Advanced Primary Care: the better way to deliver healthcare and the focal point of Aligned Marketplace

Aligned Marketplace Founding Team
October 27, 2023
There is a better way to deliver healthcare, it’s just not evenly distributed. Advanced Primary Care, across modalities, populations and geographies, has delivered better outcomes for patients while driving down the total cost of care. There are a range of aspects to Advanced Primary Care, but they all share a common theme: by offering a broader range of services under a value-based care1 payment model, these groups improve patient access, experience and outcomes. Importantly, patients favor a healthcare model that compensates providers for improving patients’ health and coordinating the care they receive across the system. Even though these patients may prefer terms such as “quality-focused care” or “patient-first care” to the better-known “value-based care”2, the specific attributes these patients prefer is one that Advanced Primary Care is purpose-built to achieve.

Most employer-purchased primary care options today fall short

Advanced primary care (or “APC”) is notably distinct from two other types of healthcare providers: direct primary care (DPC), and telehealth urgent care solutions. We’ll discuss the differences in greater detail in future posts, but one key difference is that Advanced Primary Care is built to blend the hybrid modalities and holistic, comprehensive approach used by these models and implement them through a value-based payment contract that enables better outcomes at scale. This commitment to success in a value-based model – better access, experience and outcomes at a lower total cost of care – fundamentally differentiates Advanced Primary Care from these other models.

Different approaches, but the same goal

There are a range of approaches to APC, including employer-focused brick-and-mortar clinics such as Marathon or Everside, value-based care (or “VBC”) enablers such as Aledade or Wellvana, retail-like clinics such as Carbon Health or One Medical, virtual-only or virtual-first groups, such as Galileo and Nice Healthcare, and Medicare or Medicaid-focused groups, such as Oak Street Health and Cityblock. This diversity of approaches is good for patients and purchasers, who seek a healthcare experience that meets their unique needs.  

APC providers, without the constraints of a fee-for-service payment model, can leverage modalities, workflows and care teams that emphasize holistic patient outcomes over billing codes. These groups have also begun to expand their virtual offerings to account for a more distributed workforce, and are starting to expand their offering to include mental health and physical therapy service. VBC enablers that partner with independent physicians with long-standing community ties can deliver advanced primary care at scale faster and more capital-efficiently. Even in a more challenging financial market, the enablers continue raise capital and grow their offering for healthcare purchasers3. Employer-focused groups were purpose-built to provide the white-glove service that employees expect from an on-site or near-site clinic. Each APC has found their own approach to delivering better care, and together APC has massive potential to positively impact our healthcare system.

Increasing commercial healthcare costs must be addressed

The trajectory of commercial healthcare costs is untenable. The average employer-sponsored health insurance premium in 2023 is $8,435 for individuals and $23,968 for families, both 7% increases from 20224. While these costs are mostly borne by employers, employees and their families are responsible for a significant amount of this spend as well, $1,401 and $6,575, respectively. These increases outpace wage growth and inflation, putting additional financial strain on families while increasing employer costs.  

Fortunately, independent primary care, including Advanced Primary Care can serve as a key driver to address these cost increases. Association with a primary care provider led to a $3,976 decrease in total costs after a single visit in a Veterans Health Administration study5, and commercially-insured patients of health system-employed PCPs were over 6% more costly than those seeing independent PCPs. Expanding access to independent, advanced primary care providers can directly address the rising healthcare costs in the commercial population.

We can also look to Medicare, where cost growth has been surprisingly flat since the passage of the Affordable Care Act in 2010.6 The ACA came with a significant focus on value-based payments, including the Medicare Shared Savings Program and models operated by the Centers for Medicare and Medicaid Innovation, as well as programs targeting hospitals readmissions rates to improve outcomes and reduce waste in the healthcare system7. Applying that same focus to the commercial population is key to bending the cost curve while improving patient access, experience and outcomes.  

Advanced primary care works across payers

The track record for Advanced Primary Care driving positive quality and cost outcomes has the longest track record in the Medicare population, but has been shown to succeed across payers. In Medicare, the Medicare Shared Savings Program, the successor to the Pioneer ACO Model, saved more than $1.8 billion in 20228 for beneficiaries in traditional Medicare. Medicare Advantage continues to grow rapidly, now up to 51%9 of Medicare beneficiaries, and APCs targeting this population, such as Agilon have thrived as well in capitation arrangements. The launch of the ACO REACH program will now give those MA-focused APCs a similar path to capitation for traditional Medicare beneficiaries. Medicaid beneficiaries have also seen positive outcomes from APCs10 – the expanded offerings for that population are often more focused on behavioral health and social services that improve social determinants of health.  

While value-based care payment models have only more recently become widespread in the commercial population, we’re already seeing great impact at scale. Employer-focused groups have long incorporated performance guarantees based on access to care, patient experience and quality of care outcomes. More recently, these groups11, as well as VBC enablers12 that see commercial patients and virtual-only providers13 have reported exciting outcomes in total cost of care models.  

