Primary Health is…a “Commercial Advantage” Plan

When employers complain about the ever-rising costs and increasing complexity of providing healthcare for their employees, they seem blind to a proven model that’s right in front of them. 

During the last several years, there has been an explosion of enrollment in Medicare Advantage plans throughout the country. The Medicare Advantage plan is a type of Medicare health plan offered by private companies that contract with Medicare to provide Part A, Part B, and Part D benefits to members. These plans are typically offered by large insurance companies including Humana, United, Aetna, Cigna, and many others who are seeking to provide better alternatives to managing cost, quality, and experience for some of the most vulnerable Americans. The growth in these plans over the last 20 years can be seen below:

The rationale for this growth is very clear – it cost less, the quality is arguably higher (still need definitive proof but very strong leading indicators), and members love the plans. The Kaiser Foundation has done some nice work with highlighting these outcomes including the 20% savings for enrollees even when adjusted for risk:

Effectively, Medicare Advantage plans restore the primacy of primary care as a foundation, but they also include strong incentives to innovate with new services, new provider types, and new care models that more comprehensively—and more effectively—control the cost of care. Nearly all beneficiaries (97%) have access to dental, fitness, vision, and hearing benefits, which are not covered by traditional Medicare. Many beneficiaries also have access to some transportation assistance (92%) and a meal benefit (96%), but some benefits are less frequently available, such as in-home support (54%), bathroom safety (49%), tele-monitoring services (29%), and support for caregivers of enrollees (12%).  A key driver of the growth has been the early evidence that these models have been very effective in achieving not just cost advantages, but outcomes and experience advantages as well. Given the US Government is footing nearly 50% of the bill for healthcare, they can and should be expecting to receive high-value healthcare for the taxpayers who are also funding these programs.

A handful of companies that provide these services at scale have emerged. Many of these are often highlighted in books, magazines, and other reports for achieving the elusive Triple Aim for these challenging populations. These companies include Oak Street, Iora, Chen Med, Devoted, along with many new entrants that all provide variations on the same theme—they are a relationship-based care model paid for with a fixed fee arrangement, with the goal of fundamentally altering how care is provided. They have typically developed their own proprietary member engagement software, as traditional third-party EHRs have not been effective in either collaboratively or longitudinally managing patients. Commonly, risk prediction software are heavily invested in, in order to proactively engage their high-risk members to better manage their own health.  Unique clinical and social programming is offered, and adapted to the particular  health needs of their members, targeting their most pressing needs (Meals on Wheels, transportation, home visits, medication reconciliation, etc.). They also utilize multiple mechanisms to control the referrals to the secondary care network. Finally, many of these companies have raised enormous amounts of money to achieve some level of scale that is required to achieve the necessary operating efficiencies. And, clearly, as Oak Street’s (OSH) recent public offering indicates, there is a ravenous appetite from the investment community for the predictable subscription revenue, high growth rates, and near infinite addressable market (Oak Street’s currently valuation is $10B, with a 9.3x multiple on their 2021e— very impressive for a healthcare service company). 

As I have cheered on the success of both Medicare Advantage in general, and these innovative medical groups specifically (many of the founders and CEOs I personally know), I cannot help but pause to wonder where the large employers are in demanding the same types of model, programs, processes—and outcomes!— for their commercial populations.  Large employers make up more than 50% of healthcare spending, and despite all the talk about value-based healthcare, I don’t see many companies that are meaningfully attempting to engage in managing healthcare costs. By that I mean going way beyond simple deductible/co-pay tweaks, past the “feel good” but totally disconnected point solutions, further than the minor network adjustments that in the end just prove to be major irritants for their members, and certainly beyond the “du jour” telemedicine offerings that only further fracture a complex delivery landscape. As I always say, if you want to manage healthcare costs, you have to get involved with redesigning healthcare delivery. It’s the rare company that truly understands this on a fundamental level and has the conviction to dedicate real resources to solving this challenge.

Which brings me back to my original question – where is the “Commercial Advantage” plan for self insured employers? When you start to see Medicare Advantage as a precedent, then the template to redesign healthcare can also be seen right in plain view. 

Crossover has been offering employers and our members  a “Commercial Advantage” plan since our inception. Over the years, our level of sophistication has grown, our capabilities have increased, and the impact we have is deepening. We have always practiced with a comprehensive, integrated, and coordinated care team as part of our Primary Health model. Depending on the sophistication level of the employer , we can offer our services in several variations of fixed fee arrangements. We developed, and from day one have utilized, our own proprietary member technology that allows us to directly engage with our members, provide them with the simple conveniences and communications they expect, and most importantly, to give them direct access to their care. We have also invested heavily in an enterprise data warehouse with strong analytic capabilities, which allows us to track over 40 (and growing) clinical metrics and social determinants of health. This is what unlocks our ability to proactively identify members who may need us most, and directly engage them in their care with general health programming, specific condition management, and other clinical, social, or affinity programming (young mothers, newly married, group fitness classes, and other social activities, etc.) that may encourage them forward in their health. We have also augmented our care model by embedding Care Navigation so that we can more effectively manage the referral process end-to-end when sending our members into the secondary care network. 

Crossover’s underlying Primary Health model of care is what allows us to effectively create a “Commercial Advantage” health plan for our employer clients. We are not simply a medical group that provides convenient and accessible care through onsite, nearsite, and now primarily virtual care channels. Rather, we are a sophisticated population health service that manages the total spend for our clients. There are no point solutions available that can plunge the depths, cover the breadth, engage the masses, while also reduce the complexity like a medical group delivering Primary Health. Every employer should be looking at implementing a “Commercial Advantage” plan to control costs, increase quality, and deliver an exceptional experience. The most forward thinking already have, and are, with Crossover Health. 

Join your fellow health activist employers now by taking advantage of Crossover’s Commercial Advantage!