Advancing primary care for better health, access and cost control

To improve health outcomes and control employer healthcare costs, all roads lead to primary care. Blue Cross and Blue Shield of Minnesota is at the forefront of primary care innovation, addressing challenges such as access, cost and member engagement through our trusted approach. We are committed to providing access to primary care that meets members where they are, which is foundational to closing gaps in care and driving affordability.

Studies show that consistent access to primary care can lead to longer, healthier lives.¹ U.S. adults who regularly see a primary care physician have 19% lower odds of dying prematurely than patients who see only a specialist. They also have 33% lower healthcare costs. In fact, every $1 increase in primary care spending produces $13 in savings.² That’s why 70% of employers were expected to use at least one advanced primary care strategy in 2024, up significantly over past years.³

The importance of primary care

Primary care in the U.S. historically has been underfunded and undervalued relative to specialty care. Despite the proven benefits, only 5% - 6% of total U.S. medical expenditures are for primary care.⁴ Primary care also is understaffed because of a national shortage of primary care providers.⁵

Other challenges for primary care practices include managing large numbers of patients and caring for an aging patient base with complex conditions and other critical needs. This, in turn, causes access problems: One-third of Americans lack access to primary care⁶ and the average wait time to see a family medicine physician is almost 21 days.⁷

While primary care doctors treat the patient holistically, specialists are trained and qualified to treat a specific bodily system. Specialty care not only is more expensive, but it can also miss the early warning signs for related conditions and comorbidities, including behavioral health.

Blue Cross offers primary care innovations like behavioral healthcare integration, network expansion, value-based payment models, and data-driven provider tiering and steerage to help employees easily access primary care.

Behavioral healthcare integration for whole-person health

Integrating behavioral healthcare is an imperative for primary care. Behavioral health conditions account for an estimated 57% of total healthcare costs,⁸ and up to 75% of primary care visits include a behavioral health component.⁹ For members with chronic health issues, a comorbid behavioral health condition can raise total cost of care three to six times higher.¹⁰

Results show that integrating behavioral health and primary care can lead to an 11% reduction in total cost of care.¹¹ Blue Cross and Blue Shield of Minnesota offers employees a primary care referral model to ensure all members have access to high-quality behavioral healthcare from expert clinicians. Through early diagnosis and integration of behavioral healthcare, members receive customized treatment addressing their whole-health needs.

To enable members to access behavioral healthcare wherever they live, Blue Cross nationally has expanded its mental health network by 55% over the past five years.¹² We now offer virtual treatment options for substance use and eating disorders, so members can receive treatment at home without time away from work or school. And for children and young adults, we’re offering virtual intensive outpatient treatment with flexible scheduling, often within 24 hours of referral.

Primary care innovations yield results for your employees

A top consideration and driver of financial value is preventive care, which is very dependent on employees’ ability to keep and choose their primary care doctor. To extend the benefits of primary care to your employees, Blue Cross has launched several initiatives aimed at improving access and guiding members to high-quality providers:

• Network expansion: Blue Cross has expanded networks and developed geo-access matching, to ensure employees can visit high-quality primary care providers within a convenient distance from home. Blue Cross has the industry’s broadest preferred provider organization with deep local market understanding and 98% of claims paid in network.¹³ Expanded networks include more providers, such as nurse practitioners and physician assistants, to free up appointments and shrink wait times.
   
• Blue National Physician Performance Dataset (BNPPD): The BNPPD evaluates the performance of more than 360,000 individual physicians across 20 specialties, including primary care, leveraging the largest repository of commercial provider data available in the market. The BNPPD evaluates provider performance on dimensions of cost, quality and appropriateness of care, enabling benchmarking and comparison across medical specialties to improve health outcomes for members and increase efficiency of healthcare spending.
   
• Blue Care Advisor: Blue Care Advisor^SM is another high-performing solution that guides patients to appropriate primary care providers based on quality, site of service and cost – all of which encourages preventive care. Blue Care Advisor brings together health, wellbeing and navigation into one easy-to-use digital resource.
  
  Blue Care Advisor uses artificial intelligence and machine learning to segment members based on health status as determined by their health history and claims data, individual assessments and other engagement parameters. These segments are used to direct members to the care they need when they need it, using the most appropriate channel to close their gap in care.
  
  Results are encouraging: Registered members are twice as likely to complete preventive care exams compared to those that are unregistered. In 2024, Blue Care Advisor drove nearly 104,000 members to close a preventative care gap for the first time in at least two years.¹⁴
   
• Coupe Health: Coupe Health, an alternative health plan design offered by Blue Cross, is a transparent, straightforward and intuitive product that gives members control over their healthcare. The Coupe app uses data-driven provider tiering to help members select high-quality providers. With this model, more than 50% of care shifts to lower-cost, higher-quality providers and has helped reduce employer and member plan costs by 12%.¹⁵

Value-based care models impact primary care outcomes

Value-based care means providers are paid for value rather than volume.

Nationally, Blue Cross has three times more providers in value-based arrangements than competitors, and 70% of Blue Cross members have access to value-based care programs.¹⁶ These include wellness and preventive services, same-day or next-day primary care provider visits, and 100% of plans with access to virtual behavioral healthcare.¹⁷

Value-based care has positive effects on primary care:

• Chronic condition management: 4% better comprehensive diabetes care¹⁸
• Preventive testing: 6% increase in breast cancer screening rates¹⁸
• Inappropriate and unnecessary care: 10% fewer emergency room visits¹⁸
• Integration with behavioral healthcare: 13% better mental health outcomes¹⁸

Value-based care encourages providers to keep members healthy, preventing disease rather than treating disease after it occurs. Under value-based care incentives, doctors and other healthcare providers can get creative, working as a team to manage a person’s overall health and enable the individual to reach personal health goals.

Healthcare providers may schedule more frequent visits with the member to check in on chronic conditions and medication compliance. They also may address social drivers of health (SDoH), such as nutrition, lifestyle and family support. This approach to care has proven to help members avoid the emergency department and prevent hospital admissions.¹⁸

Access to primary care helps lower total cost of care

When employees can access primary care, they have a path to better health outcomes throughout their wellness journey. With Blue Cross, your employees get primary care with expanded networks, integration of behavioral healthcare, data-driven navigation support and value-based care models. Our commitment to accessible, affordable, quality care makes Blue Cross a trusted partner for employers who want the best possible healthcare for their employees while reducing the overall cost of care.