At first, taking a free yoga class at her doctor’s office was simply a way for the patient to increase her strength and flexibility. But soon the woman, a retired Denver resident, befriended her classmates and developed a routine: After each class, they’d walk to a nearby store and shop together. “Our practice has meant so much to her, not just for her health, but for companionship,” says Cole Zanetti, DO, MPH, who practices at at Iora Primary Care, a capitated primary care clinic that operates in several states.
Addressing health needs beyond the strictly medical is one of the hallmarks of capitated primary care, which Modern Healthcare recently dubbed “the next disruptive innovation in health care.” Under this model, a practice works with health insurers to negotiate a prepaid monthly rate for a set population of patients. The practice is then responsible for all health costs for those patients, from primary care to inpatient services at nearby hospitals. Since costs are paid upfront, billing is streamlined and patients can see their primary care team as often as needed without copays.
Dr. Zanetti and Farhad Modarai, DO, who practices at a capitated primary care clinic in Tennessee, say this care model gives them more time with patients while lightening their administrative burdens. Here’s a closer look.
Capitated primary care in action
Iora Primary Care in Denver uses a capitated model to care for patients who are part of Humana’s Medicare Advantage plan, Dr. Zanetti explains. Each patient is assigned to a physician and a health coach and can receive care in the office, by phone, by telemedicine or by home visit. Dr. Zanetti treats between seven and 10 patients on a typical day and estimates that 85% of his time is spent on patient care, with 15% spent managing electronic health records and completing paperwork.
At office visits, which average one hour, the patient, physician and health coach sit around a circular table viewing the patient’s medical records. Iora Primary Care uses a proprietary electronic medical record system that’s designed to be physician-friendly and easy for patients to understand.
“We get to push the limits of creativity in how care is delivered,” Dr. Zanetti says. “In capitated primary care, the incentives actually make sense. When our quality of care is better and our patients are healthier, our practice does better financially.” On the downside, Dr. Zanetti notes that insurance companies must agree to the capitated payment structure, which limits the pool of potential patients.
Dr. Modarai works for CareMore Health System and practices in its Hickory Hill clinic in Memphis, which cares for 12,000 Medicaid patients using a capitated primary care model. The care team, which includes physicians, nurse practitioners and social workers, help patients with social needs, such as finding affordable housing, as well as addressing medical issues. “Because we can offer longer appointments or see patients every day if needed, capitated primary care gives clinicians the freedom to give our sickest patients extra attention. That can help us bend the cost curve of their care,” Dr. Modarai says.
Mind, body, spirit
Because of its emphasis on personalized, holistic care, capitated primary care is a natural fit for DOs, Drs. Zanetti and Modarai agree. “We want to know what our patients are struggling with, not just physically, but existentially,” says Dr. Zanetti.
In the future, Dr. Modarai predicts increasing interest in alternative health care delivery models, either capitated primary care, direct primary care or another model. “Rather than a blockbuster drug or a new medical technology, innovations in our systems of care will really be what define the health care of the future,” he says.