Democratization of value can only happen through the replication of full-risk APM adoption in primary care.  As a country, we must accelerate primary care progression towards fully-capitated risk by thoughtful health policy and payment model redesign.  Change is underway -- primary care is already moving to a capitated model of reimbursement, and ACO REACH is our first real test of realigning financial incentives to improve care of patients living with chronic conditions.  Furthermore, this inflection point in the value movement is finally bringing much needed emphasis to those living in underserved communities facing health inequities.  So how do we operationalize primary care transformation at scale?  Is it possible to replicate a ‘clinical flywheel’ that provides RN care coordination, home-based care, embedded pharmacists, and floating health concierges to close care gaps and addressing health inequities?

This week we are joined by two executives from UpStream, a billion-dollar, full-risk health services organization that embeds clinicians into participating doctors' offices as an advanced, full-risk Medicare program for network physicians.  By focusing on patients living with chronic conditions, and physically embedding highly trained prescribing pharmacists and coordination nurses at each primary care physician office, UpStream partners with its client practices to create the right infrastructure and resources for the whole-person care experience. Their approach has been to fully invest in primary care delivery models accountable for Total Cost of Care, whereby reducing care fragmentation for chronically ill patients while also achieving the best clinical and financial outcomes.

Dr. Sanjay Doddamani (CEO and Co-Founder of Upstream) and Valinda Rutledge (Chief Corporate Affairs Officer of Upstream) are two of the biggest thought leaders in the value movement. In this episode, they talk about the transformation opportunity of massively powerful primary care, the impact of COVID-19 on the value movement, technology innovation, health equity, capital investment in primary care infrastructure, collaborative care models, and the new ACO REACH payment model. Together they are leading one of the most innovative companies out there supporting primary care physicians in the Race to Value!

Episode Bookmarks:

01:30 Upstream – the fastest-growing healthcare solution provider in the country

02:30 Introduction to Dr. Sanjay Doddamani and Valinda Rutledge

04:00 The transformation opportunity of massively powerful primary care within a value-based purchasing construct

05:00 Can we reach a “Win-Win-Win” for patients, primary care physicians, and patients?

06:00 Valinda on the impact of the pandemic on the value-based care movement and how it unleashed tech-enabled consumerism in primary care

08:00 Payment reforms and looming insolvency of Medicare and how it will impact the independent Primary Care landscape

09:00 The development of ACO REACH as a model for capitated primary care reimbursement

09:30 Sanjay speaks to the challenges of the post-pandemic environment and the ‘Great Resignation’ on physician networks

10:00 “Primary Care physicians influence 90% of all medical costs.”

11:00 PCP burnout and recent findings on how family medicine is one of the five most stressful specialties

13:00 “If you continue to practice in a fee-for-service environment, it is like being on a hamster wheel with no way to get off.”

13:30 Sanjay speaks about the need to reallocate investment dollars to build primary care infrastructure for the 21st century

15:00 Critical Success Factors: Pharmacy integration, home-based primary care, and advanced data science capabilities

16:00 Valinda speaks to the challenges of decreasing PCP panel size when there are access barriers in underserved communities

18:00 Population health infrastructure requirements as the table stakes needed to play the game of value-based ...

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