The Rise of the Novel Primary Care Model

That foreboding ring as you call to manually schedule your annual primary care appointment, soon to exchange times and dates across the line at a whopping 1% success rate. Or shrugging your shoulders as you reach for last year's TIME magazine in the waiting room, thinking, “I might as well, I’ll only be here for another two hours.” Or misremembering the particular combination of lefts and rights that were to guide you on the mystical journey from the PCP to the lab, leaving you zig-zagging hopelessly through the hospital behemoth.

Do any of these images sound familiar? They just may be the archetypes of the primary care system that companies have been increasingly trying to innovate for the past decade. A system plagued by outdated technology, siloed care services, and fee-for-service restrictions. Out of the dust of the PCP waiting room has emerged something new: the “integrated,” the “preventative,” the “advanced,” the Novel Primary Care Model.

A little under a month ago, I came across the startling February 16th headline: “CVS acquires Oak Street Health primary care for $10.6 billion.” Intrigued, a quick search yielded other big-ticket primary care acquisitions—One Medical acquires Iora Health for $2.1B Sep 2021, One Medical was acquired by Amazon for $3.9B Jul 2022—and fundings—CityBlock Health reaches a $5.7B valuation with a $400M round Mar 2021, Forward raises a $225M series D Mar 2021, Carbon Health follows close behind with a $100M series D Jan 2023. Fast forward a few days, and I had discovered 30+ companies touting these new primary care models, most of which were founded within the past decade and most of which had raised at least $50M.

So, what are these novel primary care companies (alt: “blank Health”) all about? Once you start profiling 2, 15, 20 of them, you’ll notice some common themes:

1. Holistic care: primary care that focuses on the whole patient, whether that means behavioral and mental health services or social services like food stamp guidance and even childcare

2. Preventative care: primary care that keeps patients healthy and escalation-free by encouraging visits, using advanced diagnostics and screenings, and managing chronic conditions

3. Integrated care: primary care that acts as a “(digital) front door” to the healthcare system, including urgent care (often via 24/7 messaging) and connecting patients to specialty and emergency services through robust care coordination systems

Importantly, this transformative primary care concept is empowered by a transition from the notorious fee-for-service payment model to a value-based model. The wide majority of these novel primary care companies function by entering into value-based contracts with different payers, whether Medicare (traditional and MA), Medicaid (through MCOs), commercial plans (for example, the Aetna Advanced Primary Health plan with Crossover Health), direct-to-employers (to be offered as a benefit), or direct-to-consumer (as a self-pay concierge service).

Given the promise of improving outcomes while cutting costs, these models often focus on one population (read: one payer) in order to deliver targeted care. CityBlock Health, for instance, partners with MCOs to take on the risk of their Medicaid patients, and in turn emphasizes SDoH services that improve patient engagement. Oak Street Health treats Medicare patients by focusing on chronic conditions, prescription management, and coordination with specialists. With a self-pay membership model, Forward highlights advanced diagnostic technology and specific programs like nutrition and mental health. And so on, and so forth.

By reducing redundancy, managing and even preventing health conditions, and intercepting otherwise costly emergency room visits, these new primary care models—in varied and in similar ways—promise, and in many cases prove, to save payers money while improving patient outcomes. And if nothing else, the past few years have demonstrated that investors believe they will too.