The current state of healthcare is disjointed. The key players involved — the payers, the health systems, the providers, and other companies providing services — are all trying to achieve different goals. What we’re left with is a misaligned system lacking cohesion. This results in stalled health outcomes and a less than optimal experience for members, payers, and providers.
Our experience has been that payers and their clients are frustrated with the breakdowns in the system — the high utilization, the escalating costs, and the types of care being delivered are all points of contention. It’s not working for anyone, and they’re looking for meaningful change.
APC solves the major issues of the disjointed system when a payer chooses to implement their own care center:
APC is a highly differentiated and valuable solution. In the commercial space, APC provides the ability to retain clients and grow their businesses.
The APC model follows the methods below to make this successful:
By providing this type of care with aligned incentives, payers are able to provide solutions that meet the needs of commercial clients.
APC is also a solution that allows payers to attract and retain more Medicare Advantage members. Medicare Advantage members have complex needs, and they’re frustrated when they can’t get in to see their primary care providers. They’re swimming in a sea of referrals to specialists.
The members need care coordination and a medical home that can help ensure adherence to a care plan. However, this is difficult to achieve when payers lack control over the member experience or the ways in which providers and systems are incentivized to provide care.
APC will allow payers to guide Medicare Advantage members through their care, making the process more effective and less frustrating. This allows them to retain members as well as attract more new ones.