Commercial risk will be a critical catalyst of progress – it’s complicated, but is it possible? We think so.



How to scale team-based primary care according to financial risk

As payment reform pressures provider organizations to manage total cost of care for their patients across the continuum, leaders rely more than ever on primary care to provide upstream services that prevent more costly downstream utilization. To deliver effective, patient-centered care, organizations are transforming their primary care practices to deliver new-in-kind services that address the full range of needs contributing to patient health. This requires organizations to expand their care teams to help manage patients’ behavioral health, non-clinical, and complex care needs across an often-confusing system. Team-based primary care not only improves patient and population health, but also lowers health system costs overall.

But team-based care is expensive and the traditional payment system is not set up to support investment in non-reimbursable services. As fee-for-service billing still makes up a majority of most organizations’ revenues, organizations struggle to make primary care investment plans that include extended care team members (e.g., social workers, pharmacists, care managers, etc.). To finance these roles, organizations rely largely on grants and risk-based payment contracts. However, even under risk-based contracts, organizations often fail to hire and deploy staff in a way that’s cost effective.

Therefore, to scale team-based primary care sustainably, organizations need to align their investments in team-based care with the amount of financial risk they’ve taken on. This report makes the case for investing in team-based care and outlines how organizations with varying degrees of revenue tied to risk-based contracts have successfully implemented team-based care across their systems.

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