Post on 07-May-2022
Who is taking the market by storm?
CMF 2021 - Friday, October 22, 2021, 5:40 pm - 6:15 pm EST Jim Eischen, Esq./Lofty Learning/Eischen Law Office
Jim Eischen has over 32 years of experience practicing law, and for the last ten (10) years, he has developed a national reputation as a private direct medicine, healthcare business planning and regulatory compliance attorney. Jim frequently lectures on healthcare & wellness business planning, data privacy compliance, and avoiding professional burnout.
Jim is a national expert in the creation and implementation of private direct practice models, and how to create effective healthcare/corporate platforms. In 2018 and again in 2020 he re-wrote the private direct medicine compliance chapter of the California Medical Association’s physician legal handbook. His legal analysis is peer-reviewed.
To better distribute guidance on private direct practice formation and operation best practices and compliance solutions, he formed www.loftylearning.com. Lofty Learning delivers educational insight to a wide audience via live/taped/audible webinars.
Jim continues to practice law and assist with practice and business formation projects throughout the US as Eischen Law Office.
Disclosure Statement: Jim Eischen is the founder/owner of Lofty Learning and Eischen Law Office.
Copyright © Lofty Live Learning, Inc. All rights reserved. | www.loftylearning.com
SUMMARY
▪ The future of the US healthcare system: virtual, connected, patient-focused health data, integrative, plan-plus (i.e. combines private fees and plan reimbursement)
▪ Private direct primary care models and plan-only models are innovating past legacy plan-based thinking: from medically necessary diagnosis/treatment to virtual integrative care connection (as predicted!)
▪ Disruption pandemic and post-pandemic: continues
Copyright © Lofty Live Learning, Inc. All rights reserved. | www.loftylearning.com
HOW OUR
HEALTHCARE
SYSTEM IS
CHANGING
Spending on primary care is increasing
▪ Rhode Island required insurers to increase spending on primary care by 1% annually from 2010 to 2014
▪ This led to a $27 million increase in totally primary-care spending from 2010 to 2017
▪ But, resulted in $115 million decrease in total health care expenditures
Companies want employees to be healthier
▪ In 2019, PepsiCo agreed to pay employees health insurance premiums for a year if they selected a high-value primary care physician
New primary care models are winning
▪ Advocate Aurora Health is partnering with Oak Street Health to open high-touch clinics for seniors in the Chicago area
“How leading health systems are partnering with primary care disruptors”. Advisory
Board. (2020) https://www.advisory.com/daily-briefing/2020/01/28/primary-care
Copyright © Lofty Live Learning, Inc. All rights reserved. | www.loftylearning.com
IMPACT OF COVID-19
Losses in primary care
▪ Majority of practices are no longer physician-led
▪ Drops in routine office visits and elective procedures
• 60% decline in patient volume
• 48% of practices have had to furlough staff
• 22% have laid off employees permanently
Increase in telehealth usage
▪ February 2020: <0.1% of Medicare patients per week received a primary care telehealth visit
▪ April 2020: 44% of visits were via telehealth
▪ Mid-summer: 10 million+ beneficiaries on telehealth
▪ Large market that may persist after the pandemic
Copyright © Lofty Live Learning, Inc. All rights reserved. | www.loftylearning.com
▪ (Landi, H., “Primary care is ripe for disruption. Here are the players trying to shake up the market.” Fierce Healthcare. July 2, 2020)
https://www.fiercehealthcare.com/practices/primary-care-ripe-for-disruption-here-are-players-trying-to-shake-up-
market
Copyright © Lofty Live Learning, Inc. All rights reserved. | www.loftylearning.com
▪ Founded in 2007
▪ Personalized support for employees’ healthcare
▪ 3 solution models each with a different range of benefits
▪ Uses technology to help connect individuals to physicians and healthcare solutions
https://www.accolade.com/solutions
Copyright © Lofty Live Learning, Inc. All rights reserved. | www.loftylearning.com
ALEDADE
▪ Founded in 2014
▪ Partners with primary care physicians to build and lead Accountable Care Organizations(ACOs)
▪ Works with more than 550 primary care practices
▪ Provides practices with data analytics, policy and ACO expertise
▪ Manages more than $7.3 billion in healthcare spending
https://www.aledade.com/
Copyright © Lofty Live Learning, Inc. All rights reserved. | www.loftylearning.com
▪ Helps convert medical practices to membership models
▪ Administrative and front-end support for practices
▪ Clinic operations, communications, revenue flow, etc.
