Employers and Health Plans

Employers in the U.S., as purchasers of healthcare, are increasingly recognizing the patient-centered medical home (PCMH) as a means to improve their workforce's health and control healthcare costs. The PCMH fosters a team-based approach to an ongoing, accessible, and comprehensive relationship between a primary care physician and patient. Improved information management, use of guidelines, reengineering of payment systems, and care coordination are pillars of the PCMH that allow it to deliver high-quality care and drive costs down (for example, through the avoidance of hospitalizations through stronger preventative care) when compared to traditional primary care practices.

Those invested in healthcare want to accomplish several things, including improving the experience of care, improving the health of populations, and reducing the per capita costs of health care. There is a fourth component that is a direct result of higher-quality healthcare: improved workforce productivity, which is highly relevant to employers. There is substantial business value for employers in investing in improved healthcare delivery. As such, there is a strong incentive for employers to support the PCMH as a means for having both lower-cost healthcare and healthier employees.

Major health plans, as payers of health care, are in turn discovering the benefits of the PCMH. For example, Aetna and WellPoint recently announced plans to significantly increase their fee schedules for primary care practices that abide by principles of the PCMH, such as by offering increased provider access and availability and coordinating patient care. WellPoint is predicting that around seventy-percent of doctors in its network will join this program by 2014, and that supporting the PCMH will drive its projected medical costs down by up to twenty percent by 2015 through the improvement of patient health and the reduction of the need for expensive medical interventions. "We felt that we had an opportunity and a responsibility to do it," said Dr. Harlan Levine, WellPoint's executive vice president of comprehensive health solutions. Elizabeth Curran, head of Aetna's national network programs, said that the insurer wants to "make the appropriate investment to help support" doctors who improve their practices by abiding by the guidelines of the PCMH.

For purchasers and payers of healthcare in the U.S., it is now clearer than ever that the only way to address the ills that afflict the healthcare system is through truly transformative change in healthcare financing and delivery. One promising strategy for effecting such change is to redesign primary care delivery and to re-emphasize the centrality of primary care via the patient-centered medical home. Both insurers and purchasers of care (employers) play an important role in the multi-stakeholder effort to advance this promising model. The Patient-Centered Primary Care Collaborative, through the Center for Employer Engagement (CEE), works to provide resources to activate purchasers and health plans to become active in this transformation. To learn more about the CEE, its current activities, and how you can get involved, please click here.