Jim Eischen, Esq./Lofty Learning/Eischen Law Office

Who is taking the market by storm?

CMF 2021 - Friday, October 22, 2021, 5:40 pm - 6:15 pm EST Jim Eischen, Esq./Lofty Learning/Eischen Law Office

Jim Eischen has over 32 years of experience practicing law, and for the last ten (10) years, he has developed a national reputation as a private direct medicine, healthcare business planning and regulatory compliance attorney. Jim frequently lectures on healthcare & wellness business planning, data privacy compliance, and avoiding professional burnout.

Jim is a national expert in the creation and implementation of private direct practice models, and how to create effective healthcare/corporate platforms. In 2018 and again in 2020 he re-wrote the private direct medicine compliance chapter of the California Medical Association’s physician legal handbook. His legal analysis is peer-reviewed.

To better distribute guidance on private direct practice formation and operation best practices and compliance solutions, he formed www.loftylearning.com. Lofty Learning delivers educational insight to a wide audience via live/taped/audible webinars.

Jim continues to practice law and assist with practice and business formation projects throughout the US as Eischen Law Office.

Disclosure Statement: Jim Eischen is the founder/owner of Lofty Learning and Eischen Law Office.

Copyright © Lofty Live Learning, Inc. All rights reserved. | www.loftylearning.com

http://www.loftylearning.com/

SUMMARY

▪ The future of the US healthcare system: virtual, connected, patient-focused health data, integrative, plan-plus (i.e. combines private fees and plan reimbursement)

▪ Private direct primary care models and plan-only models are innovating past legacy plan-based thinking: from medically necessary diagnosis/treatment to virtual integrative care connection (as predicted!)

▪ Disruption pandemic and post-pandemic: continues


HOW OUR

HEALTHCARE

SYSTEM IS

CHANGING

Spending on primary care is increasing

▪ Rhode Island required insurers to increase spending on primary care by 1% annually from 2010 to 2014

▪ This led to a $27 million increase in totally primary-care spending from 2010 to 2017

▪ But, resulted in $115 million decrease in total health care expenditures

Companies want employees to be healthier

▪ In 2019, PepsiCo agreed to pay employees health insurance premiums for a year if they selected a high-value primary care physician

New primary care models are winning

▪ Advocate Aurora Health is partnering with Oak Street Health to open high-touch clinics for seniors in the Chicago area

“How leading health systems are partnering with primary care disruptors”. Advisory

Board. (2020) https://www.advisory.com/daily-briefing/2020/01/28/primary-care


https://www.advisory.com/daily-briefing/2020/01/28/primary-care

IMPACT OF COVID-19

Losses in primary care

▪ Majority of practices are no longer physician-led

▪ Drops in routine office visits and elective procedures

• 60% decline in patient volume

• 48% of practices have had to furlough staff

• 22% have laid off employees permanently

Increase in telehealth usage

▪ February 2020: <0.1% of Medicare patients per week received a primary care telehealth visit

▪ April 2020: 44% of visits were via telehealth

▪ Mid-summer: 10 million+ beneficiaries on telehealth

▪ Large market that may persist after the pandemic


▪ (Landi, H., “Primary care is ripe for disruption. Here are the players trying to shake up the market.” Fierce Healthcare. July 2, 2020)

https://www.fiercehealthcare.com/practices/primary-care-ripe-for-disruption-here-are-players-trying-to-shake-up-

market


https://www.fiercehealthcare.com/practices/primary-care-ripe-for-disruption-here-are-players-trying-to-shake-up-market

▪ Founded in 2007

▪ Personalized support for employees’ healthcare

▪ 3 solution models each with a different range of benefits

▪ Uses technology to help connect individuals to physicians and healthcare solutions

https://www.accolade.com/solutions


https://www.accolade.com/solutions

ALEDADE

▪ Founded in 2014

▪ Partners with primary care physicians to build and lead Accountable Care Organizations(ACOs)

▪ Works with more than 550 primary care practices

▪ Provides practices with data analytics, policy and ACO expertise

▪ Manages more than $7.3 billion in healthcare spending

https://www.aledade.com/


https://www.aledade.com/

▪ Helps convert medical practices to membership models

▪ Administrative and front-end support for practices

▪ Clinic operations, communications, revenue flow, etc.

