Categories
Employer

Value-Based Care: What Is It and Why Is It Better?

According to the American Medical Association, health spending accounted for 18.3% of the United States GDP in 2021. This equates to $4.3 trillion or 12, 914 per capita, the highest among developed nations, as reported in a study by John Hopkins University. As an employer, the need to rein in spending while ensuring your employees are healthy and productive is also a growing problem. The solution to this problem lies in Value-Based Care, a payer model we have utilized since our inception in 1982.

In the traditional fee-for-service model, healthcare providers are paid a set amount for each medical service provided. Value-Based Care (VBC) on the other hand, pays providers on the health outcomes of their patients and the quality of services rendered. In addition to negotiated payments, providers can earn incentives for providing high-quality, efficient care. Quality care can be provided under both models, but it’s the difference in how providers are paid, paired with the way patient care is managed, that creates the environment for monetary savings to be realized.

To do this, the Live360 Health Plan value-based care model takes a much more proactive approach. Many think of the healthcare system as one that takes care of people after they’re already sick. But why would you only play defense? At Live360, we prefer to improve the health of our members and therefor reduce the cost of their healthcare overtime by also having a strong offensive game. With a team-oriented and data-driven approach working across the care continuum, we can work to engage with members and providers to help our clients better manage their total health and costs. 

Our team of triage nurses, health coaches, case managers, chronic disease managers, pharmacists, physician-led board of directors, etc. all work together to help identify and preventively address member healthcare needs. These wellness efforts and care coordination strategies help better manage chronic conditions and improve overall population health. For example, a member with a history of diabetes, hypertension, and chronic obstructive pulmonary disease (COPD), and not regularly being seen by a provider, became hospitalized with pneumonia and was discharged with supplemental oxygen. In addition, he was gaining weight and had elevated blood sugar. Through enrollment in our disease management program, which is free for our members, he has made significant lifestyle changes, lost weight, improved blood sugars, and has resumed regular visits with his primary care provider. Overall, the member is motivated to become healthier, and he feels energetic and more in control. Our case management nurse checks in with him frequently to ensure he is staying the course. 

We want to be clear that savings do not come from the denial of services. On the contrary, we average about four member appeals per quarter. The VBC model helps our clients save money through:

  • Established care standards based on best practices.
  • Proactively addressing risk factors through data and early detection.
  • Direct communication and engagement with members.
  • One-on-one management of complex cases and chronic conditions by an assigned registered nurse to better avoid late-stage interventions and hospitalizations.
  • Better pharmaceutical utilization and adherence, including encouraging the use of generics and biosimilars when appropriate with providers.
  • Enhanced care coordination and data sharing to streamline administrative processes for prior authorizations and claim payment and reduce wasted spending on things like duplicative tests

By working together to analyze data, identify gaps in care, and communicate one-on-one with patients who are currently struggling to manage a treatment plan or condition, or those who are at risk for this, Live360 can achieve considerably better outcomes for a lower cost. When evaluating plans as an employer, we challenge you to ask the other insurance carriers about their value-based care approach. Live360 utilizes this model for every single one of our commercial groups (and every Medicare member), no matter the size of your group or the type of plan you select.

Interested in learning how our value-based care model can both save you money and improve the health of your employees? Contact us today at 563-556-8070, toll free at 1-800-747-8900, or click here to request a free quote.

Sources:

American Medical Association

John Hopkins University

Categories
Member

Seven Reasons Why You Need a Primary Care Provider

The term “primary care provider” is commonly used in healthcare. But what exactly is it, and why is it so important that you have one? Primary care providers are doctors, nurse practitioners, or physician assistants that serve as your main medical contact.  In fact, a primary care provider — who may come from family medicine or internal medicine, depending on your needs — specializes in diagnosing, treating, and preventing a wide variety of conditions.

Without a primary care provider, you may either ignore medical problems or visit the emergency room for an illness that doesn’t really require emergency care. Neither is an ideal choice! Having a primary care provider helps you focus more on staying healthy, instead of only seeking help when you are sick or hurt. Your practitioner becomes your health coach, showing you better ways to stay healthy and live longer. Here are seven main reasons to find a primary care provider or PCP:

1. Provide Acute Care

Primary care can diagnose and treat up to 85% of issues that present to them without a referral.  Building a trusting relationship is important in acute and ongoing medical care.

2.Better Preventive Care

One of the main responsibilities of a PCP is preventive care. A PCP can make recommendations that will help you protect your health. The practitioner can get to know you, your history, and family history. This enables them to make the best recommendations for needed screenings and to identify and treat many minor problems before they become major ones. Their office will also keep an accurate record of your vaccinations, ensuring you stay up to date on this crucial preventive tactic.

3. Continuity of Care

Having a competent PCP offers a continuity of care that long-term health maintenance requires. The practitioner can treat the “whole person,” taking into account your history and existing conditions. Timely diagnosis increases the chances that you will be able to lead a longer and more productive life.

4. A Central Point of Contact

A PCP coordinates information between other healthcare providers. All healthcare that is done by specialty providers gets funneled through the PCP’s office to assist when you have questions, or are getting multiple reports. PCP’s can also make sure there is no duplication of care and testing, and that nothing is being left out.

5. A Key Resource

A PCP should be the first person in the healthcare system that you contact when you have a question or a problem. The practitioner can provide answers and recommend an appropriate specialist if needed. They can also help you find other resources, such as support groups and classes.

6. Fewer Trips to the ER

Research has shown that regular visits to a PCP initiate more proactive healthcare measures and significantly decrease the instances of emergency room visits while also improving your quality of life.  A PCP can offer options that help prevent you from making unnecessary trips to the emergency room. For example, your doctor may be able to answer questions about a condition, call in a prescription, or suggest a course of action that can be taken at home.

7. Coordinated Care = Better Quality & Lower Costs

As the medical, specialty, and mental health fields continue to change, coordination between your PCP and other practitioners has become increasingly important. Without effective communication between different healthcare providers, you may experience delays in care, misdiagnosis, incorrect or unnecessary treatment, and potentially higher healthcare costs. Part of the task of a PCP is to help you navigate through the healthcare system.

When you put the focus of your health on primary care and prevention, a PCP can better manage chronic conditions and keep you healthy and out of the emergency room. This is great for your health and your pocketbook.

Be sure to choose a primary care provider that is in your network.

If you’re in search of a PCP, make sure they are part of your health plan’s network. Choosing an out-of-network provider may leave you responsible for the full cost of the care they provide. You can look up providers in your network through our secure, online health portal, My eLink. This convenient resource offers 24/7 access to your health plan information. You can also review your coverage, check on claims and authorizations, print and request I.D. cards and more. Haven’t created a My eLink account yet? No problem. Signing up is easy. All you need is your Live360 ID card.