One Primary Care Disruptor Focuses on Preventive, Proactive Care

May 23, 2023
Chicago-based Oak Street Health spoke with Healthcare Innovation about its disruption of the primary care market, by entrants like itself, and how this space might look down the road

The move toward nontraditional players “disrupting” primary care is now in full force. With the U.S. not having a sufficient number of primary care providers and underserved communities lacking adequate primary care services, organizations like Oak Street Health have taken the opportunity to innovate and change the landscape from the traditional fee-for-service arrangements that the majority of primary care providers operate under today.

Healthcare Innovation had the opportunity to speak with Geoff Price, Oak Street Health co-founder and chief innovation officer about Chicago-headquartered Oak Street Health’s beginnings, initiatives, and the disruption of the primary care sector overall.

Can you give us some background on Oak Street Health and its current initiatives?

We founded Oak Street Health in 2012 with the mission to rebuild healthcare as it should be—with a focus on care quality, not quantity of services. Now, more than 10 years later, our network of value-based primary care centers for adults on Medicare serve more than 224,000 patients across more than 170 centers in 21 states.

We intentionally built our model to support underserved communities. In particular, we focus on serving moderate- to low-income adults on Medicare across the country (many of whom face multiple chronic conditions) who have been left behind by our nation’s healthcare system. In fact, 42 percent of our patients are dually eligible for both Medicare and Medicaid, and 98 percent of our primary care centers are located in communities where the average income is 300 percent of the Federal Poverty Level or below. Seventy-seven percent of our centers are located in areas designated medically underserved or health professional shortage areas.

Because we operate a value-based care model where we’re responsible for the total cost of care for our patients, we can focus on care that is preventive and proactive, as opposed to reactionary sick care. This approach results in improved patient experiences and better health outcomes.

An exciting update from the past year is that our proprietary data platform, Canopy, was recognized by the MedTech Breakthrough Awards as the winner of the “Best Overall MedTech Software Award” for 2022. We custom-built Canopy because existing health technology platforms were built for fee-for-service medicine, focusing on services rather than patients. Our technology delivers context-rich, intuitive experiences to care teams, which ensures follow-through in the many places our patients need support.

We’re also proud to be leading the way in bringing value-based care to more Medicare beneficiaries through the ACO REACH model and are excited to continue our strong momentum in the new performance year. We’re also incredibly proud of our 2020 results in the Medicare Shared Savings Program in which Oak Street Health was the 4th highest saver of 513 Accountable Care Organizations participating, achieving a savings rate of 16.86 percent compared to 4 percent on average for the participating organizations.

Due to the care we’re able to deliver through our model, we’re incredibly proud  AARP selected us to be their trusted primary care partner. In fact, we’re the only primary care provider to carry the AARP name.

Additionally, we recently made an announcement about OakWell, a joint venture in partnership with Interwell Health to offer the highest-quality primary care to end-stage kidney disease (ESKD) patients directly in the dialysis center. It’s a unique approach designed to better leverage the roughly 12 hours each week these patients spend in a dialysis center, removing barriers to comprehensive care to improve their overall quality of life.

In addition, most physicians have only been exposed to fee-for-service medicine, and transitioning to value-based practice can feel daunting without the proper training and support. To help support this kind of workforce transformation, we are also investing in training providers in value-based care to provide the necessary skills, support, and education to become highly confident and competent clinicians for older adults. We launched a nurse practitioner fellowship in collaboration with the University of Michigan School of Nursing in 2022 and are launching a new graduate Behavioral Health Specialist training program. We are also partnering with the Kellogg School of Management at Northwestern University to offer a Fellowship for Value-Based Care Leadership. This is a two-year program offering physicians a unique opportunity to combine medical training with executive leadership business units to earn a sponsored Master of Business Administration degree that prepares them for effective clinical leadership roles.

There seem to be more primary care startups today than ever before, why is this?

The recent primary care report card issued by Milbank Memorial Fund and the Physicians Foundation made three key conclusions about primary care in America:

  • The U.S. doesn’t spend enough on primary healthcare
  • The U.S. doesn’t have enough primary care physicians – and the availability of primary care physicians varies widely from state to state
  • Primary care is not getting better in underserved communities

So, when you look at that failing report card, it’s clear there’s ample opportunity to improve how primary care is delivered in America. While I am biased and think Oak Street Health is the answer to these national challenges, the significant gap between what is needed and what exists is breeding a lot of innovation in this space.

At the same time, The Centers for Medicare & Medicaid Services (CMS) put a stake in the ground on value-based care, with a goal to have every Medicare beneficiary in an accountable care relationship by 2030. Primary care is the natural answer to advance value-based care models, with primary care providers (PCPs) serving as the quarterbacks of care.

In a system that still mostly delivers care through fee-for-service medicine, this goal from CMS is ambitious. There’s a lot of great work being done by new primary care entrants to support this transformation, and I think the markets recognize this shift.

What impact or impacts are these primary care startups having on the healthcare industry?

I’d love to start with the impact that Oak Street Health is having. Beyond just bringing primary care access to communities who have long lacked healthcare investment—we’re making a transformative difference in the lives of our patients.

Our value-based model allows us to deliver more proactive, preventive care, and our patients have on average eight annual visits compared to two to three for the average senior in America. That enables us to provide more preventive screenings and disease management, which in turn enables us to achieve a 51 percent reduction in patient hospital admissions, 51 percent reduction in emergency department visits, and a 42 percent reduction in 30-day readmission rates versus Medicare benchmarks.

Broadly, I think new primary care entrants are challenging the status quo in creative and positive ways to improve care for patients and to improve the health of the primary care workforce. There are many different approaches being tested in the market today, and that combined innovation will only serve to move primary care forward.

I’m incredibly proud of the value-based model we’ve built and scaled at Oak Street Health, and I look forward to continuing to bring high-quality care to more seniors across the country as we begin the next phase of our work.

Will more primary care startups join retail companies, like CVS, Walgreens, etc.?

Again, there’s many innovative primary care models being tested in the market today. Combining models with retail companies may be the right path for some. We are sure it is the right path for Oak Street Health.

For us, we see this as an opportunity to accelerate our ability to deliver on our mission to rebuild healthcare as it should be. Most importantly, that means continuing to make a meaningful difference in the lives of patients we serve by improving outcomes, lowering medical costs, and providing a better experience.

Together with CVS, we’ll have access to greater resources and capabilities to expand our reach and bring these improvements to more patients.

Where is this space going to be in the next, let’s say, five to 10 years?

Like I said before, we’re seeing some exciting new approaches to primary care and they’re all being tested in the market right now. The next five to 10 years will be incredibly instructive for which ones gain traction and drive the best results for patients, for providers, and for the system as a whole.

The strength of our model is evident from the results we’re able to deliver for our patients, so from an Oak Street Health perspective, we’re going to be laser-focused on bringing that model to more seniors and communities across the country; our goal is 300 centers by 2026.

For me, this is my life’s work. Being able to improve the lives of so many individual people and their families while tackling one of the biggest societal challenges we face has been incredibly rewarding.