Health insurers today are facing an existential challenge.
Partnerships and mergers between systems, insurers, and providers are gobbling up market share. The entry of large, powerful and traditionally non-healthcare organizations is threatening the payer business model. The scrutiny being paid healthcare in elections, including the overwhelming negative narrative in the media about a bloated system, is turning consumers against them. The market is changing rapidly, and payers know they must evolve or fall.
The first question health insurers are asking is what they can control. The quickest answer is the supply chain, which is why so many payers are getting into the business of providing care, not just paying for it. They all know the best, most effective care to provide is at the front end of the system: primary care.
When implemented correctly, an integrated primary care offering is the most effective addition to their business model. It adds value to their plans and establishes a competitive advantage to outside threats.
The case for primary care investment
In a traditional healthcare environment, providers are forced to focus on controlling costs rather than increasing the quality of care or improving population health outcomes. There is no incentive for members to use their plan with any frequency and, as a result, they often delay care until an issue is acute. This increases cost for both the payer and the member.
When payers control the design and delivery of primary care, they can offer greater access to all members from individuals, groups and those of Medicare Advantage, a best-in-class experience and true population health.
Having a dedicated provider and care team in one convenient place makes it easier for members to receive care, which, in turn, means they’re more likely to come in for regular visits rather than make expensive trips to urgent care clinics or the emergency room.