freelance health and technology writer based in Oakville, Conn.

Related SHRM Articles:

Small and Midsize Employers Can Contract with Health Providers, SHRM Online, May 2019

Direct Contracting with Health Providers Can Lower Costs, SHRM Online, October 2018


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