“You never change things by fighting the existing reality. To change something, build a new model that makes the existing model obsolete.” ~Buckminster Fuller
In early December, I had the privilege of participating on a panel at the 32nd Annual Piper Sandler Health Conference with Amir Rubin, MD and CEO of One Medical, and Jonathan Bush, Executive Chairman of Firefly Health (he was the co-founder and former CEO of athenahealth) to discuss next generation primary care models with longtime and astute healthcare technology industry analyst Sean Wieland. Sean has been speaking and writing about his Primary Care 2.0 thesis for many years and it was a great opportunity to bring together several innovative companies as case studies.
Amir was able to share the impressive growth of One Medical and their experiences since going public, including the expansion into multiple new markets, as well as new partnerships and new services that they have introduced to meet membership needs. One Medical has done an incredible job educating the broader investment community about membership-based primary care, “care margins,” and the operationalization of primary care at scale, and they have been both recognized and rewarded since their initial public offering.
Jonathan, who built athenahealth into one of the most disruptive health IT companies, and who also has a well-deserved industry reputation—equal parts disruptive innovator and artform-level unconventionality—was in classic form. His QPM (quips per minute) was definitely revving. In his self-proclaimed “return from exile” appearance, he was able to colorfully characterize the current challenges in our industry as a “Healthcare Goiter” with anatomically correct gesticulations. Furthermore, he was able to to define new Primary Care 2.0 models like Firefly as more akin to an order of “Franciscan Monks” aligned with the people and intent on rooting out the sclerotic medico-industrial with his own version of innovation catheterization. Gotta love that guy!
That conversation was followed by another one with an equity research team at a major bank. In this conversation we got to tell our story in a more linear fashion, describing both the background context as well as our history, highlighting our unique points of differentiation. We’ve been describing our business quite a bit lately, and the way it gets framed is important in helping people understand not only what we do, but more importantly what we believe. What we believe is infused in everything that we do, including why we create and how we deliver care—and we are accountable for the achievement of results.
To help bring awareness and clarity to this differentiation, I recently started writing a series of posts on “Primary Health Is . . .” (see here, here, here, here, and here). What the analysts are beginning to see is that while primary care may be the key to solving the costs and complexity in our healthcare system, it will take more than a tweak to the existing primary care model. You can’t just put new lipstick on the same pig!
You have to reinvent it—from the services offered and the channels through which they’re offered, to the commitment to being data-driven at both the individual member level as well as at population health level—while also including an entirely new payment model. Most of the analysis that describes PCMH, ACOs, and related models, outlines that their shortfall is in the commitment to taking on more risk in the form of operating under an agreed upon fixed fee. Most of these experiments have struggled when they bandage on an additional fee (with no commensurate value creation), pay lip service to integration and coordination (but offer no new changes in care delivery), and attempt to gloss over the results by various forms of handwaving, smoke and mirrors, and a booming voice. Providing a monthly employee membership to a local clinic on top of the traditional fee-for-service model just shifts the costs around—but it’s the employer that still picks up the increased expense in the end without much ROI to point to either clinically or financially. It’s true, there is no wizard behind the curtain. It simply takes hard work to engage members, to deliver consistent, exceptional care, and to couple these with new payment models that reward for results and award for accountability and achievement.
My Primary Health series goes into significant detail about what this new future looks like. In a nutshell, though, it all comes down to effectively and transparently managing the entire patient journey. No matter how compelling the initial primary care experience, if in the end the patient is still shuffled off to uncoordinated specialists, expensive health systems, or unnecessary diagnostics/testing that remain outside of direct oversight, the primary care provider loses control of the outcomes and costs, to the detriment of both the member and the payer. In spite of the cool clinics and fancy apps of many of these new-style medical groups, the employer payers are simply paying for a new kind of Black Box—one that’s still opaque, conflicted, and expensive—when what they need is an arrangement like our “Commercial Advantage” model that is transparent and accountable to them and their employees.
No lipstick required. No lip service necessary. No lame storytelling or roundabout explanations. Just good old-fashioned Primary Health based on a trusted relationship, modern communication tools, and financial alignment of all parties. A unique, new Commercial Advantage for all self-insured employers and payers alike.