Top Primary Care Innovators To Watch (Part 1 Of 2)
Primary care has long been attributed as being the life blood of the American healthcare system and serves as the foundation for referrals and patients for any large health system. Primary Care has traditionally been built upon a fee-for-service (FFS) model and has experienced a relatively low reimbursement compared to other services. This has led to an emphasis on maximizing the number of patients that a primary care physician treats to run an efficient practice and generate revenue. However, with the movement to value-based care, traditional FFS primary care is being disrupted. The adoption of value-based arrangements—which emphasizes the total cost of care for a patient and capitated payment arrangements—has sparked an increased level of investment and growth into the primary care market.
There are many entrants and start-ups who are looking to disrupt the traditional primary care players. This blog post series will highlight five primary care innovators that will impact how primary care is delivered across the country.
In today’s post, we’ll talk about the first two organizations: CareMore and ChenMed. Our next post in the series will provide an overview of three additional innovators: Iora Health, Oak Street Health, and VillageMD.
CareMore, a subsidiary of Anthem, is an integrated care delivery system and health plan dedicated to providing highly coordinated, interdisciplinary care to high-needs Medicare Advantage (MA), Medicaid, and dual-eligible populations. CareMore’s recognized clinical model promotes wellness and whole-person health through care coordination, patient education, and upstream prevention. CareMore complements high-touch primary care with protocol-driven chronic disease management and innovative programs that address seniors’ physical, emotional, and social needs.
- KEY DIFFERENTIATORS: CareMore’s acquisition by Anthem offers expanded access to capital, technology and data, and allows CareMore to quickly launch innovative models of care. Anthem’s 2018 acquisition of Aspire Health, a large community-based palliative care provider, extends the reach of CareMore’s model, which is already poised to serve seriously ill populations (the focus of recent CMMI models, in which CareMore and Aspire are participating). CareMore’s expansion into Medicaid in recent years has prepared the organization to be an attractive cost-cutting partner.
- FOOTPRINT & GROWTH: CareMore was founded in Southern California and has since expanded to nine states and the District of Columbia, serving over 160,000 patients.
- TARGET MARKET: Complex MA, Medicaid, and dual-eligible populations.
- CARE DELIVERY MODEL: CareMore improves care coordination and manages high-risk patients through three mechanisms: The CareMore Neighborhood Care Center (care centers that act as extensions of the patient’s PCP offices), Chronic Care Management Programs (programs designed to help patients proactively approach chronic conditions), and The CareMore Extensivist (employed physicians who manage hospitalized patients and monitor care transitions).
Starting as a small family practice, ChenMed has evolved into a family-owned medical provider, management, and technology company dedicated to providing affordable and accessible “VIP” healthcare to high-needs seniors with multiple chronic conditions, funded through full-risk arrangements with Medicare Advantage plans. ChenMed’s patients are predominantly elderly (average age of 73), seriously ill (75% have five or more chronic conditions), and low-income (95% are within 300% of FPL).
- KEY DIFFERENTIATORS: ChenMed invests significant resources into attracting the correct “type” of provider that aligns with the organization’s values and mission. Hired physicians enter a two-week training course at ChenMed that focuses exclusively on developing value-based practices. ChenMed creates technology in-house, including custom decision-support software and an EHR that is optimized for its full-risk MA model, rather than the typical documentation needs of off-the-shelf systems that are designed to justify fee-for-service billings. Having software engineers on staff has allowed for the rapid development of small ideas, such as the patient identification “life card,” which is used to measure patient flow within the center.
- FOOTPRINT & GROWTH: ChenMed currently operates 76 care centers in 10 states, concentrated in the southeast. The organization intends to open 25 – 35 centers in 2021 and another 40 – 50 in 2022.
- TARGET MARKET: High-risk seniors enrolled in MA. ChenMed’s patients are predominantly elderly (average age of 73), seriously ill (75% have five or more chronic conditions), and low-income (95% are within 300% of FPL).
- CARE DELIVERY MODEL: ChenMed applies a one-stop-shop approach to delivering multispecialty services in the community, utilizing smaller physician panel sizes of 350 – 450 (significantly lower than the national PCP average of 2,300) to focus on health coaching and preventive care. ChenMed practices offer a broad range of additional services on site, including dental care, imaging, acupuncture, as well as 15 high-volume specialties.
As the primary care landscape continues to evolve, primary care disruptors and innovators will continue to capture new market share from existing health systems and other organizations. These disruptors will increasingly become attractive partners for payers, vendors, and other healthcare organizations. Healthcare organizations looking to prepare themselves for the future should adequately understand the implications of these disruptions and strategically plan to prepare their organizations to either partner or appropriately compete with the primary care disruptors.