Ep 193 – Beyond Brick and Mortar: Home-Based Primary Care with Full-Risk Medicare Advantage, with Dr. Jeffrey Kang and Mike Stuart

The future of care is not confined by walls; it thrives in the heart of homes, where compassion meets innovation, and healing becomes a daily experience. Home-based primary care with full-risk Medicare Advantage is a transformative model that not only brings health care to the doorstep of our seniors but also places the responsibility for their well-being squarely in the hands of dedicated providers, creating a proactive and patient-centered approach to aging with dignity and comprehensive care. By making primary care easier to access for our nation’s seniors, we can deliver personalized care that meets their needs; help them stay healthy and feel better; and live well with existing conditions so they can prepare for what’s ahead.

This week we are joined by two executive leaders from WellBe Senior Medical — the largest and fastest growing independent home-based medical group in the country. WellBe is a global risk medical group that provides longitudinal geriatric care to underserved, frail, complex, and homebound Medicare Advantage beneficiaries. In this episode, we feature Dr. Jeffrey Kang, Chief Executive Officer and Mike Stuart, Chief Growth Officer from WellBe Senior Medical.

Dr. Kang is a geriatrician with extensive experience in global risk and primary care for frail, elderly, and disabled populations.  Mike Stuart has extensive experience in fostering partnerships with health plans, health systems, and provider groups and leads commercial strategy and partnership development for WellBe Senior Medical.  In this interview you will learn about the home-based care continuum, primary care innovation, mission-driven leadership, Medicare Advantage risk, and the future of value-based primary care.

Episode Bookmarks:

01:30 An overview of WellBe Senior Medical – a global risk primary care group providing longitudinal geriatric care in the home.

02:30 Introduction to Dr. Jeffrey Kang, WellBe CEO (formerly served as ChenMed President, Walgreens SVP, Cigna CMO, and CMS CMO).

03:00 Introduction to Mike Stuart, WellBe Chief Growth Officer (formerly served in executive leadership roles at Somatus and Evolent).

05:00 An overview of the home care continuum (e.g. acute, post-acute, custodial, longitudinal primary care, DME, home infusion).

08:00 How WellBe is helping patients navigate and coordinate the fragmentation of home care point solutions.

10:30 A mission to help senior patients “lead healthier meaningful lives by delivering the most complete care”.

11:30 Opportunities to make care in the home more multidisciplinary, personalized, and SDOH-responsive.

12:00 Proactive vs. Reactive Care (leveraging analytics and unique provider skillsets for population health).

13:30 The clinical persona of the “frail elderly” and why WellBe focuses on this target population.

14:30 “Everything done in a primary care office can actually be done at home.”

15:30 “Home-based primary care is the best thing to do. You get better outcomes and better patient satisfaction.”

15:45 Is it possible to deliver high quality primary care (like ChenMed or Oak Street) in the home setting?

16:30 Referencing Marcus Welby, M.D. as an example of an empathetic approach to delivering care in the home (see Season 1 Trailer)

17:00 Care Fragmentation Challenges – NEJM found that the average Medicare patient sees a median of two PCPs and five specialist physicians per year.

18:00 “Quality of Life” is more important than “Quantity of Life” (why empathy and compassion matter most in caring for frail seniors).

19:30 Patients define a good doctor by bedside manner and respect given.

20:30 How the economics of full global risk enable complete care models for seniors.

20:30 Scalable home-based primary care is a new approach in value-based care.

23:00 WellBe’s results (e.g. >50% neighborhood engagement, patient satisfaction is at 95%, and MLR improvement >40% in 3yrs).

23:30 The importance of reaching a 4 Star Rating in a Medicare Advantage plan.

24:45 Key Measures of success:  Patient Engagement, HEDIS, Medical Costs and MLR

25:45 Bringing health plan leaders on a ride-along to see high quality care in action.

26:00 Negotiating global risk deals with MA plans that offer favorable economics for both parties.

27:00 The starting HEDIS Stars score of a typical WellBe patient is 2.3-2.5 (polychronic, frail, high-risk).

27:45 “When you are at full global risk, it is in your interest to do care innovation.”

28:00 Innovation #1 = Access (“Primary care in the home needs to be both convenient and responsive.”)

29:00 How WellBe developed a mobile paramedic program to enhance responsiveness to emergent acute care needs.

30:00 Mobile paramedic program reduced emergency room visits by 33%!

31:00 Dr. Kang’s recent article in Health Affairs responding to concerns from Berwick and Gilfillan about Risk Adjustment in MA.

31:30 The CMS-HCC V28 changes to the Risk Adjustment model that begin the phasing in next year.

33:00 The evidence for Medicare Advantage being overpaid relative to FFS?

33:45 Eliminating disease-based risk adjustment is the wrong policy (e.g. need for fair payment for complex populations, avoidance of cherry picking healthy populations).

35:30 The case for HCC under-coding in Traditional Medicare (due to lack of incentives in FFS).

36:45 “The bulk of the problem with HCC coding is under-diagnosis in fee-for-service Medicare – not over-coding in MA.”

38:00 Modern Healthcare Best Places to Work 2023 – WellBe Senior Medical

38:30 WellBe Senior Medical providers see 4-5 patients per day allowing them to build trusting relationships.

39:30 A recent study from Elation Health and the AAFP confirms that VBC can ameliorate the suffering of the physician workforce!

40:30 The culture of WellBe that empowers workforce collaboration with a “patients first” mentality.

42:00 Examples of how risk-based economics improve patient care.

43:00 Creating a foundation of values to underpin a culture of collaboration is crucial before accepting risk!

43:30 A clinically-led culture vs. a financially-led culture (“If you take good care of the patients, the financials will follow in a value-based model.”)

45:00 A financially-led organization will focus almost exclusively on risk adjustment (as opposed to delivering patient-centered care).

45:30 “Most of our MLR improvement is from medical cost reduction, not HCC coding.”

46:45 Wellbe Senior Medical is now in 7 states caring for 107,000 MA patients (20% of them which are dual eligibles).

48:00 Proving the scalability of a home-based primary care model.

48:45 Expansion into rural areas.

49:45 Future growth plans.

50:00 Advantage in Scalability: (“When launching new markets, we could actually be up and running in 90-days – we don’t have the problem of bricks and mortar.”)

51:00 Disadvantage in Productivity: (ChenMed and Oak Street providers can see 20 patients a day in the office, while we are only seeing 4-5.”)

52:30 The ethno-geriatric imperative (one-third of older Americans are projected to be from one of the minority populations by mid-century).

54:00 Dr. Kang discusses how the Chinese cultural significance of taking care of elders informs his leadership at WellBe.

54:45 Healthcare disparities are driven by inadequate access to care.

56:00 An example of how WellBe provides linguistically appropriate and culturally competent care in Chicago.

57:00 The number of Americans aged 65 and older will more than doubling over the next 40 years — reaching 80 million in 2040.

58:00 Optimism for the value-based future of caring for seniors – does hope mostly reside only with Medicare Advantage and ACO REACH?

61:00 Multi-payer alignment in value-based care as an imperative to a hopeful future.