What the future of senior primary care can be

Nearly 20 years ago, the term “value-based care” was first coined by Michael Porter and Elizabeth Olmstead Teisberg in their book, Redefining Healthcare. Since then, rigorous, peer-reviewed research has continued to find strong evidence of value-based care’s positive impact on patient care. With a focus on quality, care coordination and deeper patient engagement, not only is it producing better health outcomes for patients, it’s also increasing satisfaction among physicians and other clinicians.

Now, within Medicare Advantage, we are seeing the value-based care model being deployed in a more targeted approach focused on meeting and caring for the needs of seniors, aptly named “senior-focused primary care.”

While there are plenty of studies that have looked at the impact of value-based care compared to care delivered through a fee-for-service model, which is the predominant payment model for the vast majority of care being delivered in the United States today, none have been focused on senior-focused primary care. Until now! On September 3, the Humana Health Research (HHR) team, in collaboration with Harvard University, published a first-of-its-kind study on the impact of senior-focused primary care organizations, such as Humana’s senior-focused brands, CenterWell Senior Primary Care and Conviva Care Center .

While Humana’s research team has done quite a bit of work over the past several years examining the health outcomes being delivered through Medicare Advantage and value-based care (when compared to Traditional Medicare and fee-for-service arrangements, respectively), this new study takes it one step further by comparing senior-focused primary care to other types of primary care models. And what they’ve found is really interesting.

The results revealed that seniors who see senior-focused primary care clinicians have significantly greater access to primary care, to the tune of 17% more primary care visits compared to other primary care settings. Better yet, the impact was even greater among Black and low-income patients, who experienced 39% and 21% more primary care visits, respectively, demonstrating the vital role senior-focused primary care can play in reducing health disparities moving forward.

Furthermore, findings suggest patients in senior-focused primary care organizations may experience better outcomes on several other measures, such as lower acute care hospital use as well as improved rates of cancer screenings, medication adherence, blood pressure, and diabetes. Due to study design limitations, more research is needed but the signs all point to the same conclusion – that the senior-focused primary care model is great for seniors!

While this study didn't look specifically at the reasons why senior-focused primary care performs better than other primary care models, we do have some theories.

First, many senior-focused primary care clinics are located in historically disadvantaged communities where primary care doctors are often in short supply. By positioning themselves where the need is greatest, senior-focused primary care organizations are closing those access gaps and allowing seniors, who often have issues securing transportation to appointments further away, to receive care closer to home.

Second, the clinical model for senior-focused primary care is quite different than it is for traditional fee-for-service primary care. Instead of the financial incentives being driven by quantity of visits, the incentives for senior-focused primary care models are directly aligned with quality:

• ?Quality time with patients: The big differentiator is time. Our senior-focused primary care clinicians have more time with their patients, sometimes up to as much as 40 minutes a visit. In fee-for-service or traditional primary care clinic visits tend to be closer to 10 - 15 minutes. Seniors often have a myriad of topics they need to discuss with their doctors, including their medical needs as well as social health related needs, like food insecurity or loneliness. By prioritizing more time with patients, senior-focused primary care creates the space for its clinicians to truly connect with and understand the needs of their patients.
• Availability of data: To care for their patients, who on average have two or more chronic conditions and are receiving care from four or more care practices each year, senior-focused primary care organizations must have robust access to data and the capabilities to use it. To ensure they’re meeting the holistic needs of their patients, clinicians in senior-focused primary care clinics have point of care access to data about the patient in front of them, allowing for more informed and targeted decision-making.
• Quality of support: Given the complex needs of seniors, senior-focused primary care clinics also have additional staff, often within their office walls, that can help address a patient’s behavioral health or social needs. From social workers to behavioral health specialists to care coaches, senior-focused primary care clinics ensure their patients have the appropriate resources at every step of their care journey.

We know that senior-focused primary care clinics are having a significant impact on the experience of seniors. What we don’t know yet is the extent of that impact on longer term health outcomes, which is why I’m very excited for Humana’s HHR team to explore future research opportunities in this area.

Before I wrap up, I wanted to offer a congratulations, and thank you, to everyone involved in making this study possible! It’s imperative that we continue to leverage rigorous, peer-reviewed research to shape how care is delivered across this country to improve the health and well-being of all those that we serve.

You can access the full manuscript on Health Affairs and explore other published studies on the Humana Healthcare Research hub . If you are interested in exploring this topic through a policy lens, please consider reading a recent Health Affairs Forefront article I co-authored with Ann Greiner and R. Shawn Martin on strengthening primary care reimbursement models to improve Medicare’s outcomes and efficiency.

Sincerely,

Kate