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Primary care providers can help streamline the health care experience for employees, which may lead to lower costs and better health outcomes.
Primary care providers (PCPs) are the coaches of the health care system, according to Dr. Gerald Hautman, chief medical officer of National Accounts for UnitedHealthcare Employer & Individual. “Primary care providers have the broadest scope of the field. They call the shots,” he says.
PCPs are often the first line of defense when a health issue arises, whether that’s for preventive care, chronic disease management or the early detection and treatment of disease. When more specialized care is required, PCPs typically make the referrals. Plus, research shows that one or more primary care visits a year increased the likelihood of vaccination by 127%, colonoscopy by 122% and mammography by 75%.1
These preventive measures may lead to earlier detection of chronic conditions or other health issues, which can be associated with better health outcomes, lower costs and higher productivity.2 In fact, the nearly 3 in 5 UnitedHealthcare members who engaged with a PCP had improved decision making, better treatment adherence and lower claims trends compared to non-engaged members.3
Here are 3 reasons why employers should care about whether their employees have a designated PCP:
- PCPs provide preventive care, which may be helpful in averting serious and/or costly conditions down the road
- PCPs typically know the health history and goals of their patients better than any other health care provider, best positioning them to address whole-person health needs
- Using tools integrated with their electronic medical record (EMR) systems, PCPs may be able to help their patients access lower-cost prescriptions, more appropriate sites of care sites of care or specialists when needed
Actions for employers to consider
- Choose a carrier with network options that include providers who are recognized for delivering quality, cost-efficient care and who can meet the diverse needs of their unique group population
- Check to see if the carrier supports providers with the tools and information they need to help their patients make more informed health care decisions and more easily navigate the health system
- Select a network configuration that requires or encourages members to see a PCP before seeking further care
- Promote preventive care visits and screenings through employee benefits communications
PCPs offer preventive care
In addition to being the first line of defense when a patient comes down with a cold or gets an injury, a PCP also plays an important role in providing preventive care services, such as well-child visits, annual checkups, screenings and immunizations.
Preventive care can help PCPs and their patients identify and diagnose health problems earlier, when treatment can typically be more effective.4
The reality is that providers are often viewed as the face of health care. So, employees’ impressions of their providers can greatly influence their overall health care experience. In fact, bedside manner, staff and the competence of providers were identified as the top 3 drivers of health care sentiment among patients.5
PCPs help deliver whole-person health care
It’s increasingly important that employers offer access to providers who can support employees across the care continuum.
For instance, when medical benefits are integrated with behavioral health, pharmacy or other benefits, providers have a clearer picture of an individual’s overall health and well-being. This may allow providers to connect members to the care they need more quickly and efficiently, resulting in a better and more coordinated care experience.
Employers may also want to consider how they’re meeting the needs of their multigenerational workforces. Depending on an employee’s generation or life stage, “primary” care may look different. For example, some women may view their OB/GYN as their PCP, and Millennials or members of the Generation Z population may not think they need a PCP at all — or may prefer on-demand or virtual care to an in-person visit.
PCPs may help contribute to reduced costs
PCPs may help employers and employees reduce their costs, too.
“When members have a primary care physician, they tend to have a lower cost of care,” Alberti says. “And our research demonstrates members who have a PCP have a better experience because they’re able to navigate a complex health care system a little more easily.”
Under most plans, annual preventive care visits with PCPs are covered at $0 out-of-pocket, which may help prevent or identify potential gaps in care or health issues before they become more serious. When employees have a good, trusting relationship with their PCP, there’s often more open communication, improved compliance with treatment plans and an overall better health care experience.6
PCPs can also act as an employee’s care coordinator when more complex issues arise, recommending quality, cost-effective prescriptions, specialists and sites of care. Point of Care Assist®, a UnitedHealthcare tool that equips providers with reliable, real-time health plan information, may help simplify the process of delivering more value to patients. Information such as quality gaps and social drivers of health needs can be used by providers before, during and after patient encounters with one user interface updated and at their fingertips 24/7.
PCPs in action
- During her annual PCP visit, Lisa* discusses the gastrointestinal issues she is experiencing
- Lisa’s PCP recommends she get a colorectal screening
- Using Point of Care Assist, Lisa’s PCP sees that Lisa’s health plan requires her to see a gastroenterologist at an outpatient facility to ensure a colorectal screening is the next best-action
- Lisa’s gastroenterologist appointment and a follow-up colorectal screening reveal abnormalities in her colon
- Knowing this information upfront prompts her to schedule the appointment the next day rather than waiting for her symptoms to get worse
- Lisa’s PCP refers Lisa to a gastroenterologist within her network and provides an estimate of what her cost-share will be based on her specific benefits and coverage information
- Lisa’s gastroenterologist develops a personalized treatment plan to help Lisa manage her symptoms and condition
- Lisa’s gastroenterologist and PCP regularly check in with Lisa during routine and follow-up appointments
Why this matters: This coordinated health care experience, facilitated by her PCP, resulted in Lisa getting the diagnosis and treatment she needed faster — without any costly surprises to her or her employer.
*Lisa is not a real member. This hypothetical case scenario is intended to be used for illustrative purposes only.
