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In baseball, high-salaried home run sluggers have always gotten the glory. The equivalent in health-care may be high-priced drugs and medical specialties that help save lives in critical cases.
But 20 years ago, there was a big shift baseball. Leveraging data analytics, the Oakland A’s found success with undervalued players, who reliably hit singles and doubles to rack up runs. Chronicled in Michael Lewis’ “Moneyball,” their story ushered in a new era in the game.
Health-care may be looking at its own Moneyball moment. From venture-backed start-ups to drug store retailers, there is a big push this year to use technology and data to supercharge the less glamorous side of the industry — physician-centered primary care.
“Our sense is the primary care physician or group, being the navigator for the health care system is, is where they’re trying to move the models,” said Susan DeVore, CEO of Premier, a health care consulting firm.
It’s not a new concept, by any means. But unlike the old Health Maintenance Organizations, or HMO plans, of the 1990s which made doctors gatekeepers for obtaining coverage, the new primary care services aim to give consumers easier access to their doctors and reward general practioners for keeping patients healthier.
“I think there are a lot of things different today than what existed in in the 1990s that would really create an environment that’s more conducive for technology-enabled primary care,” DeVore said.
Primary care unicorn
One Medical could be the poster child in 2020. The tech-enabled primary care provider filed to go public last week. Its membership plans give patients same-day office visits and 24-hour telehealth access to primary care doctors for $199 a year.
Since launching in the Bay Area in 2007, One Medical has paired with physician groups and hospitals in more than nine major metropolitan areas including New York, Seattle and Los Angeles and counts more than 4,000 employers who have offered their workers memberships to the One Medical service.
But the competition in both the consumer and employer health markets is ramping up from start-up rivals and large health care incumbents, who are looking to leverage primary care.
Retail giants to expand
CVS Health launched its new Health Hub model in Houston last year, and plans to roll out 1,500 new enhanced in-store clinics over the next 24 months, offer check-ups, testing services, and nutritional and health counseling. While the drugstore giant says it’s not trying to compete with primary care physicians, it does aim to engage patients who need care for chronic conditions.
“There is a tremendous amount of focus on access — and we certainly agree that Americans should have access to care. I don’t think there’s nearly enough focus today on outcomes,” said CVS Health CEO Larry Merlo, adding “we think that what we’re building out can make a meaningful difference in terms of engaging consumers around their health.”
Walmart, which already operates one of the nation’s largest pharmacies, has set its sights on low-cost primary care in its stores. Its Care Clinics now offer doctor visits, lab and x-ray services in Georgia, Texas and South Carolina. The retailer plans to roll more expanded care modeled after its flagship clinic in Dallas, Georgia, which also offers dental and counseling services, as well as fitness with Tivity Health’s Silver Sneakers Program.
“I think what Walmart is doing is empowering … seniors and the young to have a more holistic approach” to their health, by making access easy, said Dr. Donato Tramuto, Tivity Health CEO. “Primary care needs to be moved to this kind of empowered care, and not just engagement.”
For retailers, the move is a natural extension of the urgent care services they’ve built out over the last decade. But the leader of the nation’s largest doctor’s organization isn’t sure retail is the best setting for true primary care.
“In our view, case management and care for multiple chronic diseases really requires a consistent source of care from a physician who has the necessary medical training and really knows the patient,” said Dr. Patrice Harris, president of the American Medical Association, adding “these clinics can serve to supplement a regular source of care, but they should not be relied upon for all of a patient’s primary care needs.”
Virtual primary care plans
Some of the newest primary care models won’t be relying on physical locations at all. Just like urgent care clinic providers, telehealth services are trying to get into the business of more long-term services with virtual primary care.
Doctor on Demand has built out a primary platform called Synapse. It is offering a virtual primary care employer plan with insurer Humana, and has also partnered with Walmart on a new video-based primary care service that the retailer is offering workers in Colorado, Minnesota and Wisconsin.
“It’s a much higher level of service. You’re automatically assigned a virtual PCP that stays with you. And we have a virtual care team that works around (the doctor) — nurses and pharmacists and dietitians and all sorts of non-provider types to work as a team,” explained Hill Ferguson, Doctor on Demand CEO.
For now, the focus of the virtual providers is on employer plans which have more flexibility on reimbursement contracts, but analysts say health systems are also exploring how to partner on new types of virtual primary services for individual consumers.
The premise is that the convenience will appeal to younger workers, who often don’t have a relationship with primary care physicians. But a big test for the new plans will be how workers react if they’re pushed toward virtual-first treatment.
“Many of the larger employers are willing to pilot some new innovations that will improve the health of their employees. I think that’s the good of the focus of employers,” said Dr. Craig Samitt, Blue Cross Minnesota CEO, but he adds “employees are also seeking to preserve their choice as much as possible,” he notes.
Virtual and onsite care
Most large employers are using virtual care as a convenience option, while looking to steer workers to brick and mortar services which offer the promise of lowering costs, while delivering better coordination of care for workers.
For One Medical, that’s a big area of strength, but the firm faces stiff competition in the employers’ market as well.
Crossover Health provides onsite clinics for companies like Apple, Facebook and CNBC parent company Comcast, which provide a team concierge medicine approach to primary care, including behavioral health and physical therapy services, along with 24-hour virtual care.
The 10-year old start-up’s employer clients for near-site clinics include Facebook, Intuit, Microsoft, LinkedIn and Symantec.
In baseball terms, it is still early innings for these primary care models. It’s not clear at what point these big bets will really pay off in profitability for the start-ups or the incumbents.
“We have more complex systems we have a lot more data and data science of at our disposal and I think we’re in the middle of trying to figure out how to put those things together,” said Premier’s DeVore.
Yet, like Moneyball, the new models are likely to change the game over the next decade in health care.