▪ Professional support network
▪ Patients engage with a personalized care team through the network
https://ccphp.net/
Copyright © Lofty Live Learning, Inc. All rights reserved. | www.loftylearning.com
CHENMED
▪ Founded in 1985
▪ Provides geriatric care
▪ Physician-led primary care company focused on providing services to moderate-to-low income seniors with complex chronic conditions
▪ Operates more than 60 primary care practices across 8 states and plans to open 15 more centers
▪ Pivoted from 98% in-center patient appointments to 95% virtual appointments in just one week to help patients during COVID-19
▪ Physician-led primary care model
https://www.chenmed.com/
Copyright © Lofty Live Learning, Inc. All rights reserved. | www.loftylearning.com
▪ Founded in 2018
▪ Provides house calls for primary/urgent care, COVID testing, vaccines, and other health and wellness service
▪ Personalized on-demand medical care
▪ Pricing:
▪ $499 for a basic house call
▪ Extra charge for certain services
▪ $149 for testing
▪ $199 for lab draws
▪ $99 for intramuscular injections https://conciergemdla.com/
Copyright © Lofty Live Learning, Inc. All rights reserved. | www.loftylearning.com
▪ Founded in 2010
▪ Primary care provider focused on the self-insured employer market
▪ Raised $168 million in Series D funding in 2021
▪ Provides behavioral health services, health coaching, acupuncture, physical therapy, and optometry services
▪ Notable customers include: Apple, Facebook, Visa, LinkedIn, and Microsoft
▪ No-cost membership
▪ Corporate practice of medicine
https://crossoverhealth.com/
Copyright © Lofty Live Learning, Inc. All rights reserved. | www.loftylearning.com
▪ Founded in 2015
▪ Platform for connecting healthcare provides and patients
▪ Streamlining information delivery for care coordination, patient health monitoring, and risk assessment
▪ Live texting between patients and physicians
DOCENT HEALTH
https://www.docenthealth.com/Copyright © Lofty Live Learning, Inc. All rights reserved. | www.loftylearning.com
▪ Founded in 2016
▪ Healthcare service plans distributed through employers and commercial landlords
▪ Mobile phones act to deliver telehealth services
▪ Patients have a care team to manage their needs
▪ 800% increase in revenue in 2020 and 500% increase in demand after the pandemic began
▪ $60 million in Series C funding in 2021
https://www.edenhealth.com/Copyright © Lofty Live Learning, Inc. All rights reserved. | www.loftylearning.com
EVERMED DIRECT
PRIMARY CARE
▪ Founded in 2018
▪ Based in Washington
▪ Primary care services at a fixed costs for patients/employers
▪ Does not cover specialist or hospital visits
▪ Does not take Medicare/Medicaid patients, but works with other insurance
https://evermeddpc.com/Copyright © Lofty Live Learning, Inc. All rights reserved. | www.loftylearning.com
▪ Founded in 2016
▪ Membership-based preventive and primary care company
▪ Custom electronic health record system, chronic condition management, health monitoring, virtual visits
▪ Launched Forward at Home to support patients during COVID-19
▪ Forward has raised $225 million in Series D funding in 2021
▪ Physician-led primary care model
https://goforward.com/technology
Copyright © Lofty Live Learning, Inc. All rights reserved. | www.loftylearning.com
High-touch care with 24/7 care team
Genetic testing
Real-time blood testing and body scans
Unlimited visits with private physicians
Membership cost = $149/month
Copyright © Lofty Live Learning, Inc. All rights reserved. | www.loftylearning.com
▪ Founded in 2017
▪ Sells health and wellness products, prescriptions, and medical advice tailored to men & women
▪ Focused on “non-critical” medical conditions only
▪ Pricing varies depending on the good/service – e.g.
