Medicare Populations Demand A Primary Care Reboot

The aging baby boomer population is exposing flaws in traditional primary care service models, especially among Medicare Advantage (MA) populations. Providers aren’t given the time to treat complex health issues, if they’re able to get access to primary care at all.

In some markets there’s a six-month wait for MA members to see a provider for an annual wellness exam. Worse, these members are left to manage their own care as they navigate through a complex specialty care system.

“Despite the high importance currently placed on chronic disease management and patient wellness, most primary care providers say they don’t have enough time to address these issues with their older populations.” — Sara Heath, "Primary Care Time Constraints Limit Chronic Disease Management," PatientEngagementHit.com

Sara Heath’s article in Patient Engagement HIT discusses a survey of providers and Medicare patients that highlights many of these issues and illustrates why payers must make an investment in increased primary care options. Here’s what they found.

Healthcare spending is driven by chronic care management

According to the survey cited in the article, “Seventy-one percent of all healthcare spending is dedicated to chronic care management.”

That’s a staggering number when you consider that the Medicare population is only growing. And as they get older, the chances of developing multiple chronic conditions only increase. But for all the money spent on chronic care management, it isn’t improving results.

Payers like Prominence Health Plan in Nevada have partnered with us to solve this problem by increasing access to primary care which will provide much needed care coordination so that MA members aren’t left to navigate their care journey alone.

Together we’re working to offer increased access to primary care providers, even in the midst of the COVID-19 outbreak when we switched to video and telephone visits for routine care.

Providers are short on time

Even if a patient can get access to primary care, there are still challenges. It takes time to truly care for a patient’s whole health and develop a comprehensive care plan. In traditional primary care systems, that’s time that most providers don’t have.

“Eighty-five percent of providers said they don’t have enough time to address all their patients’ clinical concerns and 66 percent said they can’t address behavioral concerns,” writes Heath. Those behavioral health concerns are critical, especially when you consider that “80 percent of chronic conditions can be attributed to social determinants of health.”

When patients don’t have time to communicate all their health issues, minor issues are far more likely to develop into serious problems further down the road. Over time, problems compound and health deteriorates even more.

More time, better care

When providers and patients have adequate time together, they’re able to discuss all their health issues fully.

The result is a personalized care plan that acknowledges a patient’s whole health, including its bio, psycho, and social components. A shift toward a primary care model that recognizes this is crucial if providers want to be capable of responding to the growing aging population. 

Heath writes, “Longer appointment times, an emphasis on both clinical and social health, and better appointment distribution based on chronic care management could improve the patient-provider relationship."

Client spotlight: Seattle Children’s

After Seattle Children’s launched an onsite Vera Whole Health clinic, they saw dramatic results, particularly among high-risk diabetic patients.

With longer appointment times, a whole health approach, and empathetic listening practices, Vera’s providers were able to offer their patients the time and attention their chronic conditions warranted, and it paid off.

Overall spending dropped by $920 per member annually for patients with Type 2 diabetes. This is the type of care needed to ensure baby boomers can stay healthy longer as they head into their retirement years.

Learn how we're providing this type of breakthrough primary care using our advanced primary care model in our eBook: Advanced Primary Care: The Front Line Of A Health Revolution.