A joint venture between health system and health insurer to implement a team-based primary care practice

Fellowship Paper - March 16, 2021

The current infrastructure for primary care is grossly insufficient to meet the population management needs of a primary care provider’s patient panel.1 In a study of primary care provider work hours required to meet existing guidelines for acute, preventive, and chronic care, it was estimated that it would take a primary care physician 22.6 hours a day to effectively meet the needs of a panel of 2500 patients: 4.6 hours for acute care, 7.4 hours for preventive care, and 10.6 hours for chronic care.1 Not surprisingly, this same study found that adults in the United States only receive an average of 54.9% of recommended care in each of these areas. Despite this predictably poor performance, numerous studies have shown that the absence of primary care leads to dramatic worsening of population health outcomes, increased mortality, and increased costs.2 It is not possible to achieve improved population health outcomes without substantially strengthening the infrastructure of primary care, improving the collaboration of stakeholders in a health ecosystem and increasing the number of primary care providers.

Compounding this problem of an insufficient population health and primary care infrastructure, The Queen’s Health Systems (QHS), a large regional health system in Hawaii, is late to the market in its primary and urgent care expansion efforts in a growing suburban area. QHS is also at risk of losing market share in those growing suburban communities because its two main competitors, Kaiser Permanente and Hawaii Pacific Health, are nearing completion of respective clinics that aim to enhance member and patient business. Similarly, the largest health insurer in the state, Hawaii Medical Service Association (HMSA) has been losing membership in the same suburban area, which can be attributed to the aggressive growth strategy and actions of its primary competitor, Kaiser Permanente. In order to expand into the priority market and meet the primary care needs of the community, QHS and HMSA must implement an expedient and innovative approach to care delivery; otherwise, both organizations will be unable to maintain brand equity or develop a strong presence or solid foothold within that community.

To address this lack of primary care infrastructure and the lateness-to-market threat that both HMSA and QHS are facing, the health system and payer will partner to develop, and quickly operationalize, a joint venture clinic enterprise that will deliver brand presence, increase membership for the payer, increase primary care panel size and attributed lives for the health system, and improve quality while lowering cost though shared data. To achieve these shared goals, this joint venture will deliver a large primary and urgent care site with expanded, team-based and patient-centered services to the community of West Oahu.

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