Advanced primary care can combat provider burnout

The healthcare workforce has experienced record levels of reported burnout14, driven in large part by the experience of primary care physicians during the COVID-19 pandemic, which exacerbated existing challenges and continued to push independent physicians to sell their practices15. This shift takes place in the context of an expected physician shortage16 and hesitancy of graduating residents to pursue careers in primary care17. These statistics should cause real concern – decreased primary care coverage is associated with an increase in mortality18.

It’s imperative to create opportunities for PCPs to thrive by implementing and growing models that offer greater patient and provider support. Advanced primary care, by working within value-based care models, can invest in greater provider support and build teams that can manage the broad range of patient needs, including care management and navigation.  

Advanced primary care is the answer

To address these challenges – rising costs, patient populations with diverse needs, and provider burnout – the healthcare system requires a new approach that can meet the needs of all stakeholders. Advanced primary care can continue to serve self-insured employers and the 100 million individuals whose healthcare they sponsor. Now, with the growing geographic coverage of provider groups experienced in implementing value-based care models, these APCs can serve employers in a sustainable economic model that drives value for employers, providers and members.  

  1. The Commonwealth Fund. (2023). Value-Based Care: What It Is, and Why It’s Needed. https://www.commonwealthfund.org/publications/explainer/2023/feb/value-based-care-what-it-is-why-its-needed
  1. United States of Care. (2023). Our Messaging Findings on Patient-First Care (a.k.a. Value-Based Care). https://unitedstatesofcare.org/the-latest/value-based-care-patient-first-care/  
  1. Wall Street Journal. (2023). These Startups Are a Bright Spot in Sluggish Healthtech Financing Market. https://www.wsj.com/articles/these-startups-are-a-bright-spot-in-sluggish-healthtech-financing-market-5521a80f  
  1. Kaiser Family Foundation (2023). 2023 Employer Health Benefits Survey. https://www.kff.org/health-costs/report/2023-employer-health-benefits-survey/  
  1. Journal of Primary Care & Community Health. (2022). The Effect of Primary Care Visits on Total Patient Care Cost: Evidence  From the Veterans Health  Administration. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9793026/  
  1. The New York Times. (2023). A Huge Threat to the U.S. Budget Has Receded. And No One Is Sure Why. https://www.nytimes.com/interactive/2023/09/05/upshot/medicare-budget-threat-receded.html  
  1. The New York Times. (2023). Does Obamacare Explain Medicare’s Spending Slowdown? https://www.nytimes.com/2023/09/09/upshot/obamacare-medicare-spending-slowdown.html?smid=url-share  
  1. CMS.gov Newsroom. (2023). Medicare Shared Savings Program Saves Medicare More Than $1.8 Billion in 2022 and Continues to Deliver High-quality Care. https://www.cms.gov/newsroom/press-releases/medicare-shared-savings-program-saves-medicare-more-18-billion-2022-and-continues-deliver-high  
  1. Kaiser Family Foundation. (2023). Medicare Advantage in 2023: Enrollment Update and Key Trends. https://www.kff.org/medicare/issue-brief/medicare-advantage-in-2023-enrollment-update-and-key-trends/  
  1. JAMA Health Forum. (2023). Medicaid Value-Based Payments and Health Care Use for Patients With Mental Illness. https://jamanetwork.com/journals/jama-health-forum/fullarticle/2809746  
  1. Jama Network Open. (2020). Utilization and Cost of an Employer-Sponsored Comprehensive Primary Care Delivery Model. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2765201  
  1. Aledade. (2023). Value-Based Primary Care Network from Florida Blue and Aledade Shows Significant Health Care Quality Improvements. https://resources.aledade.com/aledade-news/value-based-primary-care-network-from-florida-blue-and-aledade-shows-significant-health-care-quality-improvements/  
  1. Included Health. (2023). Included Health Unveils New Virtual Primary Care Results Alongside Walmart. https://includedhealth.com/announcement/included-health-unveils-new-virtual-primary-care-results-alongside-walmart/  
  1. The Commonwealth Fund. (2023. Responding to Burnout and Moral Injury Among Clinicians. https://www.commonwealthfund.org/publications/2023/aug/responding-burnout-and-moral-injury-among-clinicians  
  1. Primary Care Collaborative. (2022). Report: Supermajority of U.S. physicians are employed by health systems or corporate entities. https://thepcc.org/2022/04/25/report-supermajority-us-physicians-are-employed-health-systems-or-corporate-entities  
  1. American Medical Association. (2022). Doctor shortages are here—and they’ll get worse if we don’t act fast https://www.ama-assn.org/practice-management/sustainability/doctor-shortages-are-here-and-they-ll-get-worse-if-we-don-t-act  
  1. JAMA Internal Medicine. (2023). Career Plans of Internal Medicine Residents From 2019 to 2021. https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2808652  
  1. JAMA Internal Medicine. (2019). Association of Primary Care Physician Supply With Population Mortality in the United States, 2005-2015. https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2724393  

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