P2P+E: Understanding the employer role in an improved patient-to-primary care physician relationship

January 28, 2019

Perspectives in Primary Care (formally the Primary Care Review) features perspectives from practitioners and students representing organizations, practices, and institutions across the country and around the world. All opinions expressed in this article are owned by the author(s).


Creating sustainable, timely care delivery models designed to help patients achieve improved health outcomes is a challenge. The complex, chronic conditions of America’s workforce are driving the need for these models forcing employers into the position of leading health care delivery innovation.

Employers, the primary source of insurance for 55.7% of Americans[i], have found themselves tasked with reducing healthcare’s unprecedented, rising costs to protect employee health, talent retention, productivity, and their bottom line. The necessity cannot be overstated: diabetes, which cost the U.S. $237 billion in care-related costs in 2017, and $90 Billion in lost productivity annually[ii], can be better managed through intensive primary care physician interaction that effectively changes a patient’s long-term behavior for the better. Consistent, monitored behavior modification focused on greater medication compliance, diet, and lifestyle modification (with an awareness of socio-economic factors) is more than a “corporate wellness initiative,” it’s the only long-term way to guarantee a productive, talented U.S. workforce.


Better health outcomes increase employee satisfaction. Healthy employees, satisfied with a benefit health plan that provides the health services they need when, where, and how they need them, are productive (and loyal) employees. Millennials, currently 35% of the US workforce[iii], cite health benefits as a reason they will or won’t stay with a company[xxxi]. As the first generation on track to spend half of every dollar they earn on healthcare-related costs within their life time[iv], excellent benefits guide Millennials’ decision to stay with an employer or leave over other preferences—including raises[iv]. Unfortunately, superb health insurance benefits are useless if employees lack the time, transportation, incentives, or resources to utilize them.


Employers grasping at financially viable ways to effectively bear their unsung role as America’s health care insurance provider must understand the best care is worthless if it’s inaccessible. Traditionally, only cost and member benefit were thought to be in an employer’s span of control. Increasing access to primary care as a part of a value-based, care-coordinated solution may eliminate or mitigate the need for costlier future hospital interventions and lost productivity, offering additional sources of savings. Despite the broad nature of many health plan configurations, employers and employees alike are growing more frustrated with their lack of access to timely, appropriate care.


The advent of high-deductible health plans, which shifted more cost-share responsibility to the patient, yielded mixed results: when health care is too costly, patients choose cheaper healthcare options, often lacking appropriate coverage or going without coverage entirely[v, vi, vii]. These high-cost plans ultimately failed to produce the desired outcome of more educated and healthcare-industry savvy consumers, leaving huge swaths of America’s workforce functionally uninsured and financially fragile [viii]. Greater patient engagement, access to care, and appropriate service utilization can reduce the total cost-of-care per employee while improving health outcomes and maximizing talent retention and productivity. If employers remain America’s de-facto health insurer, value-based, care-coordinated benefits are not only a model for health care reform and a way to restore the patient-to-physician relationship, they are the United States’ best option for remaining a powerful, global economic force.


Creagh Milford, DO, MPH, FACOI is a physician executive currently serving as Chief Medical Office for Healthcare Highways, Inc. Dr. Milford has held several C-suite and senior executive positions. His prior roles include CEO of FullWell, LLC; system-wide division president of population health services for Mercy Health; Assistant Chief Medical Information Officer for Massachusetts General Physician Organization and Massachusetts General Hospital; and Associate Medical Director for Population Health Management at Partners Healthcare.



[i] https://www.census.gov/content/dam/Census/library/publications/2017/demo/p60-260.pdf

[ii] http://www.diabetes.org/advocacy/news-events/cost-of-diabetes.html

[iii] https://www.ncbi.nlm.nih.gov/pubmed/29567642

[iv] https://www.forbes.com/sites/forbesbostoncouncil/2018/09/10/the-three-benefits-millennials-are-demanding-from-employers/#4cbfb0c05bd3

[v] https://www.usatoday.com/story/news/nation/2015/01/01/middle-class-workers-struggle-to-pay-for-care-despite-insurance/19841235/

[vi] https://www.beckershospitalreview.com/payer-issues/analysis-high-deductible-health-plans-broke-the-us-health-insurance-system.html

[vii] https://www.bloomberg.com/news/features/2018-06-26/sky-high-deductibles-broke-the-u-s-health-insurance-system

[viii] https://www.npr.org/sections/health-shots/2016/03/08/468892489/medical-bills-still-take-a-big-toll-even-with-insurance

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