Primary care networks can cost millions of dollars to develop, but many hospitals aren’t utilizing them to their fullest advantage. One common example of untapped potential: managed care. What steps has your hospital taken to integrate your investment in PCPs with your managed care strategy? If your answer is “None,” it’s time to consider three core questions.

How can I leverage my PCPs to influence local employers?
Though the employed population is responsible for your whole bottom line, hospitals rarely try to influence employer decisions. Create a Unique Value Proposition with major local employers by turning your PCP network into a trusted resource within the provider community. What prevention programs are effective? What behaviors should the employer try to influence through benefit design? Who should be in the preferred segment of a tiered network? Your primary care physicians have insights into all of these issues, and can be of great help to employers.

How can I leverage payers to get the best rates?
While it may be easy to exclude hospitals from narrow networks, PCPs are in short supply and even narrow networks can’t do without them. Trying to corner a large segment of the primary care market will give you leverage with insurers when negotiating rates both for the hospital and for your employed physicians.

How can I leverage my PCPs to manage care?
New payment incentives require health systems to concentrate on efficiency. That means focusing on resource utilization during episodes of care – inpatient care combined with the pre- and post-discharge care processes. But equally as important are your primary care models and PCP insights into how to coordinate care, what specialists to use, and what resources are required to increase efficiency. If you aren’t focusing on this issue already, you’re missing the boat.

 

David W. Miller

Founder, Board Member