3 min read
Believe it or not, only 5% of the total $3.8 trillion spent on healthcare every year in the U.S. goes towards primary care. That makes primary care one of the specialties we spend the least on, despite being our first-stop in care and wholly focused on disease prevention and our overall health.
But employers have long been out to change this. Since the 1970s they have been innovators in primary care, developing new programs and embracing advanced primary care models, including HMOs, high deductible health plans and near- and on-site primary care.
Despite these efforts, employers have not been able to quell the surge in overall healthcare costs which are driven primarily by the need for chronic disease management and adverse outcomes and complications that arise from various treatments. In fact, over 10% of health plan costs are wasted annually on these adverse actionable events.
Employers need an approach to care management for chronic conditions that can work in tandem with — and allow them to capitalize on — their investments in advanced primary care models. They are looking for a better way to power up primary care to ensure members get the various services they need over a period of time to manage those conditions and to reach the best possible outcomes.
Enter episodes of care
By forging a link between primary and specialty care within a payment structure, reductions in inappropriate care are incentivized and measurable improvements in patient outcomes are rewarded. In the past, episodes of care were typically limited to acute conditions and procedures such as maternity care and knee replacements, but now commercial and public plans are turning to episodes of care programs to address chronic conditions such as back pain and diabetes.
Episodes of care programs align incentives and get all stakeholders on the same page:
- Employers benefit from savings generated from improved quality as well as greater predictability and transparency in costs of care
- Primary care providers benefit from the opportunity to participate in measurable and relevant quality and cost improvement initiatives, thereby raising their reputation in the community while delivering better care
And most importantly…employees and their dependents benefit from better care and better outcomes.
The healthcare industry is galvanizing around episodes of care because they work. GE, Walmart, Lowe’s, and Boeing are among the first wave of employers driving episodes of care adoption in their contracting activities.
Employers that encourage their near- or on-site vendors to implement episodes of care payment programs – or use a company such as Signify Health to implement them – are doing so because they see it as a necessary step toward value. Together, we can decrease the country’s overall spend on healthcare, while also investing in primary care.
Want to learn more? Check out our latest whitepaper, where we delve into how episodes of care can help employers improve management of chronic conditions and reduce adverse events, ensuring lower costs and better outcomes for employees and their dependents.
Marc Rothman, MD is the Chief Medical Officer at Signify Health
Tami Hutchison is Senior Director, Business Development at Signify Health