For most Americans, it's not easy to schedule an appointment to see a primary-care physician or speak to one by phone. When patients can get in for a visit with a doctor, they're lucky to get 15 minutes of their time.
That's not the case at a JenCare primary-care center in Chicago's South Side Ashburn neighborhood. Executives for JenCare and its parent, ChenMed, urge doctors and staff to get their senior patients in often and spend as much time as they need with them. Patients there average more than three hours of face time a year with their primary-care doctor.
“Ask yourself, am I seeing patients frequently enough?” Dr. Gordon Chen, chief medical officer of Miami-based ChenMed, told the company's more than 200 doctors and care coordinators across the country during a video conference late last month. “If we could increase the average number of visit slots used to 18 a day per physician, think of what would happen to our outcomes and how many lives we could save.”
ChenMed operates 53 clinics in seven states, including this JenCare facility in Chicago's Ashburn neighborhood. (Harris Meyer)
That admonition isn't because the company, privately owned by the Chen family, makes more money by seeing patients more often. On the contrary, ChenMed, which operates 53 clinics in seven states, serves most of its patients under a fixed per-member, per-month payment from Medicare Advantage plans.
So its intense focus is on keeping its elderly patients, who average five chronic conditions, as healthy as possible and avoiding expensive emergency room and hospital stays. That means investing heavily in prevention and getting patients, particularly higher-risk people, in at least once a month and spending lots of time with them.
Otherwise, the company loses money, as Chen pointed out, citing negative results for the first quarter of 2018 due to a bad flu season. “We are behind budget; we have to catch up for all those hospital days,” he told the assembled doctors. “If we could touch our top 30 (high-risk) patients, our admissions would go down.”
Indeed, ChenMed's approach has resulted in 50% fewer hospital admissions compared with a standard primary-care practice, 28% lower per-member costs, and significantly higher use of evidence-based medications, according to a new study in the American Journal of Managed Care.
Dr. Gordon Chen (on screen), chief medical officer at ChenMed, addressing the company's doctors via videoconference (Harris Meyer)
ChenMed is one of a growing number of companies using intensive, team-based primary care to improve patient outcomes and the overall patient experience while reducing healthcare costs. Other players in this “high-touch” primary-care space—many of which are backed by venture capital investors—include CareMore Health System, Iora Health, Oak Street Health and One Medical. In addition, UnitedHealth Group's Optum, Humana and other insurers have invested heavily in coordinated primary-care groups.
Some of these firms, like ChenMed, Iora Health and Oak Street Health, focus on Medicare Advantage. Some, like Cerritos, Calif.-based CareMore, which is owned by Anthem, target high-needs patients in managed-care plans serving patients eligible for both Medicare and Medicaid. Others, like One Medical, target younger commercial members and employer groups. These companies often employ their own physicians and contract with specialists like cardiologists at some sites.
The companies have big expansion plans, with ChenMed having opened 10 clinics this past summer, while Iora Health has 10 practices about to open and aims to double in size each year.
Insurers offering Medicare Advantage plans like working with these primary-care groups because they've learned how to make money under risk-based payments by keeping patients out of the hospital and ER. Plus, they tend to produce high patient satisfaction, with Net Promoter Scores in the 80s and 90s, far above scores for insurers and hospitals.
“Because they've got a stable payment, these groups can do the things you can't do in fee for service—addressing social determinants of health such as transportation, food security, social isolation and housing,” said Dr. Roy Beveridge, chief medical officer at Humana, which serves nearly two-thirds of its Medicare Advantage members through value-based provider groups including ChenMed and Iora Health.
“We think what's missing in healthcare is there isn't an agent out there taking full responsibility for the health of patients and all the stuff that influences their health,” said Dr. Neil Patel, a regional medical director at Boston-based Iora Health, which mainly serves Medicare Advantage and traditional Medicare patients at 25 practices in seven states. “Primary care is the right seat. We're the ones to do it.”