Reimagining primary care is “harder than rocket science”
Reforming primary care is “harder than rocket science”, according to Dr. Griffin Myers, the CMO of Oak Street Health, a primary care clinic provider. Oak Street Health takes a novel approach to primary care, focusing on Medicare and community-based care. Its doctors only oversee 500 patients each, giving each individual more time per appointment and focusing on the provision of value. Each clinic offers a community space with regular patient events and providing remote monitoring services. The centers also provide transport and counselors for insurance coverage queries. The ability to provide value-based care may be difficult to implement initially due to a lack of impetus to change the status quo, but the company’s model is working. The company funds itself by using a Medicare Advantage contracts, moving away from fee-for-service and actively investing in value. The approach has decreased the hospitalization rate for managed care patients by over 40%.

Reimagining primary care has become a common refrain in healthcare these days, and one company endeavoring to do that is Oak Street Health.

Unlike the stark setting of the regular American clinic, a recent visit to Oak Street Health‘s Madison Street center in Chicago’s Garfield Park neighborhood revealed a welcoming place. Springtime decor on the walls greeted visitors. One section of the room held a TV beaming the latest news, which was surrounded by a couch and chairs. A set of computers stood along one wall, while open tables and chairs filled out the space. In one corner was a bulletin board, advertising upcoming events like computer classes, bingo, a movie and popcorn afternoon, trivia and step classes.

The community education and events emphasize the unusual approach that Oak Street Health is taking to its primary care clinics throughout Illinois, Indiana and Michigan.

“I’d love to be a patient at Oak Street,” said Mike Pykosz, the Chicago company’s CEO in a recent interview. “But it’d be a waste of money.”

That’s because Oak Street Health’s model is geared toward Medicare patients.

The company was founded in 2012 by three former members of the healthcare practice at The Boston Consulting Group: Pykosz, who now serves as CEO; Geoff Price, who is now COO; and Dr. Griffin Myers, the organization’s CMO. But their backgrounds also vary. Pykosz is an attorney by training while Myers previously served as an emergency medicine physician at Massachusetts General Hospital and Brigham and Women’s Hospital.

During his time at Mass General and Brigham and Women’s, Myers noticed a recurring pattern: He was seeing the same patients time and time again. Most of them were older individuals with chronic conditions and a lack of access to primary care.

The trio set out to change that, and Oak Street Health was born. The name was inspired by a desire to evoke a sense of familiarity. Oak Street, as it turns out through a Google search, was near the top of the list of common street names in the U.S.

The company’s first center opened in the Edgewater neighborhood of Chicago in 2013. Today Oak Street has 20 centers in Chicago and Rockford in Illinois; Detroit, as well as Indianapolis, Fort Wayne, Hammond, and Gary in Indiana. It has 800 employees, including physicians, nurse practitioners, and clinical informatics specialists. In sum, all of its clinics see about 28,000 patients annually.

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The company’s model of care focuses on the Medicare patient population, typically in low-income neighborhoods. Their physicians oversee fewer patients (about 500, compared to between 2,000 and 2,500, according to Pykosz) and spend more time with each patient (about 30 minutes) than the average physician (who sees patients for about 13 to 16 min).

“We’re a fully value-based practice,” Myers said in an interview. “We have a unique way to invest in preventive care in a way that keeps people healthy.”

That unique approach involves looking at patients’ lives beyond their particular malady. And that’s the raison d’être for the community centers, regular events for patients, and remote monitoring services. There’s also a van service for patients who can’t make it to an Oak Street facility on their own. Oak Street’s Medicare counselors can assist patients who have questions about their insurance coverage.

The model seems almost too good to be true. So much so, in fact, that it’s almost easy to forget about Oak Street’s hard costs like physical space and employing physicians. How can an organization like Oak Street Health manage to afford these costs, care for senior citizens who are likely to be more sick, and still profit as the executives claim?

The question wasn’t a surprising one for Myers.

“People always ask, ‘What’s your secret?’ There’s no secret,” he said. In fact, the team published their approach in NEJM Catalyst.

“Successful execution of our model rests on three principles: (1) a value-based economic model, (2) integrated population health, and (3) team-based care,” the NEJM Catalyst article states. Oak Street Health’s care teams utilize a data-driven approach to focus on accountable care.

Pykosz elaborated, citing Oak Street’s complete focus on value-based care.

“We entered into contracts with Medicare Advantage plans so we’re accountable for care,” he said. “We’re removing ourselves from fee-for-service and investing in care that leads to higher quality and lower costs.”

When Oak Street does its job, he said, older patients are kept healthier and hospital hospitalization rates are lower. According to NEJM Catalyst, thecompany has reduced the hospitalization rate of managed care patients by more than 40 percent.

An outsider with no apparent financial ties to Oak Street Health views the company’s approach positively.

“The way they set up their model makes a lot of sense,” said Chuck Feerick, a manager at Chicago-based Healthbox, in a phone interview. “They focus on those individuals that need a high-touch, high-care model.” [Healthbox assists healthcare organizations with innovation and entrepreneurship, connecting technology companies to health systems.]

Feerick thinks Oak Street’s take on primary care works because it is valuable to “build the care into the community.” But it may not translate to all patient populations — for instance, younger populations likely don’t need that community aspect tied into their healthcare.

Rejiggering primary care is not the pursuit of Oak Street alone.

Feerick pointed to companies like One Medical and Iora Health, both of which are tackling primary care. San Jose, California-based One Medical specializes in same-day appointments when and where the patient wants. Meanwhile, Boston-based Iora Health has its own primary care clinics for certain groups of patients, while also partnering with other providers such as Dartmouth Health Connect. Forward, a San Francisco startup that launched in January also seeks to reimagine primary care, but with a tech-heavy focus and for a cash-rich patient group.

When it comes to competition, Oak Street’s Myers pointed to an all-too-familiar figure: the status quo.

“Our competition is inertia,” he said. “Either patients haven’t heard about us or they’ve come to expect the nonsense primary care they get in the system.”

With 20 clinics opened in just four years, more people will likely hear about the company if the pattern of growth holds. And with that, Myers hopes that the status of the humble primary care doc will be elevated.

“I think the heroes go into primary care,” he said, and not only the ER doctors and surgeons who people hold in the highest esteem.

Going forward, Oak Street Health plans to capitalize on the work it’s already done and the lessons learned on the way.

“Each piece [of what we do] is not rocket science,” Myers said. “But in combination, I actually think it’s harder than rocket science.”

Photo: Tori Soper, Oak Street Health