Healthcare Priorities for Employers Are Changing Due to COVID Pandemic
How direct primary care is effectively addressing current challenges
Employers were already rethinking their approaches to health benefits programs in light of skyrocketing costs when COVID-19 hit. The resulting pandemic, which has spotlighted the many flaws of our country's broken healthcare system, created a sense of urgency for employers to re-examine what they were offering to employees in the way of healthcare coverage and how they were providing it. For employers, COVID-19 proved that answers weren’t found in traditional insurance solutions; answers were found in better health care models.
The "2021 Large Employers' Health Care Strategy and Plan Design Survey”, sponsored by the nonprofit Business Group on Health and conducted in the midst of the pandemic between May and June of this year, succinctly captured how employers have re-prioritized their healthcare needs. Among other things, the survey highlighted the top seven services and initiatives that large employer’s value most, as well as areas of focus for 2021 and beyond. It demonstrated how employers have reprioritized access to services – and an emphasis on quality care, while diminishing the cost-shifting and other unsustainable strategies.
While these prioritized strategies are effective independently, they can be seamlessly delivered in an alternative delivery model which is proliferating with progressive employers across the country. It delivers a technology-enabled experience, 24/7 access, comprehensive care including mental health, guided referrals and total cost of care savings that far exceeds even the most draconian high deductible strategy. Paladina Health's advanced primary care (APC) model has proven before and during the pandemic that it effectively addresses each these new priorities, successfully improving overall health outcomes and lowering costs.
Here's a quick look at what employers said matters most to them and how we're responding:
1. Telehealth. Consumers in record numbers tried telehealth for the first time because of the virus and discovered that they like it. While traditional telehealth providers have focused on urgent care needs, telehealth in Paladina’s advanced primary care model can effectively deliver longitudinal care. Our approach to virtual healthcare is unique because we maintain our strong 1:1 provider-patient relationships--even virtually--ensuring that patients are consistently seen by the same providers who have access to their backgrounds and predictive analytics. Technology-enabled care will continue to be an important part of Paladina Health's offering in a post-COVID world, with over 40% of our visits being delivered virtually and the most vulnerable populations being supported through wearables or other home monitoring technology.
2. Mental health access. The virus has created unprecedented mental health concerns from anxiety to depression to substance abuse. That's why we embed mental health screenings into every single patient experience as a foundational to ensure the most comprehensive approach to overall health, not just physical health. Our recent acquisition of Healthstat further improves our mental health offering with the addition of Ment4Me, a multi-faceted, technology-enabled program developed in conjunction with Johns Hopkins Hospital to educate, diagnose, treat and help patients manage both their mental and physical health for the long term.
3. High-cost claims control. Our track record in this area is undisputed, effectively reducing the cost of care by 79% for individuals in the highest risk population (using Johns Hopkins ACG risk stratification) when compared to costs incurred through traditional insurance plans. These high-risk employees represent a substantial portion of total healthcare costs, typically costing employers more than $50,000 per year per individual. Such reductions are the result of our preventive care approach which results in 25% fewer hospital admissions, on average, among other improvements. We project potential high-cost clinical scenarios using claim and other clinical data, predictive analytics and can typically engage that patient before their clinical situation becomes severe and costly.
4. Expansion of Centers of Excellence (COEs) to include additional conditions. One of the benefits of Paladina’s employer-focused model is that our providers only treat patients covered by one or two employers. As a result, they are trained on the benefit designs of the employers they support. This enables awareness of network design, COEs, etc., enables Our health centers and provider teams actively leverage these design features in our referrals, accelerating adoption and awareness - optimizing our client’s investments in these strategies. If there isn’t a formal COE program, we work with employers to help identify healthcare systems that are known to offer the best services within specific specialization areas. Using these proven COEs results in higher care quality and lower costs.
5. Implementation of high-performance networks. Employers incur significant costs as a result of referrals to specialists for employee care. Performance networks have been an opportunity to focus steering care to high-quality, more efficient providers. Because of the reasons mentioned above, Paladina can increase adoption of high-performance networks, reference-based pricing strategies or other strategies. But what if those referrals weren’t necessary? By leveraging peer-to-peer consultations with expert specialists, our providers have demonstrated that roughly 56% of such referrals are not necessary. Paladina Health providers e-consult with specialists before making a referral to ensure that intervention by a specialist (who is more expensive than a primary care doctor) is necessary. The resulting cost savings are substantial and do not compromise employee health. Overall specialist costs are reduced by over 50%, and can be augmented by referrals into a high-performance network.
6.Moving away from full-replacement, high-deductible health plans. Once promoted as the ideal solution for employees to lower their monthly healthcare premiums, high-deductible health plans have proven ineffective because they lead to the avoidance of necessary care which, ultimately, leads to catastrophic health outcomes and higher treatment costs. That’s less than ideal. ur APC model covers 80-90% of all services needed at no additional cost to employees, thus motivating employees to be more proactive with their health and eliminating financial barriers to care. In fact, over 85% of employees engage with our model the first year. As a result, our employer clients are seeing a 25% (or more) total cost of care savings and a compounding impact over time. More importantly from a health perspective, employees are getting the care they need rather than having to guess how to best navigate complicated healthcare systems.
7. Implementation of advanced primary care solutions in select markets. With our recent acquisition of Healthstat, we now have more than 350 clinics across the country. That is far from the full extent of our reach, however, as telehealth and cloud-based technologies allow us to effectively treat patients in areas where we don't have a physical presence. We work with local providers on implementing best-in-class care strategies, giving them access to our predictive analytics so that they can provide optimal care at lowest costs. Paladina Health provides a national, clinically integrated advanced primary care system.
Beyond these 7 considerations, we have seen a shift in employer’s strategy timelines. By partnering with a provider organization caring for their entire workforce, employers can get daily or weekly updates on their workforce’s health. Having access to such analytics in real time has been a game changer, allowing employers to modify their plans and approaches in the moment, rather than waiting for year-end reports to identify problems that need to be addressed. The ability of employers to make quick decisions will be even more important in the next two years with the projected surge in claims expected as a result of the COVID pandemic and delayed care.
Employers must have the tools, resources and delivery options to help their employees manage new, evolving health challenges. At the same time, they require the data to proactively manage high-risk populations to improve employee health and lower costs. Only a national provider deeply rooted in preventative primary care and possessing the most advanced technology can give employers a fighting chance against the massive challenges that will face them in a post-COVID world.