Nothing Narrow About It:
PBGH’s Primary and Specialty Care System of Excellence Offers Broad Array of Features and Benefits  

PBGH’s Primary and Specialty Care System of Excellence (SOE) represents a powerful new approach to health benefits that allows purchasers to contract directly with vetted, high-performing primary care and specialty practices.

But while designated groups of providers delivering cost-effective, high-quality care is central to the SOE, it’s critical to understand that the approach differs fundamentally from the “narrow network” model many insurers have adopted in recent years.

Freedom of Choice 

Narrow networks typically restrict patient access to a limited panel of doctors, hospitals and treatment facilities willing to accept lower reimbursements in exchange for the expectation or promise of higher patient volume.

PBGH’s SOE imposes no such limitations and patients are free to continue using the  provider of their choice. That said, the SOE’s rigorous emphasis on quality and efficiency, plus a range of patient-friendly features, make it more likely patients will vote with their feet and voluntarily embrace the SOE.

More Key Differences 

Other key distinctions between the SOE and the narrow network model include:

Advanced Primary Care 

Perhaps the most significant difference between the SOE and the narrow network model is both philosophical and practical: Unlike most insurance networks, narrow or otherwise, SOE puts advanced primary care – and the primary care physician — squarely at the center of the care process. This also means that referrals are made by primary care physicians with direct knowledge of a patient’s medical needs, not health plans. This not only ensures clinical appropriateness, but all evidence shows patients are most likely to follow guidance from their care team. Advanced primary care is a codified, patient-centric approach that incorporates quality metrics, interdisciplinary care, seamless integration with other care elements, including behavioral health, expanded patient access and a recognition of underlying social determinants of health (SDOH).

Lower Costs, Improved Retention and Recruitment 

Building a care system around primary care is essential for lowering employers and employees’ total cost of care. Adults who regularly see a primary care physician have 33% lower health care costs and reduced odds of dying prematurely than those who see only a specialist. Every $1 increase in primary care spending produces $13 in savings. And if everyone used a primary care provider as their principal source of care, the U.S. could save $67 billion annually.

Access to preventative and primary care likewise plays an important role in employee retention. Companies that establish effective wellness programs are considerably less likely to lose employees due to voluntary attrition. At the same time, the majority of workers say their level of satisfaction with healthcare benefits plays a major role in deciding whether to stay at a job or move on.  

An Innovative Approach

Here’s how PBGH’s SOE works: 

Back to the Future 

PBGH’s System Of Excellence marks a critical evolution in the delivery and payment of health care. At the same time, it represents a return to a time when care was patient-focused and quality-oriented, a time before monopolistic systems with strong incentives to overtreat regardless of quality came to dominate the system. That doesn’t mean we begrudge profitability among providers –in fact we want to pay our selected provider partners more and differently. But in return, we expect and demand the highest quality and cost and outcome accountability. The SOE provides a vehicle for achieving these objectives and in so doing, fundamentally alters the misaligned incentives and unsustainable trajectory of the current system. Most importantly, it gives patients and families easy, trusted access to the very best care.