How APC Eases Payer Transition To Value-Based Design

We may have pioneered advanced primary care (APC) — but we’re also realistic about the multitude of models out there failing to tie cost to value. By adopting APC and working with flexible vendors like Vera, payers can transition to value-based care without waiting for their internal infrastructure or fee-for-service (FFS) providers to adapt.

Common obstacles

Before jumping to the solution of value-based care, it’s helpful to consider prevalent barriers that may need to be navigated. While it can be challenging to build consensus around value-based care, integration is more intuitive than you may think. Start by considering these three common obstacles: 

• System limitations built to accommodate FFS care models. Hardware, software, or internal best practices can lag behind, making the transition to a value-based system like APC (with capitated payment models, as one example) feel like a distant goal. 
• Internal cultures and stakeholders that have built their entire approach around FFS healthcare may be resistant to value-based payment models.
• FFS provider networks have conditioned providers to a transactional form of care delivery. Like internal stakeholders, it can be challenging to shift providers’ thinking from volume and claims to value and health outcomes. 

For payers looking to add APC to their offerings, it’s important to know that we don’t directly target those members who are engaged with good primary care providers. What our APC model does is provide more access to members that don't have that relationship.

The APC solution

Vera’s APC model offers a myriad of benefits starting with the proven lower overall costs of care and improved health outcomes. Our value-based care model can help payers overcome common obstacles with:

• Flexibility in claims reconciliation to help bridge the gap while internal systems adapt to include value-based models
• Tips and resources for help towards an inclusive internal culture that welcomes value-based care models alongside existing FFS structures

Vera’s APC model also helps solve challenges for payers that want to retain some of their existing provider relations. We’ve seen APC greatly simplify the transition towards a broader value-based payment model just by steering members to high-value, lower-cost specialists when it’s appropriate.

The result is a kind of hybrid value-based experience where payers retain the FFS models while adding value through APC. These very same payers quickly see that both models actually work more effectively together. 

The difference of Vera’s APC

Our care teams are trained to deliver the right care at the right time — without the worry over how the right care might fit into an FFS payment structure. That means our APC providers are freed up to focus their time and expertise on caring for members. 

We have found that APC can deliver about 80-90 percent of total healthcare within the primary care environment. There's a balance of care that needs to be provided outside the physical (or virtual) walls of our care centers, and in order to do that, we develop relationships with highly skilled, lower-cost provider partners in the community. We’re reaching out to those providers to help them understand what we're trying to accomplish with a given member before sending the member to them.

By putting more into primary care spend, we can then control the other spend regardless of how tightly the other providers want to work with us, because we're influencing member behavior, aligning incentives for providers, and creating relationships with some of the best-in-class providers in each market. 

Learn how the value-based solution of APC is transforming the healthcare system into something far more sustainable for everyone involved. Read our guide on value-based care.