What is an advanced primary care model, and why does it matter?

When you hear the phrase "modern healthcare," some thoughts that may come to mind include the latest medical technology, advances in surgical procedures, or new drug therapies. What may not immediately come to mind, though, is that if patients aren’t at the center of care, none of these innovations matter. It is crucial to understand how an advanced primary care model that encompasses a patient-first mindset fits into the modern healthcare landscape.

"In the United States, there has unfortunately been a drive toward a high-turnover, in-and-out type of primary care, and people can get lost along the way," says Dr. Michael Groshner, Medical Officer at Carelon Health. "When that happens, both patients and healthcare systems suffer."

But what if there were a better, whole-health care model for managing the most complex medical patients? That is the intent of the Advanced Primary Care model from Carelon Health.

What is Advanced Primary Care?

The Advanced Primary Care model from Carelon Health provides holistic healthcare. It combines medical care and acute care intervention with wraparound supports for patients with chronic illness. It's available to patients enrolled in Medicare and Medicaid. In some states, Advanced Primary Care is also available through certain employer health plans.

It's focused on whole health

This comprehensive model of care understands and addresses issues that include:

  • Physical health.
  • Emotional health.
  • Nutritional needs.
  • Financial concerns.
  • Social relationships and supports.
  • Environmental conditions.

Providing proactive, whole-health care that extends beyond simply treating symptoms can help prevent and reduce hospital admissions, explains Dr. Groshner. It also leads to a better quality of life and healthcare experience for patients.

It's team-based

A Carelon Health Advanced Primary Care team includes:

  • A primary care doctor.
  • A case manager.
  • Physician assistants.
  • Nurse practitioners.
  • Social workers.

A team-based approach allows each team member to work to the top of their medical license. With the backing of a team, the primary care doctor doesn't need to worry about having enough time. Patients aren't rushed out the door. Each team member can help uncover another piece of a patient's healthcare puzzle.

The Advanced Primary Care team looks beyond what's in a patient's medical record. "We try to understand them and get to know them. It's about tying in multiple avenues that can cause illness," says Dr. Groshner. "Whether it's family issues at home, lack of knowledge regarding diet or exercise, or how they're supposed to be taking their medicine. We really dive into the root of the patient's problems and goals."

It's convenient

The Advanced Primary Care team can connect with and support patients:

  • In their primary care doctor's clinic.
  • At Carelon Health Care Centers in neighborhoods across the country that offer same-day and walk-in appointments.
  • Via telehealth for virtual visits.
  • At one of Carelon Health's mobile health clinics.
  • At the patient's home (private residence or nursing facility).

How Advanced Primary Care benefits patients and health plans

The Advanced Primary Care model helps patients stay healthy, so they stay out of the emergency department and hospital. "That ultimately lends itself to improved financials," says Dr. Groshner. "By getting to know patients, by building that patient-provider relationship, you realize better outcomes and more cost savings as well."

Our Advanced Primary Care model achieves better patient care that can contribute to health plan cost savings in several ways.

Wraparound emotional and social care

When a patient trusts and respects their care team, they feel confident sharing concerns about their treatment and issues impacting their care. The care team can then tailor care to meet the patient’s needs. The team can also provide wraparound services to address social and emotional issues that impact the patient’s care.

Recently, Dr. Groshner and his team identified an 86-year-old patient in need of inpatient mental health care. She lived alone, was estranged from her family, and struggled with depression and suicidal ideation. "With encouragement, she voluntarily agreed to admission to an inpatient psychiatric facility," he says.

Since the patient’s discharge from the hospital, wraparound services have continued. "We've had hands and eyes on her basically every business day," says Dr. Groshner. “Even over the weekends, there's always a team member checking in to see how she's doing or available if she needs support. We're trying to get people the support they need. Ultimately, this makes people better. It keeps them alive longer. It actually even helps them live better."

Manageable patient loads

Advanced Primary Care teams see a smaller number of patients than traditional care models. As Dr. Groshner explains, not overloading care team members helps them better focus on what each patient needs.

A top-of-license care team

Every care team member at Carelon Health works to the top of their license, allowing them to zero in on a specific aspect of the patient's health and well-being.

Earlier patient onboarding

In traditional care models, it's common for patients to wait six to nine months to schedule a first appointment with a new primary care doctor. Delayed care can result in worse health outcomes and higher costs for the patient and health plan.

Patients enrolling in Advanced Primary Care from Carelon Health can often schedule a first visit with a doctor within six weeks, says Dr. Groshner. "As soon as people enroll in our plan, a care coordinator or case manager reaches out to them to get them scheduled."

More appointment times

This care model helps the care team see patients more often, and more frequent visits help keep patients on track with their treatment plans. "When we see somebody in the clinic or hospital, we know that 20 to 30% of what we're trying to communicate ultimately sticks in their mind when they go home. So, repetition and short follow-up visits are very important," says Dr. Groshner.

Transportation to in-person appointments

Complex medical patients often need in-person care visits. For someone recovering from joint surgery, for example, getting to rehab afterwards helps them recover quicker and more completely. Going to physical therapy three times a week, however, can place a financial and transportation burden on patients and their caregivers.

Patients enrolled in Carelon Health-serviced plans have access to free or low-cost transportation to Carelon Health Care Centers. The plan uses Uber, Lyft, and wheelchair transport providers to get patients to and from their appointments.

"Reliable transportation is a game-changer not just for patients, but also for care providers to better manage their care," says Dr. Groshner.

Translation services

For many Carelon Health patients, English is not their primary language. Carelon uses translation services and bilingual providers to provide those patients with essential whole-person care.

It's made a big difference to patients whose health suffered from not understanding their care plan through other care providers. One Spanish-speaking patient came to Carelon Health with diabetes that had been uncontrolled for 20 years, resulting in blindness. Since then, her Advanced Primary Care team has helped control her diabetes through culturally competent care. They have also provided resources to help treat her depression and help her navigate life as a person without sight.

Bilingual services are part of smart, cost-saving healthcare. "When we gave this patient resources in her native language to figure out how to get around her house without falling, that's how you avoid hip fractures," says Dr. Groshner. "That's how you avoid costly hospitalizations, not just from diabetes complications, but from other health issues."

Remote patient monitoring

When possible, a patient's care team members use technology to help keep an eye on patient health at home. Someone with heart failure, for example, may receive a Wi-Fi-enabled scale to track weight gain caused by fluid retention. Depending on their weight changes, the care team can adjust the patient’s medication or dosage. A quick response to worsening symptoms can help keep these patients out of urgent care or the emergency room.

Dedicated therapists and fitness programs

Carelon Health provides dedicated physical therapy to patients who need it. Through Carelon’s Nifty After Fifty® partnership, patients over the age of 50 can take in-person group or online exercise classes to enhance their physical and mental wellness.

Innovating for the future of patient-first care

While we have seen great success with our Advanced Primary Care model, we are not interested in resting on our laurels. Carelon Health is constantly improving along with the latest evidence-based practices and future-forward approaches to patient-centered care.

"What I've seen from this company is its flexibility in figuring out how we can do things differently. That's an ongoing process," says Dr. Groshner. "Reaching people where they are is a massive focus for us. Trying to make sure we're taking the next steps and stay ahead of the curve, that's how we provide the best care we can."