Can We Deliver Affordable Health Coverage Without Compromising Quality?

Primary care is at the center of a new type of better health plan

With health benefit costs rising for employers and their employees, it’s clear the current employer-sponsored insurance options are not working. But employers do not want to compromise quality just to save money. One way to address these needs is through a focus on primary care, which lowers costs by helping people access high-value care. With this in mind, Centivo offers a health plan designed to bring quality, easy-to-use, affordable care to employers.

Dr. Wayne Jenkins, Centivo’s Chief Medical Officer,isan accomplished physician and executive with a proven track record of patient-centered, revenue-driven results. Over the course of his career, he has consistently transformed large, complex healthcare systems into market leaders that deliver quality and value in a dynamically changing environment. In this Q&A, he discusses the importance of primary care in providing affordable, efficient healthcoverage.

Why is primary care the key to controlling health care costs, and how can we put it at the center of a health plan?

WJ: When chronic conditions are uncontrolled, it leads to catastrophic clinical outcomes and high costs. Hospital visits and occasional high cost events are not entirely avoidable, but patients miss a vital preventive care step if they are not seeing their primary care doctor as the first line of defense. Centivo directs patients toward top primary care teams that provide high-value care, and then incentivizes them to build a relationship with their care team. The cost to see a primary care doctor is often free through Centivo, and we offer incentives for patients and providers to coordinate care, which leads to improved outcomes and lower costs.

There are a lot of options in primary care. How do individuals know they picked a great provider?

WJ: Centivo only partners with the top primary care providers, and we’re able to look at data and advanced primary care accreditations to pinpoint providers that are high performers, which means they deliver high-value care. We’ve also developed an interview process that can include one-on-one meetings, giving us confidence that we accurately selected high-value providers who meet our standards. And to ensure that our standards are adhered to in the long term, we compensate providers based on their record of delivering high-value care.

What are employers looking for in a health plan?

WJ: Employers need to be able to provide affordable care for their employees, particularly low- and mid-wage workers who can’t afford the high deductibles and out-of-pocket costs commonly seen today, and who are forgoing needed care. Centivo provides members with a dedicated primary care team that helps them navigate the health care system, guiding patients to the right specialists and facilities. By offering a strong primary care network and data to help them guide specialist referrals, we can deliver the outcomes patients deserve along with the value — and affordability — employers want from their health plan.

Why should providers work with a health plan centered on primary care?

WJ: Centivo is designed to deliver high-value, team-based primary care that reduces reliance on low-value treatment options like unnecessary emergency room visits that waste money and drain resources from health systems. Beyond that, Centivo also helps health systems operate more efficiently because Centivo plans are available to health system employees. In fact, a large system that partnered with us saw a significant decrease in its own employees making trips to the emergency room in the first year.

What drew you to Centivo?

WJ: Prior to Centivo, I was the Chief Clinical Officer for the Vanderbilt Health Affiliated Network and before that, I was Chief Strategy Officer for Orlando Health. At Orlando Health, I led the Medicare ACO, whose value-based care performance improvement caught the attention of Disney, and ultimately we partnered on a direct-to-employer commercial contract. My goal was to extend this model to reach the commercial market more broadly, but we didn’t have a strong health plan to partner with. I recognized that Centivo was designed to be a partner to health systems. Joining the Centivo team was an opportunity to facilitate connections between providers that have developed a strong value-based proposition and want to bring this model to the employer-based market.●