Health systems move slowly toward ‘high-touch’ primary care

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A number of hospital systems have moved to establish intensive, team-based primary care clinics along the lines of those operated by innovative independent operators like ChenMed and Iora Health.

They include Stanford Medicine, Johns Hopkins Medicine, Bellin Health, UnityPoint Health, Intermountain Healthcare and Mount Sinai Health System.

Some systems are doing it on their own, while others have partners. A recent American Hospital Association survey found that 19% of systems have purchased or partnered with an entity designed to deliver intensive primary care, while 57% said they are likely to do so.

Johns Hopkins Community Physicians launched a team-based clinic for high-utilizing Medicaid patients four years ago, and currently is rolling out similar models for Medicare Advantage and for homebound patients.

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Stanford Medicine started its Coordinated Care program for the highest-risk employees and family members in its self-insured employer health plan six years ago. It serves about 400 patients who it partners with around self-identified life and health goals.

Leaders of both programs say these high-touch primary care efforts—which feature multidisciplinary teams working intensively with smaller panels to address a wide range of factors affecting patients’ health—have produced sharp reductions in hospital admissions and emergency department visits. They want to expand the model to a wider range of patients.

But they say there have been many hurdles, including financial and cultural, to spreading this model. “You need payers who want to partner,” said Dr. Michael Albert, chief of internal medicine for Johns Hopkins Community Physicians, who heads the Hopkins effort. “Ideally, all payers would pay a per-member per-month fee for high-utilizing patients.”

“Stanford Hospital is a big part of the university’s revenue, and we were working to lower use of the hospital,” said Dr. Alan Glaseroff, an adjunct professor at Stanford Medicine’s Clinical Excellence Research Center. “That’s called an unaligned incentive.”

Nevertheless, a growing number of systems are moving forward on transforming primary care. The Center for Medicare and Medicaid Innovation and Stanford have led collaboratives and training programs to disseminate these intensive primary-care delivery models. Glaseroff, who’s led some of the programs, said the model has spread to about 15 healthcare organizations.

“Four years ago there were people scuffling out of the starting gate,” Johns Hopkins’ Albert said. “It’s amazing how far things have come.”

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