Latest Parsley Health News
Jun 14, 2021
But low-income populations on state-run assistance programs aren't key parts of their plan, the companies tell Insider. Closely watched companies like Oak Street Health and Iora Health are chasing the growing and lucrative market of caring for seniors 65 and up who are on Medicare. Rival One Medical said in June it's buying Iora in a $2.1 billion deal that'll expand the publicly traded primary care company's business beyond those who are commercially insured. These companies typically offer online booking as well as in-person and video and text-based telehealth services to patients who pay a membership fee, or whose insurer or employer covers the cost of their care. But the more than 72 million people on state-run Medicaid programs won't be able to access many of these services any time soon. And health equity experts warn that failing to include them could widen disparities that only grew during the pandemic. One Medical, for its part, has already been scrutinized for allowing ineligible patients to skip ahead in COVID-19 vaccination queues earlier this year. It's not just because Medicaid reimburses at a lower rate than other insurance programs, industry experts say—it's also because Medicaid enrollees flow in and out of the program, and because their health problems tend to be more immediate instead of longer-term conditions associated with aging like diabetes and heart disease . It's also harder to show you've saved money when you're treating acute conditions, experts said. "We need to guard against creating tiers in our healthcare system," said Ann Greiner, president and CEO of the lobbying group Primary Care Collaborative. "They exist, and we want to make sure we don't exacerbate them." Why primary care companies aren't chasing Medicaid A handful of companies, like the Alphabet-backed Cityblock Health , are developing health services including primary care specifically for low-income populations. Women's health startup Tia is also partnering with Dignity Health, which already works with Medicaid programs, to accept Medicaid in Arizona. But many others — including Parsley Health, Crossover Health, and One Medical — told Insider they do not currently accept Medicaid payment and have no immediate plans to do so. One Medical, however, does waive its annual membership fee. In its early years, Parsley is mostly focused on chronic disease, according to the company. And One Medical's business model isn't yet set up to align with Medicaid's payment requirements, the company said. Crossover Health did not clarify why it wasn't pursuing the Medicaid market. It's also likely in part because of lower reimbursement rates. "Medicaid pays providers too little," said Regina Herzlinger, a Harvard Business School professor who studies consumer-driven healthcare. Herzlinger added that low income patients should — but don't — have access to the same providers as as patients insured by employers or Medicare. And lower rates might cause investors to balk, SCAN Group CEO Sachin Jain said. Jain is the former CEO of CareMore, a subsidiary of Anthem, which previously explored treating Medicaid patients. When investors assess health-tech companies, they're looking at revenues and margin opportunities, Jain said. "The truth is, the revenues associated with taking care of a Medicare population are just higher," Jain said. But it's not just about the money. Because Medicaid eligibility is typically determined by income, people come on and off, making it hard to maintain a longterm primary care relationship, Jain said. And older populations often have higher rates of chronic conditions that constant monitoring by primary care companies can help manage, including by averting expensive procedures down the line. For someone who might be eligible for Medicaid because of their income and need immediate treatment for cancer, it can be more difficult to show the benefit of more preventive care, Jain said. "It's not necessarily easy to modify cancer care costs, whereas with other kinds of diseases you can avoid a hospital admission by better managing someone's condition," Jain said. Shoring up healthcare for patients with expensive, difficult-to-manage conditions like diabetes or kidney disease also makes it easier to demonstrate both to patients and payers that their model saves money and improves health, Oak Street's chief medical officer Griffin Myers said. Oak Street offers in-person and virtual behavioral and primary care visits, transportation, and pharmacy services largely to senior patients. "We have a very, very, very specifically engineered program," Myers said. "If you took our model and started enrolling healthy eight-year-olds, it would be the biggest, stupidest waste of time." Widening the health gap Still, health equity advocates warn that membership-based primary care companies could widen the gap between the types of digitally-friendly health services available to low-income and uninsured patients and the patients on plans that partner with these companies. Primary Care Collaborative's Greiner warned that without improving Medicaid reimbursement rates, primary care tech companies won't have an incentive to improve healthcare for low-income patients. She said her group and other health equity advocates have urged Congress and the Centers for Medicare and Medicaid Services to bump up the rates. They've supported bills that could increase patients' access to the data plans, Wi-Fi and devices that some of these primary care companies rely on for video calls, she added. Especially during the pandemic, patients who can't access video have had to use audio-only calls for doctors' visits. "We do have concerns about the equity dimension," Greiner said. Cityblock Health's cofounder and head of product Bay Gross said the majority of the company's Medicaid patients have mobile devices equipped to access digital health, but that connectivity and Wi-Fi are common barriers. But digital services may always be out of reach for some low-income patients, Joan Alker, a Georgetown University research professor and executive director of the Center for Children and Families, said. "There are going to be some folks who are, for a variety of reasons, not connected," Alker said, including that they're experiencing homelessness or are unable to pay for the technology. While tech-based services like telehealth can be useful, Alker said, "they can never be the only solution." SCAN's Jain warned that it's not clear yet that these services like apps, telehealth visits, and texts from providers meaningfully improve health outcomes — and especially not for Medicaid populations, which often have higher concentrations of children, pregnant women, and acute conditions. If these companies can demonstrate that their high-tech services lowers the number of hospitalizations, length of stays and prevents the progression of chronic disease, it could start to move the needle. "Those are the things that actually make a difference to people and families," Jain said. Was this article valuable for you?