▪ Online anonymous support groups - $15
▪ Primary care telehealth visit - $39
▪ Products such as COVID saliva tests - $150
https://www.forhims.com/about
https://www.forhers.com/aboutCopyright © Lofty Live Learning, Inc. All rights reserved. | www.loftylearning.com
▪ Founded in 2010
▪ Primary care practices with a focus on the Medicare population
▪ Operates 48 practices in 10 states and raised $126 million in February 2020
▪ Physician-led primary care model
https://www.iorahealth.com/Copyright © Lofty Live Learning, Inc. All rights reserved. | www.loftylearning.com
IORA HEALTH MEMBERSHIP
24/7 access to care
Same-day and next-day appointments (in-person or virtually)
Onsite labs
Fully integrated behavioral health services
Yoga classes
Health and wellness coaching
Membership cost is ~ $150/month
Access to your own medical records and info
Copyright © Lofty Live Learning, Inc. All rights reserved. | www.loftylearning.com
LEAA
▪ Provides doctor house calls and services in NY, NJ, and FL
▪ Vaccines, physicals, COVID testing, primary care, and more all delivered at home
▪ For a subscription plan as high as $649 or as low as $449 a month
▪ Or for a premium fee for specific services (e.g. $150 for a regular visit)
https://leaa.io/index.htmlCopyright © Lofty Live Learning, Inc. All rights reserved. | www.loftylearning.com
MOSAIC HEALTH
▪ Founded in 2014
▪ Provides telehealth and specialized health and preventive/wellness services
▪ Focused on populations with extra or special needs –seniors and patients with disabilities / behavioral health issues
▪ Services are tailored to individual needs and goals
https://mosaichealth.org/
Copyright © Lofty Live Learning, Inc. All rights reserved. | www.loftylearning.com
OAK STREET HEALTH
▪ Founded in 2012
▪ Primary care provider focused on the Medicare population
▪ Targets areas where there is a lack of quality primary care options, typically low-to-moderate income geographies
▪ Operates 54 locations across 8 states and expanding into new markets
▪ Centers have helped reduce its population’s hospital admission rate by 44%
▪ Physician-led primary care model
https://www.oakstreethealth.com/
Copyright © Lofty Live Learning, Inc. All rights reserved. | www.loftylearning.com
▪ Same- or next-day appointments
▪ Rides to and from appointments
▪ Telehealth visits and 24/7 patient support line
▪ Help navigating Medicare benefits
OAK STREET HEALTH
MEMBERSHIP
Copyright © Lofty Live Learning, Inc. All rights reserved. | www.loftylearning.com
▪ Founded in 2011
▪ Telehealth and health monitoring service via a phone application
▪ Known for its prediabetes and diabetes care
▪ Provides patients with health monitoring tools
▪ Also has services for:
• Health coaching
• Musculoskeletal health
• Hypertension
• Preventive care
• Behavioral health
https://www.omadahealth.com/Copyright © Lofty Live Learning, Inc. All rights reserved. | www.loftylearning.com
ONE MEDICAL
▪ Founded in 2002
▪ Member-based, tech-integrated, and consumer focused primary care platform
▪ Currently serves over 455,000 patients in 11 markets across the U.S.
