EXCLUSIVE: Nashville firm picks Phila. as test market, opens 3 health clinics

A Nashville company that has developed what it calls a new model for delivering primary care in urban neighborhoods has selected Philadelphia as its first test market.

Ampersand Health, started by a group of former Vanguard Health Systems executives, has opened “CityLife Neighborhood Clinics” in University City, North Philadelphia and the Spruce Hill section of West Philadelphia.

The clinics are serving Medicare Advantage and Medicaid managed care patients, but plans are underway to open additional practice sites in Philadelphia next year – some that will serve mothers, children and adolescents.

Dr Marisa Gefen

“Our culture is not fixated on how many patients we can see in a day,” said Dr. Marisa Gefen, a primary care physician who serves as practice team leader for the three CityLife sites. “Our goal is to give people what they need to get healthy.”

Gefen said the practice takes a team-based approach to primary care with each team consisting of a primary care physician, a registered nurse, administrative assistant and clinical assistant who work together side-by-side in the same room. The team is augmented by a behavioral health specialist, a pharmacist and a community coordinator who performs outreach in the neighborhoods served by the clinics.

She said another approach that differentiates CityLife’s clinics is that they provide “intensive” care coordination.

“We don’t just order a mammogram,” Gefen said. “We’ll help a member — that is how we refer to our patients — schedule an appointment and follow up to make sure the patient gets the mammogram and understands what it means.”

The CityLife clinics will also provide transportation to members who otherwise might not be able to get to a medical appointment. “You may have an older patient who doesn’t drive and can’t get to the bus,” she said. “We’ll go pick him up.”

The CityLife clinics do not provide care under the fee-for-service model that has long been a staple of health care, Gefen said, and instead have entered into risk -sharing contracts with Medicaid and Medicare insurers including Independence Blue Cross and Cigna.

CityLife’s payment rates under those contracts are based on meeting quality standards. The practices receive a portion of the savings they generate by delivering that care in a more cost-effective way.

Gefen, who was raised in Cherry Hill, said they also address the accessibility issue some patients face by having same-day appointments, and doing everything they can to eliminate wait times.

Tim Petrikin, CEO of Ampersand Health, said the CityLife clinic concept was developed by a team of former Vanguard Health executives as a way to improve care to Medicare and Medicaid managed care patients in the company-owned health plan. When Vanguard was acquired by Tenet Healthcare Corp. in 2013, the new owners decided not to keep Vanguard’s health insurance business. Petrikin and a handful of colleagues opted to start Ampersand and pursue their plan for urban health clinics.

Petrikin said, while at Vanguard, their plan was to initially develop their model in Detroit and Phoenix where the company’s health plan had members and a wealth of data on their health care utilization.

“That data showed what was needed to improve primary care, but the problem was nobody was structured to do it,” he said. “The country’s health care delivery system sometimes treats innovation like a virus. It attacks and destroys it.”

The algorithm gave high scores to Philadelphia, and Ampersand decided to start here. The company has about 60 employees in Philadelphia to go along with eight at its Nashville headquarters.

Its University City site on 40th street between Chestnut and Market streets is built-out leased space. Its Spruce Hill and North Philadelphia sites were previously health care centers owned by Cigna-Health Spring.

Petrikin said one of the key components of Ampersand’s CityLife model is building relationship with patients, which helps identify social problems that could be impacting a person’s health status.

He said malnutrition and hunger are a big problem in urban health care, telling the story of one patient who wasn’t taking his medicine because it was prescribed to be taken with food and he didn’t have any — and was too proud to tell anybody. To address problems like that, CityLife established its own food bank program that provides food on a temporary basis to help families waiting on food stamps or not yet enrolled in a social service program.

“Providing somebody with an $18 dollar-a-day food bag may save them from a $2,000 ER visit,” he said.

Petrikin said the Ampersand’s original goal was to open clinics in a second market next year. Those plans have been pushed back to 2017.

Instead, he said, the company plans to open additional sites in Philadelphia next year and to expand the program to include care for moms, children and adolescents.

John George covers health care, biotech/pharmaceuticals and sports business.