Americans are changing how they use health care. Now is the time for primary care to rebuild relationships with them.
The health care industry has experienced many shifts, especially in the last few years. Due to the impacts of the COVID-19 pandemic and other extenuating factors, many Americans have altered their utilization of health care, particularly when it comes to engagement with primary care physicians.
According to the Primary Care Collaborative, the number of people in the United States with a usual source of care has dropped 10% in the last 18 years, with only about three-quarters of people saying they have a regular primary care provider or at least a facility where they know they can access care. Much of the reason behind Americans’ disengagement with primary care in recent years can be attributed to COVID-19. During the pandemic, many people opted not to go to the doctor unless they had to and didn’t prioritize taking care of themselves other than avoiding COVID-19. Further exacerbating the issue, because many primary care physicians found themselves without direct access to administer COVID-19 vaccines, patients were often forced to seek these vaccines elsewhere. Consequently, it has been difficult for Americans to get back into the mindset of seeking regular care with primary care providers.
While some patients may have reduced their visits to the doctor due to COVID-19, for others, the financial landscape may create a deterrent. One in sixadults report cutting back on health care in the past year due to cost of care,according to the West Health-Gallup 2022 Healthcare in America Report. Increasingly, there has been a move to more episodic care with many people looking into alternative solutions, like seeking medical attention through visits to the emergency department or urgent care.
To help reverse this decline and optimize patient experiences with primary care providers, payers must focus on wellness. By keeping patients engaged with a primary care provider, payers can ensure they’re supporting them in a healthy, cost-effective setting, and helping people stay well and functioning at their highest level.
The effective and regular utilization of primary care is mutually beneficial for patients and payers alike.
For patients, having an ongoing primary care provider offers consistency, continuity, and convenience. By developing a relationship with a primary care provider, patients can cultivate familiarity and trust, both for individual care and within the wider health care system. In turn, this can help with deploying holistic, personalized engagement strategies to help meet individuals where they are to foster engagement and even improve chances of early disease detection.
Having a steady primary care provider also offers convenience for patients with greater ease for booking appointments and creating efficiencies with quality care, versus waiting in an emergency department or urgent care to see a doctor with whom they are less familiar and is not acquainted with the person’s medical history.
The trust and comfort built between a patient and their primary care provider can have a positive impact on health outcomes too, since that patient is more likely to confide in a familiar, trusted provider and even look to them for comfort should a serious illness arise.
For payers, the main focus for keeping patients engaged in a healthy provider setting centers on improving health outcomes. Ultimately, payers want to prevent chronic conditions by proactively focusing on wellness. Taking these preventive measures with a focus on wellness allows payers to reduce health care costs, increase patient and provider satisfaction, and results in better population health outcomes.
To help drive better health outcomes for patients and encourage regular engagement with primary care providers, many payers have become more sensitive to cost-sharing incentives to foster access to primary care. The financial incentive through cost-sharing can help drive care to the right setting by making primary care more affordable than cost-sharing related to urgent or emergency care.
Additionally, many employers increasingly enter into self-insured services, creating an opportunity for payers to work with these employers collaboratively to drive campaigns encouraging patients to access primary care. At times, employers will have their own incentives, but payers can play a part in engagement campaigns with premium offers for primary care providers to more effectively nurture access to primary care for employees.
Providing highly accessible virtual primary care options serves as another method for enhanced patient engagement. Demand for virtual care interactions with primary care via telehealth significantly increased during the pandemic and remains a preferred option for many providers and patients alike due to the convenience and choice. According to the Journal of Primary Care & Community Health, the proportion of primary care physicians using telehealth jumped from 5.3% before the pandemic to 46.2% during the pandemic. More importantly, more than 70% of physicians intend to use telehealth at least occasionally after the pandemic, compared to just 18.7% before. Telehealth visits can help ensure that patients don’t lose the continuity of care and care coordination that primary care provides.
As another extension of virtual care, remote monitoring enables patients to stay in touch with primary care relative to certain medical information and may serve as another method for connection and engagement. Further, having strong patient portals provides another channel for direct connections to primary care, enabling easy appointment scheduling, monitoring of lab values, access to educational materials from the provider, and other vital services.
Taking a multipronged approach to driving patient engagement with primary care providers offers people a greater array of options to establish and maintain these crucial primary care relationships and improve health outcomes.
To address appropriate utilization of services and drive toward value-based care, payers have begun to explore new ways of leveraging data analytics. As part of that, provider profiling has become a significant focus for payers and accountable care organizations (ACOs). Analytics are utilized to identify high-quality providers delivering cost-efficient care with positive patient care outcomes, reduced readmission rates, length of stays, pharmacy spending, and more. This practice of provider profiling allows payers to sculpt provider networks and steer patients to preferred providers based on key indicators within provider network tools.
Organizations also leverage analytics and predictive modeling tools to identify patients with rising risk, or to better understand where to focus resources to keep patient populations well and prevent further risk. For those falling into the high-cost population, payers may utilize medical management programs to assist with coordination of care. These programs help provide high-quality and cost-effective care to those who have the most significant needs.
Engaging patients with quality, cost-efficient primary care providers is essential for payers and patients from a population health standpoint. By serving the best interest of patients’ health, truly understanding who they are, and encouraging healthy lifestyles, primary care providers enable patients to function at their highest capacity.
Primary care providers serve as the glue to continuity of care.Utilizing these strategies in conjunction with the latest technology and data analytic tools can help payers keep patients actively engaged with primary care through a focus on wellness, ultimately helping to better serve the needs of patients and the overall cost of health care services.
Jill Warren is senior vice president of clinical operations at Sagility, a health care business process management firm with locations in the United States, India, Philippines, Jamaica, and Colombia.