How Safe is Your Primary Care Strategy From “Payviders”?

Most health systems have invested heavily in primary care practices in the last decade. The good news is this strategy is paying off. Research shows that primary care providers are key to engaging patients, coordinating care, controlling costs and ensuring the best outcomes. For healthcare organizations, a strong primary care strategy is key to succeeding under value-based care.

The bad news is that many payers have learned the same lesson — and they are now competing with traditional provider organizations for the same primary care relationships. Companies such as UnitedHealthcare are launching virtual clinics that offer a wide range of primary care services at little to no cost. These “payviders” are winning market share by emphasizing convenience and access. 

What does this mean for hospitals and health systems? The consequences are still unfolding, but one possible outcome is that payviders will increasingly control the access points to high-acuity care. 

To compete against these new entrants, hospital and health system leaders need to take a fresh look at their primary care strategy. Here are four key steps:

Understand the Convenience Market

Patients’ desire for convenience is powering the payvider phenomenon. However, convenience does not mean the same thing to every patient. Hospital leaders should use data to identify the demographic segments that make up the market for convenience-based primary care. For example, your market might include a large population of young families that value easy access to basic primary care for sick visits. Alternatively, you may identify strong demand in your Medicare population for convenient management of ongoing chronic conditions like hypertension and hyperlipidemia. 

Build the Telehealth Experience

While the pandemic is subsiding, the demand for virtual access to care will only grow. In a value-based world, or as an insurer who is taking risk, telehealth is a cost-efficient way to provide care. Payviders understand these realities, and they are putting telehealth at the center of their delivery model. In response, hospital executives should focus on expanding the virtual care experience for primary care patients. A strong telehealth model now includes:

• Immediate access to virtual appointments with physicians and other providers
• A full range of visit types, from regular check-ups to chronic care follow-ups to lab reviews
• Advanced health screenings, patient triaging and specialist referrals

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Invest in Care Management and Team-Based Care

Payviders aim to control costs and improve outcomes by using primary care to coordinate services. To compete with these new entrants, traditional healthcare organizations should emphasize primary care’s role in effective care management. Consider incorporating non-traditional providers — such as advanced practice nurses, social workers and behavioral health specialists — into the primary care team. These providers create new revenue streams while helping to ensure better patient outcomes.

Create New Partnership Models

While many payviders are now employing physicians directly, provider employment is not a viable option for many traditional healthcare organizations. Healthcare leaders should explore new ways to partner with primary care physicians. For instance, a hospital could build a clinically integrated primary care network that includes a mix of independent and employed providers. Participants could share a telehealth platform, establish common quality goals, and create defined care pathways. The result: a new primary care model that delivers convenience, improves patient outcomes, supports patient “keepage” and strengthens the hospital’s overall financial performance. 

Build on Your Strengths

While payviders may represent a threat to healthcare organizations, hospitals have one important advantage — their longstanding commitment to the wellbeing of their communities. Hospital and health system leaders can build on this foundation by combining traditional patient-centered care philosophy with modern technology and advanced team design. The result will be a powerful primary care model that preserves your patient base while better serving your patient population.

The article was written by George Mayzell, MD, MBA and Daniel Marino of Lumina Health Partners. To learn more about them, visit our About page.