The rising cost of healthcare is a challenge for patients, providers, and employers. One effective way to help curb those costs is to focus on coordinated preventative care that reduces or eliminates unnecessary expenses. Duplicative tests, multiple provider visits, and unchecked health conditions can add to the costs as well as reduce the quality of care provided to the patient.
Direct-to-employer care enables primary care physicians to provide comprehensive, affordable care that improves the quality of value-based care while reducing costs. Revcycle Intelligence reports on one such direct-to-employer care relationship that is benefiting all involved. Vera Whole Health and Blue Cross Blue Shield of Kansas City (Blue KC) have partnered on three new primary care clinics “that blur the line between provider and payer and incentivize both sides to deliver high-quality, low-cost care to patients.”
In addition to primary care services, Spira Care Centers also provide behavioral health services, x-rays, and pharmacy services. All the services provided by the primary care clinics, except the prescriptions, are covered by the insurance component. To ensure that the primary care and the insurance model work together to provide quality healthcare at reduced costs, “Vera and Blue KC had to align their financial incentives through a value-based contract.”
The key is a capitated payment model tied to quality performance, by which Vera is reimbursed for primary care services delivered to patients at the Spira Care Centers. As Blue KC’s VP of Business Development David Olson explained, “It is a per member, per month payment contingent on them meeting quality metrics. A portion of their capitated payment is withheld pending them meeting HEDIS quality metrics, including patient satisfaction. There is a lot we have in the contract that they have to meet to ensure that they are continuing to deliver high-quality care.”
Aligned financial incentives ensure that providers “no longer have to depend on service volumes to ensure they can continue delivering high-quality care to patients.” Rather, primary care providers and patients are able to work together toward their “shared goal of improving preventative care to decrease costs.”