Insurers Take Steps to Support Primary Care Providers

by Peter Johnson

The COVID-19 pandemic has caused visits to primary care providers (PCPs) to plummet, putting significant financial strain on those businesses. That crisis has been especially harmful to independent practices, and insurers have begun to step in to assist struggling practices in their networks.

"We know how critical it is for our members to have PCPs, and in light of this we’ve taken several steps to support stability for these providers," Humana Inc. Chief Medical Officer William Shrank, M.D., tells AIS Health via email.

Shrank writes that Humana has committed to doing the following:
✦ Simplify and expedite claims processing;
✦ Eliminate member copays for primary care visits through the end of the year;
✦ Collaborate "with certain PCP groups on various funding mechanisms;" and
✦ Temporarily reimburse telehealth visits with participating/in-network providers at the same rate as in-office visits.

The recent, rapid evolution in primary care that Shrank refers to has two interwoven threads. The first is a shift to telehealth care modalities in lieu of in-person visits. Also, there is a growing feeling among stakeholders across the primary care system that fee-for-service network agreements can stand in the way of sustainable reimbursement and high-quality care provision.

The Primary Care Collaborative CEO Ann Greiner says that folding telehealth visits into a value-based model can be a win-win for payers and providers alike if done correctly. And moving into a capitated or subscription-based arrangement can disincentivize redundant visits and free up providers' schedules, she adds.

Blue Cross Blue Shield of North Carolina (BCBSNC) has been working on a collaborative approach to primary care for several years, with the goals of better population health, improved quality and reducing acute care spending, according to Leslie McKinney, M.D., BCBSNC’s medical director responsible for primary care.

McKinney estimates that between 25% to 35% of BCBSNC's independent PCP network is under value-based payment arrangements, largely as part of the insurer's agreement with health care technology company Aledade, Inc. to create an accountable care organization reimbursement model called Blue Premier.

As the COVID-19 pandemic began to unfold, she says those efforts took on a new sense of urgency, and became a model for how the payer plans to do business going forward.

From Health Plan Weekly