OhioHealth Finds Partner to Help Care for Underserved Seniors

Partnership with Miami-based company features high-intensity primary care with capitated financing model.

OhioHealth is teaming up with a senior primary care company to open three new clinics next year that will serve low- to moderate-income seniors in Columbus.

Medical care is costliest for Americans over age 65, research shows. For example, medical expenses more than double between the ages of 70 and 90. In 2010, medical spending for people over 65 accounted for one-third of U.S. medical expenditures.

OhioHealth is opening senior primary care clinics as a high-impact starting point in a broader strategy to tailor care offerings to specific classes of patients, says Michael Krouse, senior vice president, and chief strategy and transformation officer, at OhioHealth.

"We have chosen to start in the senior arena because they are driving the majority of the dollar spend in healthcare. They are older, less healthy, often underserved, and driving about 80% of healthcare costs. To disrupt and have an impact, this is the best place to start," Krouse says.

The new clinics will be sited in neighborhoods that are underserved by primary care providers, he says. "The bottom line is serving as many people in our community as we possibly can, with an eye toward minimizing total cost and an eye toward maximizing access. This model fits very well with that mission."

Capitation and high-touch care
 

OhioHealth's new partner is Miami-based ChenMed, a senior primary care company that is teaming up with a health system for the first time. By next year, ChenMed will be operating more than 60 clinics in eight states.

ChenMed clinics, including the OhioHealth practices set to open in Columbus, are high-touch facilities that operate under a capitated financing model, says Gaurov Dayal, MD, president of new markets and chief growth officer for ChenMed.

"The capitated payment per member per month is much higher than what we would receive in a fee-for-service model. On the other hand, the expenses are much higher," Dayal says.

"Out of our own budget, we pay for hospitalizations. One admission for a patient might cost $10,000, which is higher than the annual premium we receive. However, if we can keep patients healthy by providing them with very good preventative care and great access so they don't go to the emergency room, those savings accrue to us. When you start spreading those savings over seven or eight states, you have an actuarial risk pool with significantly lower total costs," he says.

There are several elements of ChenMed's high-touch approach to senior care.

• Patient panels cap out at 400 as opposed to patient panels at traditional primary care practices, which can be higher than 2,500 per physician
   
• Onsite specialty visits such as cardiologists
   
• Transportation services
   
• Onsite pharmacy and radiology services

"We see our patients often and manage them very closely. On average, our doctors see their patients once a month, which is about 10 times more than the average primary care physician," Dayal says.

The frequency of the interactions elevates the clinical care, Krouse says.

"If you have a patient who has many complex conditions, the best way to provide clinical care is to talk with them and work with them on a regular basis. If they are not filling their prescriptions, or they are not showing up where you need them to be, you can intervene far more easily if you are seeing them regularly," he says.

The ChenMed model's frequency and intensity of care generates positive outcomes, recent research shows. Data published in American Journal of Managed Care include about a 50% reduction in hospitalization, 33% reduction in emergency room utilization, and 28% reduction in costs.

Serving the underserved
 

Krouse says neighborhoods that are "deserts of primary care" are an opportunity for OhioHealth to improve population health and lower total cost of care.

"They are clearly in underserved areas because the traditional healthcare model doesn't bode well for establishing a new practice in those communities and meeting the desire of physicians to make revenue. We are targeting these communities because when you take the long-term view of an unhealthy life and a desert of primary care, patients go to the emergency room, they go to the hospitals, they go to places that are available to them. Those are clearly the most expensive places to seek out care," he says.

The ChenMed model for senior primary care clinics in underserved neighborhoods has the potential for national scale, Dayal says.

"The need for this model exists in every city. There are underserved seniors in practically every part of the country. There's a lot we can do for these patients nationally, and we are looking forward to working with more health systems."