Humana and Oak Street Health in Chicago have decided to partner on a model for value based primary care that facilitates the Medicare and dually-eligible beneficiaries.
By all accounts from the chief medical officers from both the Humana and Oak Street Health, the model that started on the west side of Chicago is victorious on all the metrics that matter, such as reducing hospital admission rates by 45%.
Since it started 3 years ago, the Oak Street model has expanded to 19 locations in the Midwest, in accordance to co-founder and Chief Medical Officer Griffin Myers, MD.
“Our population is merely shy of 25,000 sufferers,” Myers claimed. “About half are dually-eligible.”
Humana provides the claims data and analytics so that, for example, after the doctor writes a prescription, Oak Street gets the feedback on either that prescription was filled.
“In this new value world, the payer is no longer the enemy,” claimed Roy Beveridge, MD, chief medical officer for Humana. “The payer is supporting the practice in its crucial mission.”
Myers demonstrated he is not worried about how potential new healthcare plans under a Trump administration would impact the PCP value-based model.
“Low on my list of uncertainties is how policy affects (this),” Griffin stated. “When we first initiated, it was regulatory this and regulatory that. If we’re the best, highest quality place for sufferers to get value based primary care, we’ll always be in place.”
Griffin is an ex-emergency room doctor who said he discovered the practice because he was tired of seeing the same sufferers over and over again.
“It was low income older adults with chronic disease,” he stated.
The sufferers were not managing their conditions, he said, because they were not seeing a primary care doctor.
“The reason you end up in the ED is always due to a failure in primary care,” he stated. “We began knowing we could never give care in a fee-for-service model because the sufferers could not afford it.”
Oak Street has a team of 6 doctors and nurses for over 400 to 600 sufferers, who are capable to spend more time with a patient than on a fee-for-service model. Physicians do no data entry.
Getting there was not that easy.
“It is insanely tough,” Myers claimed. “You look at the degree of expertise and capital needed to develop an independent value based primary care practice. There are folks who merely need to offer the front-end of care. An average PCP has 2,500 sufferers.”
Beveridge and Griffin advise providers needing to initiate a similar practice to jump in, instead of being split in the fee-for-service and value-based worlds.
“It is tougher for entities to have a foot in both worlds,” Beveridge claimed.
The risk-based arrangement established meaningful savings, Myers stated. Humana reported 20% lower costs for members treated by providers in value-based reimbursement settings vs. traditional Medicare Advantage settings.
Oak Street has a complete value-based arrangement with Humana for their Medicare Advantage and dual-eligible patients.
“We take a sick population of sufferers and acquire measurably better outcomes at measurably lower charges,” Myers stated. “That is our business model.”
Humana claimed that it has more than 900 value-based relationships with near to 50,000 physicians in 43 states and Puerto Rico.
Almost, 63% of Humana individual Medicare Advantage members are affiliated with primary care physicians who are engaging in value-based relationships.
The insurer declared previously this year that it paid $93.6 million to 4,465 providers who participated in a rewards program for value-based care.
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