Improve Access to Healthcare and Increase Choice with a Broad Provider Network
By Melina Kambitsi, Ph.D., SVP, Business Development and Strategic Marketing
Accessing healthcare is becoming increasingly challenging because of rising healthcare costs and persistent physician shortages. This scarcity affects both rural and urban areas and has left 30% of Americans without a primary care provider, exacerbating disparities in healthcare access and outcomes. As many as 80% of physicians are already reporting shortages negatively affecting their practices. With projections indicating a deficit of 37,000-100,000 physicians in the next decade, it is more important than ever for employers to have a broad provider network that meets the needs of their workforces.
Read on to learn how you can improve access to care and increase choice for your employees and their covered family members while saving them and your business money.
The Importance of a Broad Provider Network
It is crucial for employers to have a comprehensive provider network in their benefit plan design. The network should include accessible providers who can work together to provide a diverse range of services. By offering a broad network, employers enhance geographical accessibility to care and minimize wait times for appointments, improving overall healthcare accessibility for employees.
The Alliance helps self-funded employers design custom provider networks using our Smarter NetworksSM. We contract with over 39,000 medical doctors and other practitioners, 9,700 clinics, 150 hospitals, and 395 home health providers in the Midwest. This allows employers to offer a wide range of choice for their employees and covered family members. Our networks cover over 91% of Wisconsin, minimizing the changes of out-of-network charges against the health plan and protecting employees from surprise bills.
Our tailored network solutions – our Premier Networks – are designed to accommodate both employees' geographical requirements and their unique healthcare needs, including chronic condition management. Incorporating major health systems alongside alternative care delivery models such as independent primary care, behavioral health, imaging, and laboratory services providers, allows individuals to access care where they feel most comfortable, ensuring timely, high-quality services at a reasonable cost.
Independent Providers: Redefining Care Delivery
Independent providers offer care outside of a traditional hospital or health system, allowing them the flexibility to schedule their own appointments. This can reduce wait times and permit providers to spend quality time with each of their patients. When patients feel that their provider is truly listening, they are more likely to feel comfortable and engaged. Having a good relationship with a provider can lead to improved health outcomes and lower healthcare costs as patients are inspired to take an active role in their health. So, it is a smart strategy for employers to include independent providers in their networks to not only increase access but improve the quality of care for their employees.
Independent virtual health companies offer innovative, cost-effective solutions for patients and their self-funded employers. Telehealth services, including virtual primary care and behavioral health services offer more convenience and increase access to care. With flexible appointment hours and, in some cases, 24/7 patient support and care navigation, patients can access care outside of traditional office hours.
The Alliance partners with independent providers, including independent primary care, behavioral health, imaging and laboratory services, and virtual health providers to offer more healthcare choices. Our contracting methodology – Reference-Based Contracting by The Alliance – uses Medicare as a benchmark for fair pricing to reduce the financial barrier to care.
Advanced Primary Care: Elevating the Standard of Care
Advanced primary care models are gaining traction because of the unique benefits they offer. Advanced primary care is an elevated standard of primary care measured by better health outcomes, higher patient engagement, and lower total healthcare spend for employers and employees. This approach prioritizes quality of care over quantity of patients, enabling physicians to allocate more time to each individual, promoting effective diagnosis and management of conditions.
Direct primary care (DPC) is a type of primary care provided directly to patients independent of a hospital or health system, usually through an on-site, near-site, or shared-site clinic. This type of care utilizes an alternate payment method, typically capitated with a monthly cost. This greatly improves access to care with a flat, affordable membership fee.
We help employers increase access to primary care for their employees by guiding employers to incorporate Advanced Primary Care and Direct Primary Care in their benefit plans when they’re available. Building on the strength of our broad network, The Alliance partners with DPC providers to offer per-member-per-month (PMPM) payment models for employers. This can provide a more cost-effective solution to traditional healthcare delivery. We vetted partners that provide low-cost care and created a list of these preferred-value providers with our Advanced Primary Care and Direct Primary Care partners, so they can refer patients when they need specialty care.
Conclusion
As healthcare costs continue to escalate and we face increasing physician shortages, the need to maintain access to healthcare has never been more critical. The Alliance empowers self-funded employers to address these challenges head-on by leveraging our Smarter NetworksSM and our Advanced Primary Care and Direct Primary Care solutions.
Reach out to us to learn how self-funding with The Alliance can help you offer your workforce unparalleled access to quality, affordable healthcare, saving your business and your employees money.
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