About the series
"The Business Case for Advanced Primary Care" is a podcast series co-presented by Marathon Health and BenefitsPRO.
Speakers
Introduction
Hello everyone, and welcome to this podcast series, "The Business Case for Advanced Primary Care." This podcast series is sponsored by Marathon Health, and it is hosted on BenefitsPRO. I'm your host, Scott Ferguson.
In the first episode of this series, called "More Than a Clinic: Advanced Primary Care Explained," BenefitsPRO contributor Michael Krieger sits down with Marathon CEO Dr. Jeff Wells. Together, the two discuss the growing popularity of advanced primary care and some of the misconceptions around these services. Let's join them.
Meet your host and guest
Hello, and welcome to "The Business Case for Advanced Primary Care," a podcast by Marathon Health. I'm your host, BenefitsPRO contributor Michael Krieger, and in this first episode, "More Than a Clinic: Advanced Primary Care Explained," I'll be talking with Dr. Jeff Wells, the CEO of Marathon Health, a leading provider of advanced primary care through nationwide onsite and nearsite health centers.
Reports have indicated that 22 percent of employers have advanced primary care strategies in place, and another 54 percent plan to adopt them soon. And while growing in popularity, many still ask: What exactly is advanced primary care, and how is it different from what employees get today?
We wanted to demystify advanced primary care, and that's why Jeff is joining us today. Jeff, welcome, and thanks for joining us to talk about advanced primary care.
Absolutely, Michael. It's my pleasure.
From physician to CEO: Jeff's path
So, as we begin our conversation, tell the audience a little bit about yourself and how you, a doctor, became a CEO.
So, I'm a kid who grew up with an interest to go into medicine and wanted to become a doctor as far back as I can recall. And I've had the great opportunity to do so. Went to medical school in Indiana.
And after all these years of this built-up excitement and energy, I just recall kind of this almost soul-crushing experience working with some of the senior physicians or nurses that had spent a lot of time in healthcare. And I found that to be just so disheartening. Folks that routinely would tell me, "If I were you, I would never go into medicine. If I could do it over, I'd go into finance" or whatever the case might be.
And I think it really inspired me to want to be part of trying to understand why that was the case and what could be done about it. I had a great opportunity to spend some time leading a state Medicaid program. And I think through both experiences—at the bedside, as well as those really understanding how healthcare is paid for and what drives, at a large population level, health inequity, what drives healthcare utilization, what influences the behavior of providers throughout the system—I recognized the power of the right kind of primary care model.
There was a proven path to actually improve the experience for patients and to lower healthcare costs for everyone, which ultimately led to myself and a partner deciding to start a business in—I guess it would be—2009. And over almost the last 17 years, I've just had a fantastic ride, working with some unbelievable people to really make a difference in the lives of millions.
What is advanced primary care?
So we wanted to talk today about advanced primary care. Set the stage for us. What is advanced primary care, and how is it different than traditional primary care?
First off, there's probably nothing more powerful in healthcare than connecting a patient to a trusted primary care provider and really a primary care team. And what I mean by that—you can kind of think back, for those that are a little bit older, to Marcus Welby, where you have this vision of being able to really get to know the doctor that's supporting you and that team. They sort of know you, they may know your family, and they have a very broad understanding of what your goals and needs are. And that puts them in the best position to be an advocate, a guide, a supporter for you.
The challenges in recent past, going back decades, the way that the healthcare system has evolved—it's really gotten in the way of access to any kind of primary care. And the model itself really limits the ability for primary care to deliver the kind of experience and outcomes that it can.
The exciting news is that there is this new advanced primary care model that's able to get back to the simple basics and do it differently. A few things to me that stand out as being real fundamental characteristics of advanced primary care:
Number one, it's a proactive model—as opposed to reactive—looking really at an entire population. So you can imagine the provider or that care team reaching out to individuals before they have a problem, trying to anticipate illness, trying to prevent disease, trying to make it easier for people to engage, even before someone may realize that they have a need.
Second, it's about a different kind of experience. Imagine access to care when you need it—not having to wait weeks and weeks to get in when you have a need that might either be resolved by that point or become something much more dangerous. Imagine being able to spend more time with the provider—on average, a 30-minute visit as opposed to five, six, or seven minutes that we see all too often in traditional healthcare.
And then imagine someone that gets to know you individually, that has the time to personalize the care, to understand your values and your goals and your needs—to decide whether medications are maybe the right next step, or lifestyle and behavior change may be more valuable and more important at that point for you. Really being able to adapt that care to the needs of each individual.
And then finally, it's recognizing this mandate to be a guide for more complex care when it's needed. The first part of that is reducing specialty or complex care when it's not needed. All too often, many providers—rushed for time—quickly order a number of tests, recommend a number of radiology tests, CAT scans, MRIs, sleep studies, or quickly refer you to a specialist like a cardiologist or an orthopedic surgeon. If you can spend more time with someone as a primary care provider, we can avoid some of those referrals where they're not necessary.
But then when it is needed to engage with more specialty care, how can we help you, as a patient, figure out in your community where the right place to go is? Who's the best in that particular area? Who can do it most cost-effectively where that matters, or with the highest quality outcomes where that matters?
