Care model

Our care model embraces VBC by engaging health care providers committed to high quality care and patient experience while lowering cost (aka Value) with evidence-based medicine. High quality care commonly leads to better health outcomes and lower cost by minimizing complications and eliminating redundant and ineffectual care.   

VBC emphasizes prevention and early intervention with proactive primary care to curtail illness, injury and disease progression. It takes a whole person approach to patient care by evaluating all physical and mental aspects of health. It measures, rewards and holds providers accountable for achieving targeted health outcomes.

Advanced Primary Care (APC)

Our care model centers on VIP primary care treating over 80% of all health issues and coordinating all other necessary care. This is delivered through a subscription service that pays for itself by eliminating unnecessary downstream specialty care.

• Lower Member Cost: No co-pay, deductible or out of pocket cost.
• More Clinician Access: Unlimited 24/7 in-person and virtual access (phone, text, email, video) to the same primary care provider (PCP) with same or next day appointments.
• More Clinician Attention: Smaller panels of 600-700 patients (compared to 2500 in traditional primary care) enable the PCP to provide 40 minute office and virtual visits (versus traditional 10-15 minutes) to comprehensively understand each patient’s health.
• Closer PCP/Patient Relationship: PCP builds a trusted and communicative relationship with patients as their health coach. PCP navigates members in health system and self management of health.
• One Stop Care: PCP manages prevention, wellness, chronic disease, illness and minor injury treatment for all family members. Chronic patients are closely managed with early intervention treatment and lifestyle coaching.
• Care Coordination: This improves outcomes by reducing care fragmentation and barriers causing care gaps and missed visits. Coordinates hospital admission/discharge and post-discharge follow-up. Needless care is eliminated which reduces emergency visits by over 50% and outpatient procedures and hospital stays by over 20%.
• Health Data: Patients have portal access to their electronic medical records and health information. Employers have access to anonymized clinical and utilization data to manage population health.
• No Insurance Claims: Saves clinician time and administrative cost.

Smaller patient panels and longer appointments enable physicians to truly know and care for their patients’ health concerns the way medicine should be practiced.

High Performance Specialty Care (HPSC)

A curated, high performance specialty care network is customized for each market. This drives superior quality outcomes and value. Members benefit from having access to the best providers with fair and transparent prices.

• Specialist: We guide members to high quality providers in the HPSC network most appropriate for their needs. Plans can combine this with a physician PPO network to provide more choice. 
• Diagnostics and Imaging: APC partners with national and local diagnostic and imaging providers at rates substantially below standard market prices.
• Behavioral Health: In-person and virtual behavioral health can be integrated with APC as mental health and substance abuse critically impact physical health and over all wellbeing. Behavior modification is necessary to tackle chronic disease. Both mental and physical health issues are best addressed early on to prevent more serious conditions that can manifest without medical attention.
• Physical Therapy (PT): PT can be integrated with APC to best address musculoskeletal conditions and avoid unnecessary orthopedic surgery.
• Centers of Excellence (COE): COEs have built expertise in specific surgeries and procedures by performing high volumes with exceptional quality outcomes at reasonable bundled prices (all costs included).
• Pharmacy Benefit Manager (PBM): Fully transparent PBM that passes all price spreads, discounts and rebates to the employer plan and is only paid a fixed monthly service fee. Many APC practices provide generic drugs onsite in their offices at very low cost.
• Specialty Care: Bundled programs for oncology, maternity care, renal care and other high cost, disease and condition related services. 

Standards of Care Excellence

Our model embodies these care delivery standards.