Healthcare Revenue Cycle Management, ICD-10, Claims Reimbursement, Medicare, Medicaid

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How Broader Primary Care Teams Can Decrease Healthcare Costs

PwC researchers contend that broader primary care teams designed to meet the needs of certain patient populations can save millions in healthcare costs.

By Jacqueline LaPointe

- Developing broader primary care teams that interact with specific patient populations can save healthcare costs and realize a return on investment, according to a recent PricewaterhouseCoopers (PwC) analysis. For example, a primary care team designed to meet the needs of complex chronic patients could save healthcare organizations $1.2 million for every 10,000 patients served.

Adding some non-physician providers to primary care teams can decrease healthcare costs, PwC contends

PwC researchers stated that healthcare organizations can reduce healthcare costs by enlarging their primary care teams, focusing less on primary care physicians, and responding to consumer desires and needs.

“Primary care has long been treated as healthcare’s underdog, a reality that is changing as the industry slowly evolves into a value-based ecosystem,” the report stated. “Primary care teams, comprised of diverse professionals and caregivers, can offer solutions and strategies that address the whole person. These teams can address consumer needs and preferences at affordable costs while reining in overall health spending.”

The analysis of 1,500 providers as well as 1,750 healthcare consumers revealed that primary care teams are not optimizing care or meeting consumer demands, leading to less return on investment. In a fee-for-service world, healthcare employment was physician-centered and providers were hesitant to share workloads with non-physicians, who were generally not reimbursed for their services.

However, most value-based care models place primary care providers at the center of patient care and require them to coordinate services. But the analysis showed that providers spend more than one-third of their time on administrative work, behavioral health discussions with patients, and care access management.

READ MORE: Do NP, PA Ordering Habits Lead to Higher Healthcare Costs?

Providers in the study reported that they see value in broadening the primary care team to include non-physician providers to optimize the workflow. Based on survey results, PwC researchers advised healthcare organizations to add community health workers, community paramedics, dietitians, mental health providers, pharmacists, healthcare stewards (e.g. care coordinators and navigators), and family caregivers to primary care teams. Including these non-physician providers could significantly reduce healthcare costs.

PwC HRI Clinician Dream Team Graph

For example, community health workers reduced healthcare costs by $137 per patient and decreased inpatient encounters at Baylor Scott & White, a Texas-based healthcare system. The community health workers focused on improving diabetes care and patient outcomes in community clinics.

In another example, researchers reported that developing a community paramedics program cut healthcare costs by $10.8 million at Medstar Mobile Healthcare in Texas. Since 2009, community paramedics have prevented 3,321 emergency department visits, 553 admissions, and 4,593 ambulance transports by treating non-emergency cases at the patient homes.

Healthcare consumers also supported adding non-physician providers to their primary care team, the analysis found. Approximately 75 percent of consumer respondents stated that they would be comfortable seeing a nurse practitioner or physician assistant in lieu of a physician for certain services, while half said they would see a pharmacist.

In addition, consumers expressed satisfaction with the care they received from non-physician providers. Those who saw a broader range of healthcare professionals reported that they were at least moderately effective at helping them achieve their healthcare goals.

READ MORE: Healthcare Costs Rise With Regional Post-Acute Care Variations

Researchers stated that healthcare organizations can be more cost-effective by responding to consumer demands for more non-physician providers, but the broader primary care teams should focus on seven consumer markets, including the frail elderly, complex chronic, chronic disease, mental health, healthy family, healthy adult enthusiast, and health adult skeptic groups.

“Different consumer markets will require different team rosters based on their whole health needs,” the report stated. “Consumers’ interactions, or touchpoints, with the teams will be distributed more broadly for sicker populations and less broadly for healthier populations.”

PwC HRI Consumer Primary Care Touchpoint Chart

For instance, researchers noted that frail elderly consumers will need to interact more with geriatricians, care navigators, and community paramedics to provide home-based medical care and prevent unnecessary admissions. On the hand, a healthy family consumer will need to see more nurse practitioners and physician assistants to address their needs.

Developing broader, but tailored primary care teams will require some investment, but should realize significant return on investment, the study added. A primary care team designed for complex chronic disease consumers, who are patients with chronic conditions that affect multiple body systems, can save $1.2 million by reducing emergency department visits and hospital admissions, but healthcare organizations are likely to incur offsetting incremental costs, such as network management, care team labor, and reinvestment expenses.

The primary care team labor will probably cost about half of the savings, the report added, but the expense will cover compensation for nutritionists, care managers, social workers, pharmacists, behavioral health specialists, and community health workers.

PwC HRI Primary Care Team for Chronic Complex Cost Breakdown

READ MORE: Post-Acute Care Network Key to Value-Based Purchasing Success

Primary care teams designed for specific consumers will also improve physician workflows, the report stated. Surveyed providers reported that they expect primary care physicians to play a more elevated role in the next decade with 64 percent saying that primary care physicians will spend more time triaging consumers to other caregivers.

With more of a consulting role, primary care doctors could offload administrative activities, address social determinants of care, and refer patients to other experts. Researchers projected that these physicians will have more time to develop care plans and manage complex medical issues.

In the new role, primary care physicians would also optimize their patient panels. Primary care teams that deal with healthier patients, such as healthy family, healthy adult enthusiast, and health adult skeptic populations, can see more patients, while providers in more complex consumer markets can see fewer patients, but spend more time with each individual.

To successfully implement the primary care team model, researchers advised providers to identify their consumer mix and understand model’s impact on healthcare revenue cycle, such as creating excess capacity in hospitals. Organizations should prepare for lower margins and revenue under the model by replacing lost volume through increasing market shares in relevant consumer markets.

Researchers also recommended that healthcare organizations understand market dynamics. In markets dominated by payers, providers may be better positioned to adopt the primary care teams because of existing network management infrastructure. However, organizations in provider-dominated markets should consider more risk-based models with payers.

Providers should also invest in data analytics to pinpoint populations and identify cost-saving opportunities as well as boost care coordination and virtual consumer interactions.

“[H]ealthcare providers should reconsider–and broaden–the makeup of their primary care teams and develop a deep understanding of the consumers they serve,” the report stated. “With these shifts, primary care can generate a return on investment and serve as a sound foundation for a value-based strategy.”

Image Credit: PricewaterhouseCoopers Health Research Institute

Dig Deeper:

Preparing the Healthcare Revenue Cycle for Value-Based Care

How to Get Started with a Population Health Management Program


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