Finance and Business Strategy

Organizations that are changing the face of the ambulatory care market

May 24, 2019 9:38 pm

National physician practices and innovators in the primary care and Medicare Advantage spaces are implementing new models that emphasize quality and convenience. Below are some notable examples.

Main article: Developing a change agenda for ambulatory care

National physician practices and outsourcers

OptumCare, a $15 billion division of UnitedHealth Group, will employ more than 43,000 physicians in multispecialty practices and urgent care centers after completing the acquisition of DaVita Medical Group (which includes high-profile groups such as HealthCare Partners and the Everett Clinic). That total is 20,000 more than Kaiser Permanente.

DaVita Medical Kidney Care, which together with Fresenius Medical Care and its subsidiaries manages 75% of the dialysis market, has introduced many advancements in clinical care models for end-stage renal disease.

Schumacher Clinical Partners, which contracts with over 400 facilities providing emergency medicine, hospitalist services and post-acute services delivered by some 7,500 providers in 30 states, is focusing on risk-based contracting arrangements. The goal is to supplement its core fee-for-service contracts with a set of proprietary outcomes data and cost-effectiveness tools that will be offered to health plans and providers.

Sound Physicians, a $1.5 billion national practice with 3,000 hospitalists, intensivists and emergency medicine physicians at 275 hospitals in 38 states, is among the NPPs that are significant participants in the federal Bundled Payment for Care Improvement initiative.

Envision Healthcare, which provides emergency, hospitalist, anesthesia and post-acute services to 1,800 hospital clinical departments, plus 261 surgi-centers and one surgical hospital in 35 states and Washington, D.C., was recently taken private for $9.9 billion by KKR, the global investment firm.

MedNax, Inc. is a $3.5 billion national medical group providing neonatal, anesthesia, maternal-fetal and pediatric services.

Primary care and Medicare Advantage innovators

One Medical is a member-based, concierge-style primary care provider focused on the commercially insured employer market, with programs designed to offer on-the-go professionals convenient access to care through same-day visits, 24/7 virtual care through secure messaging, mobile apps for appointments and health coaching for the “worried well.” One Medical has achieved national scale quickly, with 60 sites in nine cities.

98point6, a member-based primary care provider, recently launched in Seattle with venture capital financing. It provides personal and employer health plans with text-based physician care, offering diagnosis and treatment via text messages with board-certified physicians. The startup appears to compete in the same market as One Medical, with an annual membership fee patterned after Amazon Prime (the founders are Amazon alumni) and marketing targeted to large national corporations and convenience-seeking professionals. It reports a membership of 150,000.

Oak Street Health focuses on the low-income Medicare and dual-eligible market through payer-agnostic partnerships with 12 health plans in six Midwest markets, totaling about 45,000 patients. The business model combines primary care centers, multidisciplinary care teams, intensive case management and enhanced services such as behavioral health, social services and pharmacy. Oak Street assumes full-risk contracts and gets a percentage of savings from its health plan partners.

Village MD is an advanced primary care provider with a “platform” that provides the data, technology, incentives and protocols needed for physicians to successfully participate in value-based care. The company has contracts in eight markets, covering 2,500 physicians reportedly responsible for 500,000 lives.

ChenMed is a Florida-based, full-risk Medicare Advantage provider, with 40 practice sites across 10 markets in six states. Its business model is built around medical centers designed to provide concierge-type medical care for seniors, including daily walk-in and same-day appointments when needed, increased face time with primary care physicians, and availability of on-site cardiologists and other specialty physicians. Building on a base of five centers in the Miami market, ChenMed and its subsidiaries Dedicated Senior Medical Centers and JenCare now operate throughout Florida, Georgia, Kentucky, Pennsylvania and Virginia.

Bright Health is a startup, national Medicare Advantage plan that, along with Devoted Health, Clover and Oscar, competes with both traditional health plans and provider-enablement solutions like Evolent Health, Lumeris and xG Health Solutions. The Bright Health value proposition is an exclusive-care partnership — one partner per market — that is designed to keep utilization with the care partner, and a marketing approach and product portfolio that enable care partners to grow market share and reach their strategic goals.


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