Does Recent Disruption Require a New Look at Primary Care?

If you dig into recent disruptive health care investments, most have 2 key pieces: an insurer who assumes economic responsibility for patient care and a fundamental redesign of the front end of the care delivery system, often leading with primary care. Big payers like UnitedHealth Group and smaller disrupters like Oak Street Health and Iora Health are reinventing primary care with the promise of wringing cost out of the health care system and improving quality and patient satisfaction. If you dive deeper, most of the past successes and future promises to investors and stakeholders come from Medicare Advantage (MA), where success managing chronic populations yields economic benefits.

Do these new disrupters have the right recipe to succeed in markets seeking new ways to balance cost and quality of care? Challenges remain, however, there is much traditional providers can learn as they seek the right economic and primary care models to sustain their glide path to value.

Why the Recent Investment in Value-Based Primary Care?
Fee-for-service (FFS) primary care models are designed to manage episodic and chronic care needs across a wide range of patient segments, from millennials to older Medicare recipients, and it is difficult for a typical community-based primary care practice to be economically sustainable under a mix of both FFS and capitated members. This has been a source of frustration for many organizations that feel trapped between 2 contrasting and often conflicting operating and economic models.

As the pendulum swings toward MA in some markets, primary care innovators are taking a focused approach to serving the risk-based MA segment. Their models align provider incentives with clinical outcomes, patient satisfaction and cost. Expect deep-pocketed MA payers to continue investing in value-based primary care and partnering with high-performing clinically integrated primary care networks as they build their risk-based MA portfolios. Your market may be early in the transition toward MA; however, understanding how these focused models work will help you prepare. Read the full Expert Insight to find out what you can learn from MA primary care innovators. Not an Sg2 member? Contact us to learn more about what sets disrupters apart from traditional FFS primary care models.

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