A growing number of providers are adopting new primary care models and offering patients with complex conditions targeted services, including transportation and mental health care through a concierge-like approach, Alex Kacik reports for Modern Healthcare.

Just released: The future of primary care

Background

The new models come amid a push to boost primary care, Kacik reports. For instance, Rhode Island required insurers to increase the share of total medical spending on primary care by 1 percentage point annually from 2010 to 2014. This led to a $27 million increase in total primary-care spending from 2010 to 2017 and a $115 million decrease in total health care expenditures, according to Advisory Board.

In addition, CMS last year began accepting applications for the agency's direct contracting (DC) path under the agency's new Primary Care First (PCF) alternative payment model.

On the employer side, PepsiCo last year agreed to pay employees health insurance premiums for a year if they selected a high-value primary care physician.

Health systems and companies adopt new primary care models  

To address primary care gaps and other issues, a number of health systems are adopting new concierge-like approaches for primary care through in-house services and partnerships to reduce hospitalizations, lower costs, and reduce medical complications.

For example, Advocate Aurora Health in Illinois is partnering with the privately owned company Oak Street Health to open a high-touch clinic for seniors living in the Chicago area, Kacik reports. Oak Street Health uses capitated or full-risk models to offer Medicare, Medicare Advantage, Medigap, and Medicare-Medicaid beneficiaries tailored care, Kacik reports. Griffin Myers, Oak Street Health's CMO and co-founder, said, "We work with folks who justifiably don't trust the health care system anymore. Before care, we have to make sure they trust us."

At Oak Street Health in Bronzeville, Illinois, patients are paired with an assistant, nurse, physician, and scribe and they receive transportation to and from their appointments and social events. Patients also have access to a 24/7 support line, health insurance information, same-day appointments, supplemental services—such behavioral health, eye exams, in-center pharmacies, and podiatry—and social, fitness, and learning activities. Oak Street Health, which has 50 centers across seven states, has helped to lower patient hospital visits by 41% since 2012, Kacik reports.

Advocate Aurora Health's executives said partnerships are more cost-effective and efficient than developing in-house services. Scott Powder, chief strategy officer at Advocate Aurora, last year said, "There is a whole range of things that are outside of the traditional purview of a hospital or even a physician practice. As big as we are and as good as we are, we can't do everything."

In Florida, ChenMed, a Miami-based primary care company, offers patients lifestyle classes, imaging, labs and acupuncture, same-day appointments, transportation, unlimited visits, and on-site acupuncture, cardiology, imaging, labs, and medication dispensing. ChenMed, which operates 59 clinics across 39 cities in eight states, contracts with more than 20 Medicare Advantage health plans, which pays monthly per member. 

Companies like ChenMed and Oak Street Health typically employ primary care physicians and contract specialists such as cardiologists, Kacik reports.

Castell, a company recently spun off by Intermountain Healthcare, offers affiliated network management guidance, data analytics, and other best practice services, in an effort to deliver value-based preventive primary care. The health system's executives said Intermountain's Reimagined Primary Care has allowed physicians to spend more time with high-risk patients to address potential health issues, reduce hospitalizations, and cut costs.

Other health systems, including Johns Hopkins Medicine, Mount Sinai Health Systems, Stanford Medicine, and UnityPoint Health, have launched models similar to Intermountain's, Kacik reports.

What these models mean for health systems

Christopher Kerns, VP of executive research at Advisory Board, said, "These models have shown that there is no such thing as an unprofitable patient," noting that these primary care models allow providers to save money by steering the sickest patients toward lower-cost care. Kerns added, "They also create a new series of winners and losers as referral patterns change." Primary care physicians have often been seen as a source for specialty care referrals.

According to Advisory Board, health systems will likely need to partner with external groups to adapt to the changes in referrals.

Trish Anen, a principal and the advanced-practice provider workforce practice leader at SullivanCotter, said health systems generally have preferred to develop internal sources rather than establishing partnerships with existing providers. "They do it internally because they want to keep patients within their system," Anen said (Kacik, Modern Healthcare, 1/18).