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Benefits for Payers

The PCMH model is based on several core principles: enhanced primary care; coordination and integration of care; quality and safety; and improved access. These core principles are well-aligned with payers' objectives of improving outcomes and quality for their members while reducing overall costs.

By design, PCMHs are foundations for the Triple Aim of better quality, better experiences for patients and reduced costs. Numerous studies have documented their ability to improve quality, patient experience, care continuity, prevention and disease management as well as to reduce costs from emergency department utilization and hospital admissions.

For payers, there are many reasons to support PCMH implementation. PCMHs feature:

• Improved access to care, including reduced wait times, after-hour appointment availability and electronic communication between providers and patients
• Expanded access to education, tools and resources that facilitate patient engagement
• Clinical information systems to support quality measurement and improvement
• Integrated, coordinated team care, resulting in reduced duplication of tests and procedures and medical errors

How Payers Can Help

Louisiana's payers can help advance PCMH transformation in several ways:

• Offer enhanced payment or financial incentives to practices effectively providing patient-centered care based on defined performance metrics for care management of specific chronic conditions.
• Create a PCMH transformation program that provides financial assistance to providers during the practice certification phase.
• Offer reduced premiums or waived deductibles to member employers and their workers if they seek care from an approved network of PCMH providers.

Benefits for Purchasers

Louisiana's employers face three significant health care-related challenges: presenteeism, absenteeism and rising health care costs.

Presenteeism, or the loss of productivity when employees come to work while ill and don't perform well, accounts for the majority of employers' total health-related costs. Productivity losses due to presenteeism cost employers $2-$3 for every $1 of direct medical costs such as health care premiums or pharmacy spending, reports Kaiser Permanente. Absenteeism, or unscheduled absences due to illness, cost employers $2,650 per salaried worker and $3,600 per hourly worker each year, representing a full cost equaling 36 percent of employers' payrolls, according to Kaiser Permanente.

Employers know that a healthy employee is a productive employee. They also want the best value possible for their health care dollars. By supporting PCMH implementation, Louisiana's employers are getting both. Why?

• Employees have access to quality heath care, complete with wellness and preventive care programs to maintain good health and productivity.
• PCMHs keep dependents healthy, contributing to reduced employee absenteeism.
• PCMHs rely on evidence-based care to make care decisions, reducing waste and overutilization of services that cost employers more money.
• Employees become active participants in their health care and receive access to the appropriate tools and resources to reduce unhealthy behaviors.

How Purchasers Can Help


There are a number of ways in which our state's employers can help advance PCMH implementation in Louisiana.

• Bring health care in-house for employees by developing a workplace PCMH clinic.
• Contract with a health insurance plan that supports and promotes PCMH transformation for health care providers.
• Encourage employees to utilize PCMHs by including value-added services in benefit plans such as reduced co-pays when employees select a PCMH provider as their Primary Care Provider.

 
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