▪ Professional support network

▪ Patients engage with a personalized care team through the network

https://ccphp.net/


https://ccphp.net/

CHENMED

▪ Founded in 1985

▪ Provides geriatric care

▪ Physician-led primary care company focused on providing services to moderate-to-low income seniors with complex chronic conditions

▪ Operates more than 60 primary care practices across 8 states and plans to open 15 more centers

▪ Pivoted from 98% in-center patient appointments to 95% virtual appointments in just one week to help patients during COVID-19

▪ Physician-led primary care model

https://www.chenmed.com/


https://www.chenmed.com/

▪ Founded in 2018

▪ Provides house calls for primary/urgent care, COVID testing, vaccines, and other health and wellness service

▪ Personalized on-demand medical care

▪ Pricing:

▪ $499 for a basic house call

▪ Extra charge for certain services

▪ $149 for testing

▪ $199 for lab draws

▪ $99 for intramuscular injections https://conciergemdla.com/


https://conciergemdla.com/

▪ Founded in 2010

▪ Primary care provider focused on the self-insured employer market

▪ Raised $168 million in Series D funding in 2021

▪ Provides behavioral health services, health coaching, acupuncture, physical therapy, and optometry services

▪ Notable customers include: Apple, Facebook, Visa, LinkedIn, and Microsoft

▪ No-cost membership

▪ Corporate practice of medicine

https://crossoverhealth.com/


https://crossoverhealth.com/

▪ Founded in 2015

▪ Platform for connecting healthcare provides and patients

▪ Streamlining information delivery for care coordination, patient health monitoring, and risk assessment

▪ Live texting between patients and physicians

DOCENT HEALTH

https://www.docenthealth.com/Copyright © Lofty Live Learning, Inc. All rights reserved. | www.loftylearning.com

https://www.docenthealth.com/

▪ Founded in 2016

▪ Healthcare service plans distributed through employers and commercial landlords

▪ Mobile phones act to deliver telehealth services

▪ Patients have a care team to manage their needs

▪ 800% increase in revenue in 2020 and 500% increase in demand after the pandemic began

▪ $60 million in Series C funding in 2021

https://www.edenhealth.com/Copyright © Lofty Live Learning, Inc. All rights reserved. | www.loftylearning.com

https://www.edenhealth.com/

EVERMED DIRECT

PRIMARY CARE

▪ Founded in 2018

▪ Based in Washington

▪ Primary care services at a fixed costs for patients/employers

▪ Does not cover specialist or hospital visits

▪ Does not take Medicare/Medicaid patients, but works with other insurance

https://evermeddpc.com/Copyright © Lofty Live Learning, Inc. All rights reserved. | www.loftylearning.com

https://evermeddpc.com/

▪ Founded in 2016

▪ Membership-based preventive and primary care company

▪ Custom electronic health record system, chronic condition management, health monitoring, virtual visits

▪ Launched Forward at Home to support patients during COVID-19

▪ Forward has raised $225 million in Series D funding in 2021


https://goforward.com/technology


https://goforward.com/technology

High-touch care with 24/7 care team

Genetic testing

Real-time blood testing and body scans

Unlimited visits with private physicians

Membership cost = $149/month


▪ Founded in 2017

▪ Sells health and wellness products, prescriptions, and medical advice tailored to men & women

▪ Focused on “non-critical” medical conditions only

▪ Pricing varies depending on the good/service – e.g.

▪ Online anonymous support groups - $15

▪ Primary care telehealth visit - $39

▪ Products such as COVID saliva tests - $150

https://www.forhims.com/about

https://www.forhers.com/aboutCopyright © Lofty Live Learning, Inc. All rights reserved. | www.loftylearning.com

https://www.forhims.com/about

https://www.forhers.com/about

▪ Founded in 2010

▪ Primary care practices with a focus on the Medicare population

▪ Operates 48 practices in 10 states and raised $126 million in February 2020


https://www.iorahealth.com/Copyright © Lofty Live Learning, Inc. All rights reserved. | www.loftylearning.com

https://www.iorahealth.com/

IORA HEALTH MEMBERSHIP

24/7 access to care

Same-day and next-day appointments (in-person or virtually)

Onsite labs

Fully integrated behavioral health services

Yoga classes

Health and wellness coaching

Membership cost is ~ $150/month

Access to your own medical records and info


LEAA

▪ Provides doctor house calls and services in NY, NJ, and FL

▪ Vaccines, physicals, COVID testing, primary care, and more all delivered at home

▪ For a subscription plan as high as $649 or as low as $449 a month

▪ Or for a premium fee for specific services (e.g. $150 for a regular visit)

https://leaa.io/index.htmlCopyright © Lofty Live Learning, Inc. All rights reserved. | www.loftylearning.com

https://leaa.io/index.html

MOSAIC HEALTH

▪ Founded in 2014

▪ Provides telehealth and specialized health and preventive/wellness services

▪ Focused on populations with extra or special needs –seniors and patients with disabilities / behavioral health issues

