Building A Competitive Edge With Medicare Advantage Through Advanced Primary Care

Medicare Advantage (MA) plan members often face significant challenges that payers must solve to attract and retain more MA members. Some of these challenges include lack of access to primary care providers and unexpected out-of-pocket costs. To learn more check out our blog from earlier this week.

Payers who rely on fee-for-services providers in a volume-based model are stuck, if they want to solve these challenges. They foot the bills for specialty care that could be provided at the primary care level because they lack control over care delivery and are forced to work within existing provider networks that serve numerous fractured populations. 

There is a solution: advanced primary care or APC. It’s not just a revolutionary care model, it’s also a sound business model. By implementing APC, payers can win the hearts, minds, and patronage of MA members by providing better care and creating a better member experience while they build a distinct competitive advantage over their competitors.

Gaining control, improving quality scores, and reducing costs

A payer who wants to implement advanced primary care faces a build-or-buy choice: building their own methodologies and infrastructure, or teaming with an experienced partner by purchasing an existing, proven system. Either solution will provide greater control over care delivery and the member experience.

Once they control care delivery, payers can deliver care tailored to their MA member panels, increasing health outcomes and the overall member experience. Payers who have adopted this approach achieve higher CMS Stars ratings, and because they deliver care that would have normally been referred to specialists in the primary care context, they can control the total cost of care.

Removing obstacles for greater MA member satisfaction

The benefits APC provides MA members are clear. Primary care providers deliver 80-90% of all care, minimizing many obstacles to MA member health. APC realigns the incentives between payers, providers, and patients, allowing everyone to prioritize health outcomes over reimbursement. 

Care plans focus on the whole person, not just the symptoms that brought the patient in. Those plans are facilitated by health coaches, an integral part of the primary care team. Team members also provide care coordination for managing specialty care referrals along with follow up care in the care center. Those services are all supported by APC’s use of informatics for creating and maintaining personalized health plans.

Being different to make a difference

What if MA members — or any other patients — looked forward to visits with their primary care providers? What if patients saw their providers at the first sign of any health issue, rather than wait until the need for care was urgent if not critical? 

APC’s differentiators can distinguish payers from their peers so they can attract, acquire, and retain more MA members. Better overall member health and the lower costs that come with it can only enhance payer competitiveness.

With APC, payers can provide better care, create a better MA member experience, and deliver better outcomes to help build a better competitive advantage.

 Learn more about how Vera can help build your competitive advantage with APC.