Vera Whole Health Pioneering Advanced Primary Care Model

In Vera Whole Health's value-based financial model, healthcare providers are paid a flat rate much like a salary rather than volume-based compensation.

Vera Whole Health's advanced primary care model takes a comprehensive approach to patient care, with extended visit times and resource stewardship such as a disciplined manner of making referrals.

The fee-for-service model for primary care usually features short times for patient visits. The fee-for-service model for primary care has drawn criticism about access to care, with scheduling of visits with a patient's primary care provider often taking weeks to arrange.

Seattle-based Vera Whole Health operates primary care practices in eight states (Alaska, Arizona, California, Idaho, Nevada, Oregon, Texas, and Washington). In Vera Whole Health's value-based financial model, healthcare providers are paid a flat rate much like a salary. It does not matter how many patients they see or procedures they perform as long as their patients become healthier.

"With advanced primary care, we can be extremely comprehensive with the services that we are providing. We deliver care in a very patient-centric way, with high quality care that is also cost and time efficient for the patient, care team, and payers," says Jackie Riddick, MD, lead physician and primary care physician at Vera Whole Health-Fort Dent Tukwila in Washington State.

Vera Whole Health's advanced primary care is a sharp break from the fee-for-service model, she says. "It is not about seeing a volume of patients. It is about taking the best care of people. For our patients, they have flexibility in how they access their care, whether that is through video visits, the telephone, in-person visits, and care through the patient portal. We can provide many services virtually such as adjusting medications."

Vera Whole Health primary care providers have lower patient panels than many primary care practices and patients can often schedule an in-person visit with their primary care doctor within 48 hours, Riddick says. "At my previous primary care practice, the panel size was 1,800 to 2,200, which is medium-to-high for the industry. At my Vera Whole Health office, we are at 1,250 to 1,500 patients per provider. So, the patients can get same-day or next-day appointments with me. They are not waiting three weeks."

At Vera Whole Health primary care practices, in-person patient visits are 30 to 60 minutes long, depending on what the patient needs, she says.

"For our in-person care, it is the patient's needs that drive the agenda rather than the structure of the appointment. For example, in the fee-for-service world, if a patient makes a preventative care appointment covering things such as screenings and vaccinations, the moment the patient brings up something like knee pain we would have to interrupt them and tell them, 'We can't address your knee pain in this type of visit because of the billing and coding. You are going to have to come back and have a separate visit.' That is an administrative barrier. With advanced primary care, we have the flexibility to use the time we have for whatever the patient's needs might be. We can meet their needs more comprehensively in our visits."

Resource stewardship

Resource stewardship is a key component of advanced primary care at Vera Whole Health, Riddick says. "We are thoughtful about additional costs that we are going to incur in a patient's care. When we have more time in the visits to be thoughtful, then we can select more appropriate labs, imaging studies, and referrals, rather than being rushed and checking all the boxes to be sure we do not miss anything. We can tailor care much more specifically and determine what is needed—or what is not needed."

Having lengthy primary care visits tends to drive down specialist referrals, she says. 

"In having more time with the patient, I generate fewer unnecessary referrals. At my previous practice, where I had 20-minute visits and as little as seven minutes with patients, a patient would come in with four things on their list and I may have been able to tackle only one condition such as shortness of breath. But for their ankle pain, I would have to refer the patient to sports medicine; and for their rash, I would refer the patient to dermatology. I would have to make those referrals because of time management. Whereas, when I have more time with my patients, I can diagnose and treat several issues myself all in one visit. That way, the patient does not have to make several appointments and pay more for the referrals."

Health coaches

Health coaches are an element of Vera Whole Health's advanced primary care model. At Riddick's primary care practice, there is one health coach for two patient panels.

"The health coaches are specialists in navigating change with patients. They can identify practical and realistic goals that the patient can pursue. They can break down changes to make them attainable, then have an accountability partner on the journey toward success. So, patients have a concrete plan with a health coach, with whom they check in periodically to make sure that they are making progress. That makes a huge difference for people to make lifestyle changes," she says.

The health coaches take an individualized approach in working with patients, Riddick says.

"There are many issues a health coach can help address such as nutrition, exercise, and smoking cessation, but there are other issues that may not seem as directly linked to health such as sleep habits and stress management. Health coaching is about identifying what is truly meaningful for each person and joining them on that journey, rather than being prescriptive. For example, I do not tell a patient they need to go meet with the health coach and do X, Y, and Z until they meet a blood pressure goal. It is more about there being dozens of ways to reach an endpoint, and we need to figure out what works for the patient."

Preventive care

Vera Whole Health patients are incentivized to have an "annual whole health evaluation," which has three pieces, she says. "First is biometric screening. Second is the provider wellness visit, which is a 60-minute extensive visit with a provider. Third is a 'coaching connection,' which is a brief introduction to our health coach and how coaching works."

The biometric screening is conducted by a medical assistant, Riddick says. "When a patient comes in for a biometric screening, we measure height, weight, body mass index, abdominal circumference, cholesterol, and blood pressure, and we conduct two forms of diabetes screening and a physical activity assessment. We use that data to calculate the patient's cardiovascular risk score, which is their likelihood of having a heart attack or stroke in the next 10 years."