Full-Risk Primary Care Described in 'The Calling' by Drs. Chris and Gordon Chen

This video provides an in-depth exploration of the "full-risk primary care" model, as detailed in the book "The Calling" by Drs. Chris and Gordon Chen, the founders of ChenMed. Dr. Eric Bricker reviews the book, highlighting ChenMed's unique approach to healthcare delivery for Medicare Advantage patients. The core premise is that ChenMed, operating over 100 clinics in 12 states, assumes full financial risk for each patient's total cost of care, encompassing not just primary care visits but also medications, procedures, and hospitalizations. This model incentivizes keeping patients healthy and out of expensive acute care settings.

The video delves into ChenMed's "secret sauce" for achieving remarkable health outcomes and cost reductions. Central to their success is a significantly smaller patient panel size, with each primary care physician managing approximately 450 patients, in stark contrast to the typical 3,000 or more. This allows for monthly patient visits, ensuring frequent interactions. Beyond the frequency, ChenMed emphasizes direct access, with doctors providing their personal cell phone numbers to patients. These frequent, accessible interactions are critical for developing two essential elements: trust between the patient and doctor, and patient accountability for their health behaviors and medication adherence.

Dr. Bricker elaborates on how trust is paramount, enabling patients to call their ChenMed doctor before resorting to emergency room visits, a key strategy for cost control. The frequent check-ins also foster accountability, allowing physicians to consistently reinforce positive behavior changes, such as dietary modifications, and ensure medication adherence. The video cites impressive results: ChenMed has reduced overall ER visits and hospitalizations by 30-50%, CHF hospitalizations by 70%, and strokes by 22%. The speaker concludes by applying these lessons to the burgeoning "retailization of primary care" by entities like Walmart, Amazon, and CVS, asserting that these new models will fail to achieve similar outcomes unless they adopt ChenMed's fundamental principles of small patient panels, frequent visits, trust, and accountability.

Key Takeaways:

• Full-Risk Primary Care Model: ChenMed operates on a full-risk model for Medicare Advantage patients, where the primary care practice is responsible for all healthcare costs (primary care, medications, hospitalizations, surgeries) for a set per-patient amount. This financial structure heavily incentivizes proactive health management and prevention.
• Exceptional Outcomes: ChenMed has demonstrated significant success in improving patient health and reducing costs, including a 30-50% reduction in ER visits and hospitalizations, a 70% reduction in congestive heart failure hospitalizations, and a 22% reduction in strokes.
• Small Patient Panel Size: The cornerstone of ChenMed's success is a dramatically smaller patient panel, with one primary care doctor caring for approximately 450 patients, compared to the industry average of 3,000 or more. This allows for a high-touch, personalized approach to care.
• Frequent Patient Interactions: The small panel size enables doctors to see patients approximately once a month, regardless of their health status. Some patients may be seen daily or weekly depending on their needs, ensuring continuous engagement and monitoring.
• Direct Physician Access: All 450 patients have the personal cell phone number of their doctor, providing unparalleled access and fostering a strong sense of support and availability, which is crucial for urgent needs and preventing unnecessary ER visits.
• Building Patient Trust: Frequent interactions and direct access are essential for establishing deep trust between the patient and their doctor. This trust is critical because it encourages patients to contact their primary care physician first before seeking emergency care, thereby controlling costs and ensuring appropriate treatment.
• Fostering Patient Accountability: Regular check-ins allow doctors to hold patients accountable for their health behaviors (e.g., diet, exercise) and medication adherence. This consistent reinforcement is vital for managing chronic diseases effectively, as simply providing instructions once is often insufficient for lasting change.
• Importance of Behavior Change and Medication Adherence: The video emphasizes that chronic disease management relies heavily on patients changing their behavior and consistently taking prescribed medications. The ChenMed model provides the necessary framework (frequent contact, trust, accountability) to facilitate these crucial aspects.
• Economic Impact of Prevention: Preventing hospitalizations is a significant cost-saving measure, with each hospitalization estimated to cost around $15,000. ChenMed's model actively works to keep patients out of the hospital through proactive care and engagement.
• Lessons for "Retailization of Primary Care": The speaker warns that the growing trend of "retailization" in primary care (e.g., Walmart, Amazon, CVS acquiring clinics) will fail to achieve similar positive outcomes unless they adopt ChenMed's core principles of small patient panels, frequent visits, trust, and accountability.
• Beyond Physician-Only Care: While the model emphasizes the doctor-patient relationship, the speaker acknowledges that scaling such a model nationwide would require the involvement of physician assistants (PAs) and nurse practitioners (NPs) to augment the physician workforce.

Tools/Resources Mentioned:

• "The Calling" by Drs. Chris and Gordon Chen: The book reviewed in the video, which details the story and operational model of ChenMed.
• ChenMed: A full-risk primary care practice serving Medicare Advantage patients, highlighted as a successful case study for its innovative healthcare delivery model.

Key Concepts:

• Full-Risk Primary Care: A healthcare delivery model where the primary care provider receives a fixed payment per patient and is responsible for all of that patient's healthcare costs, including specialist care, hospitalizations, and medications.
• Patient Panel Size: The number of patients assigned to a single primary care physician. ChenMed's model significantly reduces this number to enable more personalized and frequent care.
• Retailization of Primary Care: The trend of large retail corporations and tech companies (e.g., Walmart, Amazon, CVS, Optum) entering and acquiring primary care clinics, often with a focus on convenience and accessibility.
• Patient Trust: The confidence and reliance a patient places in their healthcare provider, which is crucial for effective communication, adherence to treatment plans, and seeking appropriate care.
• Patient Accountability: The patient's responsibility for actively participating in their own healthcare, including adhering to medical advice, making lifestyle changes, and taking medications as prescribed.

Examples/Case Studies:

• ChenMed's Outcome Data: Specific reductions in ER visits (30-50%), hospitalizations (30-50%), CHF hospitalizations (70%), and strokes (22%) serve as concrete evidence of the model's effectiveness.
• FDR's Blood Pressure: The example of President Franklin D. Roosevelt's extremely high blood pressure (240/140) and subsequent death from a stroke is used to illustrate the historical lack of effective chronic disease management and the life-saving potential of modern medication and adherence.