Thread by @Soleil_Shah

Our new paper in @NEJM examines the massive investments into primary care by Amazon, CVS, Humana, and other corporations—what’s driving this trend and what are its implications for patients, clinicians, & trainees? 1/x

2/x. In 2022, multi-billion dollar primary care deals filled the news (e.g., Amazon/One Medical; CVS/Signify; VillageMD/Summit Health). From 2010-20, total capital raised from private investments in primary care increased over 1000-fold. See Ikram et al:
catalyst.nejm.org/doi/full/10.10…

3/x. These corporate-owned primary care practices (we dub “CPCPs”) take 3 forms: retail-owned (e.g., Amazon, CVS, Walmart), insurance-owned (e.g., United, Humana), & investor-backed (e.g., Agilon, Oak Street Health). Many CPCPs now encompass >1 category
bain.com/insights/prima…

4/x. Why so much investment? For CPCPs in value-based arrangements, primary care can generate big profits by capturing more covered lives, max'ing each patient’s “budget” thru risk adjustment, ⬇️ health expenditures, & directing patients to other offerings (e.g., pharm, retail)

5/x. A major draw for CPCP creation is also the rapidly growing Medicare Advantage (MA) market. As @MikeGeruso & @timothyjlayton reveal in their seminal work, intense coding practices in MA can increase revenue capture by drawing higher federal payments
journals.uchicago.edu/doi/abs/10.108…

6/x. As an example of MA’s role in the revenue play of CPCPs,~50% of One Medical’s net revenue prior to its Amazon deal came from MA members, who made up only 5% of its total patient population. We discuss more examples in our paper. See SEC filing here: investor.onemedical.com/static-files/e…

7/x. Compared to independent or hospital-owned PCP practices, CPCPs may be uniquely positioned to succeed in MA & VBC generally. Large CPCPs may have ⬆️ capital, extensive networks, better tech/staffing to drive better coding & “win” VBC contracts (justifying ongoing investment)

8/x. Potential upsides for CPCPs. For some (likely commercial/Medicare) patients, CPCPs could offer convenient, fast, comprehensive, and even high quality care. For PCPs, CPCPs may allow smaller pt panels, higher comp., better work-life amenities, & potentially less admin work.

9/x. Downsides exist, too, esp for health equity. As more PCPs work for CPCPs, rural & safety net hospitals serving Medicaid/uninsured patients will be further drained. CPCP mergers could raise prices & privacy concerns. For staff, there could be ⬆️ coding reqs, reduced autonomy

10/x. Actions for regulators to curtail excess CPCP harms = applying more antitrust scrutiny (e.g., cross-markets), adjusting MA risk adjustment, & banning non-competes (topical!). @CMSGov & @FTC already taken proactive steps. We discuss more in the paper
fiercehealthcare.com/payers/how-ftc…

11/11. As corporate investors move into primary care, drawn by financial opportunity, it is critical that patients’ trust in the centuries-old field isn’t sacrificed alongside.

S/o to my brilliant co-authors, @efusebrown & @Hayrook

Read our paper here: nejm.org/doi/full/10.10…