Older Adults Get State-of-the-Art Care From HAP’s New Partner – Oak Street Health
Doctors are often in short supply in low-income areas. Transportation may not be available for appointments or picking up prescriptions. Education and literacy gaps may make it hard to understand medical instructions. Healthy food may be scarce. Home life may be unhealthy. Mental health issues may compound these problems.
The results are poor health and quality of life and avoidable hospitalizations. It’s bad for the patients and bad for their wallets. Currently, over 80,000 adults in HAP’s region qualify for MI Health Link, a program run by the State of Michigan and the federal government to provide better health care for people who have both Medicare and Michigan Medicaid.
Location, location, locationHAP has long sought an effective solution for our members in that group. To effectively care for them, HAP is a participating health plan under MI Health Link, and we have partnered with an innovative new primary care provider called Oak Street Health.
“Oak Street is willing to locate themselves in parts of Detroit where local citizens don’t have access to the kind of care that other citizens in metro Detroit have,” says Dr. Peter Watson, HAP’s Vice President for Care Management and Outcomes. “And that’s a pretty courageous act on the part of Oak Street, to make that part of their business model. So, having a partnership with Oak Street to help further that is really part of what HAP is all about.”
The difference is clear as soon as you pull up to Oak Street’s Fenkell Street store-front in Detroit’s Rosedale Park.
“We’re not in a big medical suite office building 30 miles away from where people live,” says Oak Street Regional Vice President Rafe Petty. “We are where people live and we try to make it the easiest place that they’ve ever wanted to access care.”
Easy access is one of many ways that Oak Street helps patients get the amount of care they need. “Oak Street,” says Petty, “has a philosophy of being a very high-touch care model.”
Delivering “high-touch” careThe idea is to see patients frequently and for as long as they need to provide personalized support. Oak Street staff help patients see specialists, receive and take medications and create healthier lifestyles. On average, Oak Street patients see their primary care physician 7.4 times each year. That’s three times the Medicare average. The visits average 20 minutes, almost twice the Medicare average. And Oak Street’s 24-hour call center connects patients directly to a nurse whenever they need support.
The result is a 40 percent lower rate of hospitalization than the Medicare average.
“If you’re a patient of Oak Street,” says Petty, “You’re less likely to go to the hospital as your neighbor.”
Making room for communityEven the physical space is different from the average medical office. Each of Oak Street’s 24 locations has a community room where patients and community members gather for coffee, conversation and daily social and health programs.
“You can come have coffee, sit there, watch the news, talk with someone about life itself. It’s a social aspect at Oak Street,” says patient Anthony Hatchett. It is the day of his first appointment with Dr. Chris Popp at Oak Street, but he’s visited the community room three times and it convinced him to switch to Oak Street for primary care.
His previous provider was an “assembly line,” says Hatchett. “They listen to what your problems are, which you might be having with your body, but that’s about it. It just wasn’t enough. Then you would ask them questions and there were not enough legible answers.”
Oak Street, says Hatchett is “a new way of going to the doctor, a doctor that allocates his time and you’re not waiting a long time to see the doctor and the doctor spends a little more time with you and the facilities are state of the art.”
Combining expertiseIn the clinical area, there are no private offices. Practitioners work together at a long counter adapted from emergency room layouts. And there is no triage area.
“In most practices, you get your weight done in one spot and then your blood pressure,” says Petty. “That’s to improve operational efficiency. That makes it faster to get people through the rooms. At Oak Street, it’s all in the exam room. We are not designed to be fast. We are designed to have a long-term, long-standing relationship where we spend a lot of time with our patients.”
But Oak Street’s real secret sauce is multi-disciplinary groups of practitioners. The teams include the physician, medical assistant, medical scribe, social worker and nurse.
“At Oak Street, we want every single one of our disciplines to practice at the top of their license,” says Petty.
This means that, instead of doing paper work or medication refills, nurses are doing health coaching so patients know how to take care of themselves. And social workers are helping patients with issues like family or mental health issues, food insecurity and transportation.
The scribes are mostly students going into medical school. They take notes so doctors can give patients undivided attention and have better documentation.
Dr. Chris Popp has been a primary care physician for 17 years, treating as many as 10,000 patients at a time. At Oak Street, he has 1,000 patients. He says “It’s just what medicine is supposed to be. It’s addressing every issue of the patient’s medical situation with a whole team of people. It was so frustrating to try to do it by yourself, knowing that it was sub-optimal. And every day you’d go home going ‘I didn’t do a good job today,’ and that gets frustrating. There’s so much to do in medicine. I can’t do it all. My notes were terrible before. Now they’re great because I have super smart scribes. And the social worker we have here is fantastic. She has amazing connections and resources that help the patients so much.”
Partnering to help membersThe model, says Petty, “is about relationships with patients and with the insurance company. So, the relationship between HAP and Oak Street is crucial. Both parties have agreed that outcomes matter the most. In other words, Oak Street gets paid for making HAP members healthier, rather than for providing a doctor appointment.”
“We have to catch up as an industry and deliver an outcome rather than say ‘we did a whole bunch of services’ and that is a proxy for an outcome,” says Watson. “And so, Oak Street’s commitment to being accountable, and taking on risk for an overall outcome, is something that we want to do because it’s going to help us get the right thing for our members.”
If you or someone you know live in Wayne or Macomb County, currently have Medicare and Medicaid and would like to learn more about HAP Midwest MI Health Link, please contact us at (888) 654-0706, seven days a week, 8 a.m. to 8 p.m. TTY users dial 711.
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