▪ Corporate practice of medicine
https://onemedical.com/
Copyright © Lofty Live Learning, Inc. All rights reserved. | www.loftylearning.com
24/7 access to virtual care
Same- or next-day appointments
On-site lab services
Membership cost = $199/year
Copyright © Lofty Live Learning, Inc. All rights reserved. | www.loftylearning.com
PARSLEY HEALTH
▪ Founded in 2015
▪ Online & in-person “whole-body approach” to healthcare
▪ Helps with a variety of health issues, including:
▪ Hormonal health, digestive issues, mental wellbeing, autoimmune disease, thyroid conditions, maternal and fertility support, skin issues, and cardiometabolic health
▪ Priced as a tiered subscription model
▪ $154 per month for the 12-month plan
▪ $204 per month for the 4-month plan
https://www.parsleyhealth.com/
Copyright © Lofty Live Learning, Inc. All rights reserved. | www.loftylearning.com
PRIVIA HEALTH
▪ Founded in 2007
▪ National physician organization that partners with primary care and select specialist physician practices, health systems, payers and employers
▪ Includes 2,500-plus healthcare providers for more than 2.6 million patients across five markets
▪ Creating a centralized base of care with technology to streamline healthcare and achieve better outcomes
▪ Raised over $417 million to date
▪ Filed registration statement for proposed IPO on 4/7/2021
https://www.priviahealth.com/Copyright © Lofty Live Learning, Inc. All rights reserved. | www.loftylearning.com
▪ Founded in 2017
▪ Connects patients/clients to healthcare professionals “whenever and wherever” via the internet
▪ Sells various health products and services
▪ Diagnosis, medicine delivery, weight management, smoking cessation, wellness products, etc.
RO
https://ro.co/Copyright © Lofty Live Learning, Inc. All rights reserved. | www.loftylearning.com
▪ Founded in 2020
▪ At home in-person telehealth visits
▪ Has streamlined at-home testing for COVID and other things, such as the flu
▪ Patients are screened virtually, and then they can receive face-to-face care at home
https://streammd.com/Copyright © Lofty Live Learning, Inc. All rights reserved. | www.loftylearning.com
▪ Founded in 2002
▪ Multinational health corporation offering a wide range of services, primarily through telehealth
▪ One of the largest telehealth providers: over 27 million members in 2019
▪ Acquired Livongo, another telehealth giant, in October 2020, further expanding its services to provide remote health monitoring (e.g. for diabetes care)
▪ Primary care, mental health services, wellness care, specialist care, and more
▪ Patients can interact with physicians and other healthcare professionals at any place
https://www.teladoc.com/
Copyright © Lofty Live Learning, Inc. All rights reserved. | www.loftylearning.com
UNITED CONCIERGE MEDICINE DIGITAL HEALTH
▪ Operates a digital healthcare platform
▪ 24/7 connectivity with healthcare (primary, urgent, emergency)
▪ Virtual emergency room to navigate urgent health concerns
▪ Payable by patients, employers, and insurers
https://www.ucmdigitalhealth.com/Copyright © Lofty Live Learning, Inc. All rights reserved. | www.loftylearning.com
▪ Founded in 2013
▪ Operator of primary care clinics
▪ Company has 2,900 employed or partner primary care providers
▪ In-person (at home or at a clinic) & telehealth visits
▪ Care team to address patients’ health needs holistically
▪ Operates in 9 markets
▪ Partnered with Walgreens to open 5 new 2,500-square-foot primary care clinics in the Houston area
https://www.villagemd.com/
Copyright © Lofty Live Learning, Inc. All rights reserved. | www.loftylearning.com
WELLMED MEDICAL MANAGEMENT
▪ Founded in 1990
▪ Accountable care organization
▪ Collaboration of healthcare professionals
▪ Serves over 370,000 patients
▪ Streamlines the healthcare process for patients (primarily older patients)
• From primary care to transportation to insurance
https://www.wellmedhealthcare.com/
Copyright © Lofty Live Learning, Inc. All rights reserved. | www.loftylearning.com
Copyright © Lofty Live Learning, Inc. All rights reserved. | www.loftylearning.com
▪ Founded in 2002
▪ “National network of direct care practices providing quality, accessible, and transparently priced health care”
▪ Partners with physicians to deliver comprehensive primary care services
▪ Fixed monthly fees
▪ Removes the “middle man” (i.e. insurance companies)
https://www.accesshealthcaredirect.com/
Copyright © Lofty Live Learning, Inc. All rights reserved. | www.loftylearning.com
Founded in 1996
“Founder of concierge medicine”
MD2 physicians dedicate their practices to just 50 families
