The role providers play in supporting employees along their health care journeys
Providers, especially primary care providers, can help streamline the health care experience for employees, which may lead to lower costs and better outcomes.
Primary care providers (PCPs) are the coaches of the health care system, according to Dr. Gerald Hautman, chief medical officer of National Accounts for UnitedHealthcare Employer & Individual.
"Primary care providers have the broadest scope of the field," Hautman says. "They call the shots."
PCPs are often the first line of defense when a health issue arises, whether that’s for preventive care, chronic disease management or the early detection and treatment of disease. When more specialized care is required, PCPs are typically the ones making referrals.
Research shows that 1 or more primary care visits a year increased the likelihood of vaccination by 127%, colonoscopy by 122% and mammography by 75%.1
These preventive measures may in turn lead to earlier detection of chronic conditions or other health issues, which can be associated with better health outcomes, lower costs and higher productivity.2
Yet, about 30% of people who received care between 2016 and 2022 didn’t see a PCP,3 so employers should seek out ways to encourage their workforce to establish relationships and engage with PCPs.
"When members have a primary care physician, they tend to have a lower total cost of care," says Stephanie Alberti, vice president of network-based products for UnitedHealthcare Employer & Individual. "And our research demonstrates members have a better experience because they’re able to navigate a complex health care system a little more easily."
Providers help employees navigate the health system
Providers play a key role in helping their patients maneuver a complex health care system.
"When a personal health event arises, it becomes really clear how important a primary care provider is," Alberti says. "If you already have a trusted relationship with a provider who knows you and your health history and can help you navigate next steps, you’re ahead of the game."
The reality is that providers — PCPs or otherwise — are often viewed as the face of health care. So, the experience employees have with providers can greatly influence their overall health care experience. In fact, bedside manner, staff and the competence of providers were identified as the top 3 drivers of health care sentiment among patients.4
PCPs can also act as an employee’s care coordinator when more complex issues arise, recommending quality, cost-effective prescriptions, specialists and sites of care. Point of Care Assist®, a UnitedHealthcare tool that integrates real-time member information into existing electronic medical records, can help simplify that process for providers.
PCPs in Action
- Lisa visits her PCP, and they discuss the need for a colorectal screening
- Using Point of Care Assist, the PCP can see that this employee’s health plan requires a referral to a gastroenterologist at an ambulatory surgery center
- The PCP can quickly and efficiently identify a UnitedHealth Premium® care physician — physicians who are recognized for providing quality and cost-efficient care — and make the referral
The Outcome
This creates a better experience for the employee, who is not only saving money on her screening but also learning about the importance of preventive care, such as screenings. That patient-provider experience matters to employers because it can affect employee satisfaction with the health plan and benefits offered in addition to health outcomes and costs. Ensuring employees have access to quality providers who deliver a positive experience across the care continuum is essential.
Lisa is not a real member. This hypothetical case scenario is intended to be used for illustrative purposes only.
Implement network strategies that promote quality care and preserve provider choice
To help ensure employees have access to the providers they need, employers may want to consider the pros and cons of different network configurations for their own unique workforces. For instance, tiered networks, which can offer quality care, cost savings and a broad range of choices, are rising in popularity. These types of networks can help employees make informed decisions by incenting them to choose providers that are associated with better results and lower costs.
"With these networks, employees still have choice," Alberti says. "Employees can still choose to go anywhere, but they’re going to get a better benefit if they choose a Tier 1 provider. They’re probably going to have a better outcome and a better experience too because the way that those providers earn their way into Tier 1 is by providing better outcomes and better total quality."
Narrow networks that have a smaller pool of providers can sometimes detract from an employee’s health care experience.
"If an employee wants to go to this certain provider, and that provider is out-of-network, employees can feel like something is being taken from them," Alberti says. "They can go out-of network, but that exposes them to higher out-of-pocket costs."
When selecting a network, employers may also want to consider the availability of providers that mirror the diversity found in their workforces. Research shows that patients prefer providers who share a similar background as them, but 53% of surveyed Black adults and 39% of Hispanic adults said it’s very difficult or somewhat difficult to find a doctor who shares their racial or ethnic background in the area where they live.5
Deliver a whole-person approach to care
It’s increasingly important that employers offer access to providers that can support employees across the care continuum.
For instance, integrating medical benefits with behavioral health offerings can help providers address mental health concerns, which are increasing among today’s workforce and their families. Integrating benefits can also allow providers to get employees the care they need more quickly and efficiently, which can result in a better experience. With a more holistic view of an employee’s health, providers may also be able to identify social determinants of health and remove barriers that may be impacting their overall health and well-being.
Employers may also want to ensure that they’re meeting the needs of their multigenerational workforces. For instance, depending on an employee’s generation or life stage, "primary" care may look different. A woman in her childbearing years may think of her OB/GYN as her PCP while Millennials or members of Gen Z may not think they need a PCP or when they need care, they may want it on demand or virtually.
Providers can certainly help employees navigate the health care system, but it’s a team effort. Employers and carriers also have a part to play.
