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Accountable primary care model can boost employee health, reduce costs


ORLANDO, Fla. — By implementing an employee health program centered on accountable primary care, self-funded employers can reduce spending on medical costs while improving outcomes in employee health care.

Accountable primary care models, used often in conjunction with high-deductible health plans, place responsibility on preferred primary care physicians to deliver, coordinate and monitor effective care to covered workers in collaboration with specialists and hospitals, said Jed Constantz, chief operating officer of Brentwood, Tennessee-based Employer Advantage Health Care Solutions L.L.C., which helps large employers put these programs in place.

Employers encourage employees to use the preferred primary care practice for all services by offering access free of charge, while employees who choose not to participate will have a deductible and copay, Mr. Constantz said during a session Monday at the 2015 Employer Healthcare and Benefits Congress in Orlando, Florida.

Primary care providers are responsible for not only the care they provide, but also the care provided by the specialists to whom they refer patients, he said.

By giving primary care doctors the ability to administer most health care services and encouraging employees to use them instead of insurance, fewer conditions go through the health claims process, and medical spending is reduced in time, Mr. Constantz said.

The model allows the primary care practice “to provide a broad range of services and be paid adequately for those services, understanding that the more comprehensive the care is at the primary care level, the more able that practice is to cannibalize downstream spending,” Mr. Constantz said.

To ensure primary care physicians are reducing spending and improving outcomes, “we audit,” he said. “There is a need for trust upfront, but you have to be able to verify” the primary care providers are producing results and covered individuals are committed to the program.

Lynchburg, Virginia-based Delta Star Inc., a manufacturer of transformers and a client of Mr. Constantz, implemented the accountable primary care program in January. The company was seeing an 11% year over year increase in medical spending, but spending is now flat after nine months, Mr. Constantz said.

Union Hospital, based in Dover, Ohio, will launch an accountable primary care program in January after its “robust wellness program in place since 2009” failed to reduce health costs, Tina Myers, the hospital's director of human resources, said during the session.

“What we're hoping to do is to break down the barriers of primary care” by offering free doctors visits for wellness, preventative care and chronic disease management, she said. Currently 60% of the 1,950 covered workers don't have a primary care doctor.

“We are trying to make it free and easy for them to access the care that they need,” said Ms. Myers.