11 practices across 8 states
https://www.md2.com/
Corporate practice of medicine
Copyright © Lofty Live Learning, Inc. All rights reserved. | www.loftylearning.com
▪ Founded in 2000
▪ National network of primary care doctors
▪ 1,000 primary care doctors and over 325,000 patients
▪ Mission is to provide life-changing, personalized, preventative care
▪ Corporate practice of medicine
https://www.mdvip.com/Copyright © Lofty Live Learning, Inc. All rights reserved. | www.loftylearning.com
MDVIP WELLNESS PROGRAM ▪ 24/7 physician availability by phone
▪ MDVIP Connect website and app
▪ Nutrition and fitness plans
▪ Same- or next-day appointments
▪ Chronic condition support
▪ Family plan and travel benefits
▪ Annual fee = $1,650 - $2,200
Copyright © Lofty Live Learning, Inc. All rights reserved. | www.loftylearning.com
SIGNATUREMD
▪ Membership medicine
▪ Partner with primary care and specialist physicians
▪ Provide direction and support for physicians who want to convert to membership medicine
▪ Physicians can choose to fully convert to membership care, partially convert and retain non-members, or partially convert and oversee a physician extender’s care of non-members
▪ Physician-led primary care model
https://signaturemd.com/
Copyright © Lofty Live Learning, Inc. All rights reserved. | www.loftylearning.com
Personalizedwellness / care plan
Enhanced health guidance and health coaching
24/7 electronic communication connection with physician
Same- or next-day appointments
Increased availability
Copyright © Lofty Live Learning, Inc. All rights reserved. | www.loftylearning.com
SPECIALDOCS
Founded in 2002
Concierge medicine consulting firm
• Patient communications
• Staff and physician training
• Accounting and membership
management
• Patient outreach and marketing
• Legal and regulatory guidance
Provide support for:
https://specialdocs.com/Copyright © Lofty Live Learning, Inc. All rights reserved. | www.loftylearning.com
▪ Doctor On Demand lands $75 million investment
▪ VA awards 10-year telehealth contract to Phillps
▪ Walgreen’s stock rises on announced plans to open 700 primary care practices
▪ Rock Health reports: Unprecedented funding for digital health in 2020 (digital health start-ups scored $588 million in funding)
▪ Accolade raises $220 million in its IPO, stock surged in first day of trading
▪ Kroger secures FDA authorization for at-home corona virus testing
▪ Lifestyle medicine seen as key to digital health adoption?
▪ Teledoc acquires In Touch Health $150 million cash/4.6 million shares
Copyright © Lofty Live Learning, Inc. All rights reserved. | www.loftylearning.com
▪ Rapid evolution of digital health
▪ Plans adapting and attempting to incentivize high-touch care with reimbursement reforms
▪ Consumers are looking for lifestyle guidance, health education, assurance, convenience, integration (centralized solutions)
▪ Discover your place in this marketplace, find an authentic contribution to make
▪ Understand the rules of the game, learn from others, be yourself
▪ Now, let’s look at specific private direct healthcare updates….
Copyright © Lofty Live Learning, Inc. All rights reserved. | www.loftylearning.com
▪ Private direct innovations are not just about new entities; existing players are making their moves too
▪ With their vast market research and clientele, this move by Rite Aid evidences the trend of US healthcare
▪ Branding and focusing on innovative integrative care –holistic health
▪ Sustainable products and nutrition
▪ Greater connection with pharmacists
Full articleCopyright © Lofty Live Learning, Inc. All rights reserved. | www.loftylearning.com
▪ “Integrative” healthcare: referenced directly or indirectly in nearly all US healthcare disruption models, and now with Rite Aid’s national US ad campaign
▪ “Virtual” healthcare: life became virtual during the pandemic, and there’s no going back (even if telehealth stocks are sputtering, that’s because monetization in telehealth is as confused as US healthcare generally)
▪ ”Direct” healthcare: consumerization of health data and health services—uniquely American and unlikely to subside
▪ “Affordable” private healthcare: focus on 1% US economic challenges = continued efforts to create more affordable programs for wider income spectrums
Copyright © Lofty Live Learning, Inc. All rights reserved. | www.loftylearning.com
Talk to Us…
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E-mail Address: jim@eischenlawoffice.com
jim@loftylearning.com
Twitter: @JimEischenEsq
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