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Succeeding in Value-Based Care

Unleashing the Power of Primary Care through Value-Based Care Payment Models

Elation CEO Kyna Fong, PhD was thrilled to have recently joined a HLTH webinar alongside Christopher Crow, MD and CEO of Texas-based primary care network Catalyst Health Group, to talk about the potential we could realize by enabling high-quality primary care through value-based care payment models. 

Primary care holds the ability to drive better patient outcomes while managing costs and delivering high value across the healthcare system. With just 5-7% of healthcare spending allocated to primary care, the return on investment is clear: studies show that each additional dollar invested in primary care can save thirteen dollars downstream. Yet, the U.S. has a top-heavy model built on transactional, fee-for-service revenue and third-party payer frameworks. These models do not support primary care either clinically or operationally, hamstringing their ability to deliver effective care. 

Here are some of the key takeaways from the conversation between Fong and Crow, which focused on primary care’s potential to transform healthcare as we know it, the diverse models shaping its future, and efforts to pioneer innovative solutions that address these issues head-on.

Diverse Models of Primary Care

There is an array of modern primary care models, including value-based care, direct primary care, and concierge care. These models share two things: they center the patient-provider relationship and embrace prospective payment models. The latter aligns with the trend of paying for value over time, a departure from fee-for-service transactions.

Relationship-based care is a key tenet of high value primary care, according to Fong. Based on her personal experience working in her father’s practice, she quickly realized the deep personal connections between patients, physicians, and the community. This trust and rapport were more than just transactional; they were integral to driving positive patient outcomes and satisfaction. In recognition of the value of the relationship, Elation’s own system is specifically designed to help foster this collaborative connection.

Equity and Access: Making Diverse Models Work

Ensuring that diverse primary care models are accessible and beneficial for a diverse patient population is paramount. Crow says incentives and government initiatives are key to this success, particularly in underserved populations. Medicaid and Medicare are leading the charge, incentivizing providers and employers to focus on areas with health inequities and shifting to qualifying success based on outcomes. The collaboration between public and private sectors is driving positive change and tailoring solutions to meet diverse needs.

Fortifying the Transition to High Value Primary Care

Collaborative efforts, innovative incentives, and technology-driven solutions are poised to reshape primary care, transforming it into a beacon of improved health for every American. Here are a few specific suggestions designed to transition the U.S. away from transactional care and toward high value primary care: 

  • Support for Direct Primary Care: Direct Primary Care (DPC) models have shown promise in delivering patient-centered care. With clear and consistent state-level guidelines favorable to Direct Primary Care, DPC models could operate more freely and expand patient access to affordable primary care services. Tax incentives for individuals and businesses that participate in DPC arrangements could make continuous primary care services more affordable for more Americans. A reformed tax code could allow individuals to deduct primary care expenses, not only through Health Savings Accounts (HSAs) but also as a standard tax deduction, which would also make care more accessible for a broader range of individuals. 

  • Expand Value-Based Payment Models: Continue and expand initiatives that encourage the transition from fee-for-service to value-based payment models. These models align incentives with quality outcomes rather than volume of services, fostering a more patient-centered approach.

  • Increase Telehealth Accessibility: Continue policies that promote telehealth accessibility, ensuring that patients can receive care remotely when needed. This is especially important for underserved and rural populations.

  • Integrate Behavioral Health Services: Encourage the integration of behavioral health services within primary care settings. Mental health is a crucial aspect of overall well-being, and integrating these services can lead to more holistic patient care.

  • Invest in the Workforce: Support initiatives to expand and diversify the primary care workforce. By investing in training and education programs, it is possible to address shortages in primary care providers, especially in underserved areas.

  • Incentivise Care Coordination: Improve incentives for primary care providers to actively engage in care coordination, especially for patients with complex medical needs. Effective coordination can lead to better health outcomes and cost savings.

Charting the Path Ahead

Better healthcare outcomes hinge on reimagining primary care. The transition from transactional care to value-driven, relationship-based, proactive models is a pivotal step. The journey is ongoing, but by aligning policies with these goals, it’s possible to achieve a more affordable and accessible healthcare system that prioritizes prevention, wellness, and better patient outcomes. 

Read more about this important conversation from MedCity News’ perspective: Why 2 CEOs Are Clamoring For New Primary Care Payment Models.