▪ Services are tailored to individual needs and goals

https://mosaichealth.org/


https://mosaichealth.org/

OAK STREET HEALTH

▪ Founded in 2012

▪ Primary care provider focused on the Medicare population

▪ Targets areas where there is a lack of quality primary care options, typically low-to-moderate income geographies

▪ Operates 54 locations across 8 states and expanding into new markets

▪ Centers have helped reduce its population’s hospital admission rate by 44%


https://www.oakstreethealth.com/


https://www.oakstreethealth.com/

▪ Same- or next-day appointments

▪ Rides to and from appointments

▪ Telehealth visits and 24/7 patient support line

▪ Help navigating Medicare benefits

OAK STREET HEALTH

MEMBERSHIP


▪ Founded in 2011

▪ Telehealth and health monitoring service via a phone application

▪ Known for its prediabetes and diabetes care

▪ Provides patients with health monitoring tools

▪ Also has services for:

• Health coaching

• Musculoskeletal health

• Hypertension

• Preventive care

• Behavioral health

https://www.omadahealth.com/Copyright © Lofty Live Learning, Inc. All rights reserved. | www.loftylearning.com

https://www.omadahealth.com/

ONE MEDICAL

▪ Founded in 2002

▪ Member-based, tech-integrated, and consumer focused primary care platform

▪ Currently serves over 455,000 patients in 11 markets across the U.S.


https://onemedical.com/


https://onemedical.com/

24/7 access to virtual care

Same- or next-day appointments

On-site lab services

Membership cost = $199/year


PARSLEY HEALTH

▪ Founded in 2015

▪ Online & in-person “whole-body approach” to healthcare

▪ Helps with a variety of health issues, including:

▪ Hormonal health, digestive issues, mental wellbeing, autoimmune disease, thyroid conditions, maternal and fertility support, skin issues, and cardiometabolic health

▪ Priced as a tiered subscription model

▪ $154 per month for the 12-month plan

▪ $204 per month for the 4-month plan

https://www.parsleyhealth.com/


https://www.parsleyhealth.com/

PRIVIA HEALTH

▪ Founded in 2007

▪ National physician organization that partners with primary care and select specialist physician practices, health systems, payers and employers

▪ Includes 2,500-plus healthcare providers for more than 2.6 million patients across five markets

▪ Creating a centralized base of care with technology to streamline healthcare and achieve better outcomes

▪ Raised over $417 million to date

▪ Filed registration statement for proposed IPO on 4/7/2021

https://www.priviahealth.com/Copyright © Lofty Live Learning, Inc. All rights reserved. | www.loftylearning.com

https://www.priviahealth.com/

▪ Founded in 2017

▪ Connects patients/clients to healthcare professionals “whenever and wherever” via the internet

▪ Sells various health products and services

▪ Diagnosis, medicine delivery, weight management, smoking cessation, wellness products, etc.

RO

https://ro.co/Copyright © Lofty Live Learning, Inc. All rights reserved. | www.loftylearning.com

https://ro.co/

▪ Founded in 2020

▪ At home in-person telehealth visits

▪ Has streamlined at-home testing for COVID and other things, such as the flu

▪ Patients are screened virtually, and then they can receive face-to-face care at home

https://streammd.com/Copyright © Lofty Live Learning, Inc. All rights reserved. | www.loftylearning.com

https://streammd.com/

▪ Founded in 2002

▪ Multinational health corporation offering a wide range of services, primarily through telehealth

▪ One of the largest telehealth providers: over 27 million members in 2019

▪ Acquired Livongo, another telehealth giant, in October 2020, further expanding its services to provide remote health monitoring (e.g. for diabetes care)

▪ Primary care, mental health services, wellness care, specialist care, and more

▪ Patients can interact with physicians and other healthcare professionals at any place

https://www.teladoc.com/


https://www.teladoc.com/

UNITED CONCIERGE MEDICINE DIGITAL HEALTH

▪ Operates a digital healthcare platform

▪ 24/7 connectivity with healthcare (primary, urgent, emergency)

▪ Virtual emergency room to navigate urgent health concerns

▪ Payable by patients, employers, and insurers

https://www.ucmdigitalhealth.com/Copyright © Lofty Live Learning, Inc. All rights reserved. | www.loftylearning.com

https://www.ucmdigitalhealth.com/

▪ Founded in 2013

▪ Operator of primary care clinics

▪ Company has 2,900 employed or partner primary care providers

▪ In-person (at home or at a clinic) & telehealth visits

▪ Care team to address patients’ health needs holistically

▪ Operates in 9 markets

▪ Partnered with Walgreens to open 5 new 2,500-square-foot primary care clinics in the Houston area

https://www.villagemd.com/


https://www.villagemd.com/

WELLMED MEDICAL MANAGEMENT

▪ Founded in 1990

▪ Accountable care organization

▪ Collaboration of healthcare professionals

▪ Serves over 370,000 patients

▪ Streamlines the healthcare process for patients (primarily older patients)

