CommonSpirit Health Embraces Direct Primary Care Model in New Partnership

CommonSpirit Health and Paladina Health are negotiating primary care contracts with employers, unions, and other organizations.

This article appears in the September/October 2020 edition of HealthLeaders magazine. 

Chicago-based CommonSpirit Health has established a partnership with a direct primary care provider that will eventually be rolled out in several states.

Primary care services boost health condition prevention and improve clinical outcomes. A 2007 study published by the International Journal of Health Services found increasing the primary care physician supply reduced mortality for cancer, heart disease and stroke; decreased the incidence of low birth weight; and improved life expectancy.

CommonSpirit, which operates more than 700 care centers in 21 states, has established a partnership with direct primary care provider Paladina Health. Paladina, which is based in Denver, has more than 130 clinics that operate under value-based contracts with employers, unions, and other organizations. The partnership is launching in the Las Vegas area.

Paladina clinics are financed through per-member-per-month (PMPM) fees paid by employers and other organizations, says Paladina Chief Revenue Officer Kirk Rosin.

"We can tailor the financial arrangement based on several factors. Those factors include the hours of operation of the primary care center, the staffing that an organization wants to have in the primary care center, and the scope of clinical services. We have expanded the clinical scope in our primary care centers to include behavioral health, physical therapy, occupational therapy, dental, and vision," Rosin says.

The range of the PMPM fee is also linked to whether an organization contracts primary care services for an entire population of employees or members, or just contracts for the employees or members who utilize a Paladina primary care clinic. For contracts that cover an entire population of employees or members, the PMPM fee ranges from $40 to $55, and the fee is higher for the walk-in model, he says.

CommonSpirit has teamed up with Paladina to boost population health and lower total cost of care, says Rich Roth, MHA, senior vice president and chief strategic innovation officer at the health system.

"The opportunity for direct primary care is for an employer, a union, or any organized group to pay for primary care for all of their employees or members to effectively engage individuals in better preventive care and high-access services that avoid complications down the line. The uniqueness of the model is the business approach, which is having employers, unions, and other organizations invest in their employees or members through dedicated payment for primary care services. The goal of these organizations is to keep their employees or members healthy and avoid unnecessary healthcare service utilization," Roth says.

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From the patient perspective, direct primary care is free, Roth says. "Patients do not have extraneous costs for the use of primary care services because the employer, union, or organization is invested in the health of patients. In theory, there are greater primary care interventions, which results in lower costs down the line for specialty care and other avoidable care costs."

For example, employers and other organizations contracted with Paladina reduce total cost of care by about 25% and decrease specialty care costs by about 50%, Rosin says. "We avoid exorbitant specialist visits, emergency room visits, and urgent care visits. We have seen a reduction in inpatient admissions over time because what we are able to do is meaningfully move the health risk of our patient populations in a positive way."

How Paladina's direct primary care clinics work

Rosin says there are five key elements of a Paladina direct primary care clinic.

1. Data: "What we have seen is that when 80%­­–85% of the employees and their family members start to use our centralized health service, the information on that population becomes a lot richer. So, we bring individuals into our clinics who typically would not have pursued any kind of primary care relationship. We can uncover clinical conditions that would have gone unchecked or undetected, then intervene at a point where the conditions are not severe," he says.

2. Small patient panels: Paladina primary care physicians typically see no more than a dozen patients per day, Rosin says. "When you think about the quality of the discussion that can happen in 90 minutes versus the seven to 10 minutes that is allotted for a fee-for-service visit, our physicians are able to get much deeper into not only a health concern on a specific day but also have conversations about closing gaps in care and healthy lifestyle coaching. We have the luxury of time because we are maintaining smaller patient panels."

3. Tight referral network: With a concentrated patient population, Paladina can work with employers and other organizations to establish and direct a referral network that is often "tighter" than the traditional insurance network, he says. "With that referral network, we can co-manage the patient within the specialty realm, so that once a patient has been diagnosed and has an established treatment protocol, we are able to perform ongoing care in our health center with a primary care physician."

4. Individualized care: Largely through examining claims data, Paladina primary care clinics can take an advanced approach to patient engagement, Rosin says. "It is a matter of absorbing claims data from every employer we work with and running that claims data through technology such as predictive analytics, which helps identify preventive care gaps. … We tailor every message to the individual. We account for demographic factors, health factors, and attitudinal segmentation, so that the messages and reminders that each individual receives are put into language they understand and reflect their views on health and healthcare."

5. Access: Paladina patients have 24/7 urgent care access to primary care physicians, including video visits and text messaging. "If something comes up and the primary care center is not open, that allows patients the leeway to always get ahold of one of our primary care physicians. Patients have a trusted resource they can go to and have a meaningful conversation," he says.