7 Ways Health Systems Can Get More from Their PCP Networks

Are we losing sight of the true value of the primary care physician (PCP)?

PCPs have long been viewed as “gatekeepers,”coordinating care with specialists and helping patients gain access to system resources and services. But hospitals incur a net loss of $190,000 per employed PCP, according to MGMA.^[1] That’s a lot to spend on a gatekeeper.

While the losses are not insignificant, PCPs often drive patients to other healthcare providers within the system where additional revenue generation occurs. But thinking about a PCP’s value solely in terms of downstream revenue doesn’t provide a holistic view of these providers’ contribution.

So, what is the value of the PCP?

PCP as Guide

The principal value of a PCP network to a health system should be its ability to:

• Manage patient panels appropriately by anticipating and planning for each individual’s healthcare needs.
• Properly help patients navigate the complexity of the healthcare system.
• Effectively manage the total costs of care.

As government and commercial payers continue to push for the adoption of value-based care models, health systems are increasingly incentivized to provide the right care, at the right time, in the right place. This means ensuring that patients receive coordinated care that eliminates any waste (e.g., duplicative diagnostic tests) along the way.

In this framework, PCPs are more than just gatekeepers—they are guides, responsible for helping patients on their journey through the health system. How effectively and efficiently a patient is guided can affect both costs and health outcomes.

Below are seven actions health systems can take to maximize the value of their PCP networks.

1. Stratify populations: Understanding the patients your organization serves and stratifying them based on their risk profile can better position PCPs to meet the unique challenges associated with each stratified layer. For example, developing a risk profile for prediabetic patients helps providers proactively tailor a care plan for that population. The stratification of populations can transform the patient experience, prevent chronic disease, and lead to improved financial performance.

2. Incentivize Health Management: Part of guiding patients through the health system involves keeping them out of high-cost care settings. PCPs can promote better health management through improved communication about annual appointments and screenings and directing patients to community and online resources when appropriate.

3. Align Payer Contracts: Ensure that payer contract incentives are aligned with operational and clinical strategies to maximize the benefits associated with better population management. Moving low-margin populations into value-based arrangements can produce upside opportunities to grow revenue while freeing capacity for higher-margin populations.

4. Get Connected: Facilitating information exchange by integrating data across inpatient and outpatient care settings improves the patient experience and creates transparency between the different care settings. Achieving this means improving the interoperability between IT systems anywhere the patient receives care.

5. Improve Patient Access: Investing in PCP practices, understanding the needs of the community, and encouraging better physician alignment will streamline care for patients and in turn alleviate capacity constraints for health systems.

6. Partner with the Community: Not every health system offers a comprehensive portfolio of services—nor should they. By understanding the resources in the community (e.g., housing, intellectual and developmental disability services, substance use treatment centers) and removing silos, health systems and PCPs can create a healthcare environment that extends beyond the four walls of the hospital.

7. Chart the Course: Define the referral pathway and establish the means for improved ongoing communication with internal and community resources to ensure the patient is navigated to the appropriate care setting.

Efficiently guiding patients through the continuum care creates benefits for health systems and communities. The patient receives the right care, at the right time, in the right place, and the health system improves the lives of their patients while managing costs. Although the benefit of downstream revenue is significant, the true value of the PCP lies in their ability to manage their patients’ health and coordinate with health system and community resources to effectively navigate the patient to the correct care setting.

Published May 17, 2021