• From primary care to transportation to insurance

https://www.wellmedhealthcare.com/


https://www.wellmedhealthcare.com/

▪ Founded in 2002

▪ “National network of direct care practices providing quality, accessible, and transparently priced health care”

▪ Partners with physicians to deliver comprehensive primary care services

▪ Fixed monthly fees

▪ Removes the “middle man” (i.e. insurance companies)

https://www.accesshealthcaredirect.com/


https://www.accesshealthcaredirect.com/

Founded in 1996

“Founder of concierge medicine”

MD2 physicians dedicate their practices to just 50 families

11 practices across 8 states

https://www.md2.com/

Corporate practice of medicine


https://www.md2.com/

▪ Founded in 2000

▪ National network of primary care doctors

▪ 1,000 primary care doctors and over 325,000 patients

▪ Mission is to provide life-changing, personalized, preventative care


https://www.mdvip.com/Copyright © Lofty Live Learning, Inc. All rights reserved. | www.loftylearning.com

https://www.mdvip.com/

MDVIP WELLNESS PROGRAM ▪ 24/7 physician availability by phone

▪ MDVIP Connect website and app

▪ Nutrition and fitness plans

▪ Same- or next-day appointments

▪ Chronic condition support

▪ Family plan and travel benefits

▪ Annual fee = $1,650 - $2,200


SIGNATUREMD

▪ Membership medicine

▪ Partner with primary care and specialist physicians

▪ Provide direction and support for physicians who want to convert to membership medicine

▪ Physicians can choose to fully convert to membership care, partially convert and retain non-members, or partially convert and oversee a physician extender’s care of non-members


https://signaturemd.com/


https://signaturemd.com/

Personalizedwellness / care plan

Enhanced health guidance and health coaching

24/7 electronic communication connection with physician

Same- or next-day appointments

Increased availability


SPECIALDOCS

Founded in 2002

Concierge medicine consulting firm

• Patient communications

• Staff and physician training

• Accounting and membership

management

• Patient outreach and marketing

• Legal and regulatory guidance

Provide support for:

https://specialdocs.com/Copyright © Lofty Live Learning, Inc. All rights reserved. | www.loftylearning.com

https://specialdocs.com/

▪ Doctor On Demand lands $75 million investment

▪ VA awards 10-year telehealth contract to Phillps

▪ Walgreen’s stock rises on announced plans to open 700 primary care practices

▪ Rock Health reports: Unprecedented funding for digital health in 2020 (digital health start-ups scored $588 million in funding)

▪ Accolade raises $220 million in its IPO, stock surged in first day of trading

▪ Kroger secures FDA authorization for at-home corona virus testing

▪ Lifestyle medicine seen as key to digital health adoption?

▪ Teledoc acquires In Touch Health $150 million cash/4.6 million shares


▪ Rapid evolution of digital health

▪ Plans adapting and attempting to incentivize high-touch care with reimbursement reforms

▪ Consumers are looking for lifestyle guidance, health education, assurance, convenience, integration (centralized solutions)

▪ Discover your place in this marketplace, find an authentic contribution to make

▪ Understand the rules of the game, learn from others, be yourself

▪ Now, let’s look at specific private direct healthcare updates….


▪ Private direct innovations are not just about new entities; existing players are making their moves too

▪ With their vast market research and clientele, this move by Rite Aid evidences the trend of US healthcare

▪ Branding and focusing on innovative integrative care –holistic health

▪ Sustainable products and nutrition

▪ Greater connection with pharmacists

Full articleCopyright © Lofty Live Learning, Inc. All rights reserved. | www.loftylearning.com

https://adage.com/article/advertising/rite-aid-embraces-holistic-medicine-first-ever-brand-shift/2292026

▪ “Integrative” healthcare: referenced directly or indirectly in nearly all US healthcare disruption models, and now with Rite Aid’s national US ad campaign

▪ “Virtual” healthcare: life became virtual during the pandemic, and there’s no going back (even if telehealth stocks are sputtering, that’s because monetization in telehealth is as confused as US healthcare generally)

▪ ”Direct” healthcare: consumerization of health data and health services—uniquely American and unlikely to subside

▪ “Affordable” private healthcare: focus on 1% US economic challenges = continued efforts to create more affordable programs for wider income spectrums


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Jim Eischen, Esq./Lofty Learning/Eischen Law Office

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