It sounds a lot like my family doctor when I was a kid. I mean, he knew more about me than I did. So it really is a return to that kind of care.
Why advanced primary care matters for employers and benefits strategy
So how does advanced primary care fit into the program for employers and brokers when building a benefits package, and why is it important for employers to consider it today?
Employers today—and particularly benefit leaders—are rightfully frustrated that they haven't been able to make more progress in the last 10 years. Healthcare costs continue to rise faster than inflation, faster than wage growth, faster than the cost of living. As a matter of fact, in the last 20 years, we've seen healthcare costs grow by 188 percent, while wages have only grown 84 percent.
And so for a given employer, especially in competitive labor markets where you're trying to recruit talent, this is essentially putting downward pressure on wages. And so we have to find a way, as a society, to lower the cost of healthcare while still driving good outcomes—to candidly just drive high employment and high economic growth for the long term.
And why I think advanced primary care is so powerful is because it's one of the few proven interventions that will lower healthcare costs when done right. There is published literature about the power of primary care that goes back three or four decades, that consistently shows a patient engaged with a primary care provider who has the time and space to support them right will lower the cost of care and lower your chance of mortality. It can actually help people live longer with a higher quality of life.
The problem is today, there's not enough access to primary care. Most employers today are spending less than 8 percent of their total healthcare budget on primary care. And in way too many markets across the United States, it's nearly impossible to get in to see a good primary care provider. So for the first time in a long time, employers actually have an opportunity to directly engage in an advanced primary care model that can drive down the cost of healthcare and improve outcomes.
How employees benefit from advanced primary care
So let's take a look from the employee point of view. How can employees use advanced primary care to improve outcomes for themselves and improve their whole health?
I think first and foremost, it's about recognizing the value and the importance of building a relationship with a provider that you can trust. And when the employer reduces the barriers to achieve this, then those employees and their family members can actually readily engage in that relationship.
So if I just share a tangible example: I can think of a story of a patient who started a new job with a manufacturer—probably about a year ago. She had a history of moderate depression with mild anxiety and had run out of her mood-stabilizing medications because of a change in job and a few other factors. She was really struggling, was worried about maybe a relapse of substance use. She'd been trying to go find a new primary care provider when she got this new job, but was just struggling in the community—it was going to be a six- or nine-month wait.
So one of her colleagues mentioned that they had this relationship with Marathon, and there was a health center located within a five-minute drive from the facility. She was able to schedule an appointment the next day. She came in in tears—very appreciative of the opportunity, but had really been struggling for a while and just didn't quite know what to do.
And in this case, the provider and the team were able to spend upwards of an hour really understanding her background and her situation. They were able to get her re-prescribed the medications that had been demonstrated to work for her. They were also able to connect her with a behavioral health counselor to do some therapy, and just gave her the level of reassurance that really changed the dynamic.
So you can imagine, if you fast-forward: someone who maybe would have ended up in the emergency department with a crisis reaction, probably missing work—which may or may not have put her job at risk—and challenging her family and relationships outside of work. All of that was able to be avoided just because access to care in the right kind of model was made so much easier by her employer.
Measuring ROI: The financial case for advanced primary care
One of the biggest issues facing advisors is proving ROI. How can advanced primary care control costs, and how do they measure the ROI of advanced primary care?
So again, even beyond Marathon Health, there are published studies by independent researchers going back 30-plus decades that show—as a rough average—costs can be lowered between 25 to 30 percent for patients engaged with a good primary care provider. And your odds of dying—mortality—have been shown to be reduced by up to 19 percent.
It's really important to us at Marathon to not just rely on third-party data, but to track our own experience objectively using actuarially proven models, to demonstrate to our client partners and to the market broadly that the model does work.
We've done this in a number of ways, but most recently conducted and published a study that looked at over three million claims. We had about 30 clients across diverse geographies and industries. The demographics of the patients are pretty broad, and there were about 100,000 patients included over five years. So we were able to look at what the healthcare cost trend for these groups was before Marathon Health and this advanced primary care model were introduced, and then what happened afterwards.
What the study showed is a positive ROI overall by the end of year one, with over 80 percent of employers realizing that—growing to about a three-to-one ROI by year three, and almost a four-to-one ROI by year five.
You may then ask: Well, how did that happen? What drove the savings?
We saw about a 21 percent overall reduction in total claims cost. And where that comes from—despite an increase in overall primary care utilization—we see a reduction in ER visits, which were down about 15 percent among this group. There were 31 percent fewer urgent care visits, 41 percent fewer inpatient admissions, and a little over a 20 percent reduction in outpatient claims. So you think fewer diagnostic tests, fewer referrals to that cardiologist or the orthopedic surgeon or the endocrinologist. And when you add all that up on a net basis, these employers—and the patients themselves and their families—saw a reduction in total spending.
Wow, that's impressive.
Closing
Jeff, I want to thank you for speaking to us and for your insights on advanced primary care.
Oh, it's my great pleasure, Michael. I appreciate just the platform to share what so many employers are doing across the country right now—in partnership with organizations like Marathon—to really change the dynamic for their people. To fundamentally improve the human outcomes and create those life-changing stories like I shared, as well as freeing up their capital to invest, whether it's into wages or into other areas that can drive innovation and growth for those organizations.
