Recently, one of our larger employ- er-members brought an issue to my attention that reminded me of the importance of proper primary care. This employer had a patient who required an ultrasound – which, if performed during an office visit, would be 100% covered by the plan. 

The specific patient is receiving care at an office that cannot provide ultrasound services. Under the Pricing Transparency regulations many hospitals, prior to procedures, send patients out-of-pocket cost estimates. In this case, the patient who is receiving care at a provider that cannot offer in-office ultrasound services was informed by the hospital that the procedure would be billed as an outpatient service and the patient was responsible to pay$730 out of pocket the day of the procedure. 

After many inquiries from the patient, the doctor informed them that an MRI could also provide sufficient im- aging and would cost the patient nothing under their benefit plan. Inversely, an MRI means the employer would instead pay 100% for the more expensive imaging service. 

Advanced Primary Care 

If that patient had access to a primary care program such as The Alliance’s Advanced Primary Care (APC), they could have been referred to an in- dependent Ambulatory Surgery Center (ASC) from the start – at a contracted rate of around $180. 

Good primary care is at the core of our health care system and serves as the cornerstone of healthy com- munities. In a perfect world, primary care would be used first and most frequently. The fragmented, impersonal, and sometimes inaccessible primary care options wrought by the pandemic have highlighted our need for pro- grams such as APC. 

Care Coordination 

Traditionally, patients are slotted into impersonal, 20-minute appointments and can be sent to a series of specialists who, due to the nature of their profession, are each focused on a specific diagnosis – there’s no “quarterback” combining diagnoses, com- paring notes, and coordinating care. APC utilizes team-based primary care, where the primary care doctor serves as the quarterback.  

Deeper relationships 

The APC program creates long-standing, continual relationships with patients. Those trusted relation- ships reach patients in ways that specialized care cannot. 

Physicians accumulate historical knowledge about patients — their work history, mental health history, and family life — which creates a better foundation to accurately diagnose health issues, recognize them earlier, and deploy the appropriate care mechanisms to help manage them. 

Holistic Health Care 

APC treats the whole person — mind and body — and can identify and treat a broad spectrum of health concerns. This is key to preventative care treating common chronic illnesses before they evolve into more serious (and costly) health issues. 

This type of care allows physicians to address acute symptoms and solve complex problems or health issues for which there is no cure or ability to diagnose. 

Smarter Specialty Care Referrals 

When a physician does have to refer a patient to a specialist, they can work with their team to make a high-value decision and help the patient navigate their in-network options. 

For example, an APC clinic is more likely to refer patients who need an MRI to a free-standing clinic instead of a hospital, which can save hundreds (some- times thousands) on a single test. 

Improved Patient Access 

When an employer utilizes an APC clinic, patients’ co-pays are eliminated (or negligible). Removing that financial barrier drastically increases the patient’s utilization of high-quality care and patient groups report higher levels of engagement and satisfaction. 

Additionally, physicians spend more time with their patients and of- fer more flexible appointments. Lastly, because the clinic is at or near an employer’s worksite, the patient does not have a lengthy commute for their appointment. 

Melina Kambitsi

Melina Kambitsi

Melina Kambitsi joined The Alliance in 2017 and leads the teams responsible for business development, client development and strategic marketing.

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