Christopher Crow, M.D., Discusses Why We Need a Marshall Plan for Primary Care
Catalyst Health Network, the largest primary care clinically integrated network in Texas, has nearly doubled in size to approximately 1,000 providers during the pandemic. CEO and founder Christopher Crow recently discussed his organization’s growth and why he thinks the nation needs a bold Marshall Plan to bolster primary care’s role in our health system.
Crow, a family physician, began this work in 2007 at his practice called Village Health Partners. It was the first Level Three NCQA-recognized patient-centered medical home in the middle of the country, he said. “We were doing some cool value-based payment things early,” he said. “What I learned was that with independent physicians, total spend was so much less than what the hospital systems were spending when they were buying up practices.” He thought that to help communities thrive, we have got to keep independent physicians independent because otherwise the cost of healthcare would continue spiraling upward. “We started bringing in the business services to these practices because a lot of these independent practices don't have the business acumen and that's why they end up getting consolidated with the hospitals.”
Plano, Texas-based Catalyst offers scalable revenue cycle, EHR, financial management, reporting and contracting to independent practices, so that they can focus on the clinical practice and patient care, Crow said. That proved valuable during the pandemic, he added. “We got all 1,000 on telehealth in about 10 days,” he said. Almost all of them got PPP loans as well. “None of our practices went under during the pandemic, he said. “We also contract on behalf of the network of physicians with Medicare, Medicare Advantage, and all the commercial carriers and some directly with employers in value-based contracts. They're still mostly in traditional fee for service, but with a care management fee per member per month, for all the lives that we have, but we're getting into prospective payment. Now that Medicare is starting to work with direct contracting entities, we’re moving to prospective payment for primary care involving care management and care coordination.”
Catalyst also helps practices on the clinical side, with care managers, care coordinators and integrated pharmacists that they assign to the physician — a team of three individuals who work through the EHR to virtually care for the physician’s most challenging patients on an ongoing basis.
I asked Crow about the large number of physician practices that have been acquired by health systems, investors or even payers with large health IT components like UnitedHealthcare’s Optum. “The consolidators of the world are generally looking to get some type of financial return,” he said, “and primary care forever has been one of the more underfunded businesses, so I have a concern over what the incentives would look like. The way our model works is we do well if the patient does well and the payer does well from a return standpoint. It’s hard enough to align the provider, the patient, and the payer. Getting three wins is hard enough, but if you add an investor, to get four wins is going to be a little more difficult.”
Marshall Plan for primary care
Crow co-authored a report calling for a Marshall Plan for primary care in Texas and across the country. It describes the importance of moving from episodic fee-for-service payment to prospective payment models of care, improving medical education and promoting team-based care, and making sure that public health is not only funded but more interwoven with primary care. The report also calls for accelerating the growth in telemedicine. In Texas, it also recommends creating a single statewide health information exchange.
Crow said CMS is in the process of making some of these changes. “We've learned from Medicare Advantage over the last seven years — it's got a financial model that works for the patient, the provider, the payer, and the government,” he said. “So CMS is asking why can't we do some of these things more like Medicare Advantage, and you're seeing four different Primary Care First models. This is the moment because employers are starting to understand the value of primary care in this different model. I feel that we'll look back to 2020 as kind of the tipping point year where things really started going, and by 2025, I would hope that we would have a majority of our patients with primary care physicians in value-based models.”
At the state level, expanding Medicaid in Texas would have a big impact, he said. “We have some of the highest uninsured rates in the country, and a lot of people are underinsured with high deductible plans. So you're getting a population that is just going to get sicker and sicker because they don't have access to affordable care.” So the further we kick this ball down the road and don't decide to do primary care and take care of everybody, we're basically taxing the next decade and the next decade?
It's been shown that when patients have a primary care relationship it reduces overall healthcare spending, he noted. “So why wouldn't we be investing in that for everyone?”
