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  • - [Narrator] Corporate giants like Amazon, United Health

  • and CVS are investing billions

  • into primary care practices,

  • with deals tapping into the nation's

  • $4 trillion healthcare market.

  • And it's part of a shift

  • in America's costly healthcare system

  • moving away from the traditional Fee-For-Service,

  • towards Value-Based care.

  • That model is about paying providers

  • for keeping patients healthy,

  • while a Fee-For-Service model is when medical providers

  • are paid based on the amount of services performed.

  • So why are companies spending billions

  • on primary care practices,

  • and what could the growing shift to Value-Based care

  • mean for doctors, patients and health insurers?

  • The US spends more per capita on healthcare

  • than any other developed nation,

  • but still fares worse on most major health measures.

  • Health experts say the incentives baked

  • into America's Fee-For-Service system

  • are part of the problem.

  • - So critics say that under the Fee-For-Service model,

  • it basically encourages providers to recommend

  • as many services as possible, which drives up the cost

  • of healthcare without necessarily ensuring

  • patients are at the forefront of care.

  • - [Narrator] Essentially, doctors are rewarded

  • for the volume of healthcare services they provide.

  • Now, companies like Amazon, CVS, and Walgreens

  • are tapping into the growing Value-Based care movement.

  • That model provides incentives to improve patient health

  • outcomes within hospitals and doctor's offices.

  • - In Value-Based care, the idea is to keep track

  • of the patient, to have more contact

  • between primary care doctors and patients,

  • and reduce the amount of time that people

  • actually spend in hospitals where the costs are very high.

  • - [Narrator] Those costs are high for patients

  • and health insurers.

  • Some private health plans and government programs

  • like Medicare have already adopted this model.

  • They want to move more of the healthcare system

  • to that approach, which makes providers accountable

  • for some or all of the cost of their patient's care.

  • While Value-Based care can be traced back decades,

  • the 2010 Affordable Care Act

  • accelerated the government's transition to this model.

  • - The government essentially said that

  • it'll start shifting a lot of healthcare

  • towards Value-Based care

  • with the idea being to control costs.

  • - [Narrator] Still, there can be downsides

  • to a Value-Based model.

  • - [David] A key concern is that patients might be delayed

  • in seeing specialists or in undergoing procedures,

  • and basically insurers and providers could be

  • doing that to prevent costs from escalating.

  • - [Narrator] One obstacle behind shifting

  • to a Value-Based model is a shortage

  • in primary care physicians or PCPs.

  • Because the US healthcare system rewards

  • more expensive procedures, medical students may prefer

  • to become cardiologists or surgeons.

  • - [David] The cardiologist makes close to $500,000

  • on average, whereas a primary care physician

  • will make around 200,000.

  • - [Narrator] In other countries,

  • PCPs compose a much higher proportion

  • of all practicing physicians.

  • For example, 45% in France,

  • compared to 12% in the United States.

  • Yet PCPs play a central role in keeping people healthy

  • and preventing problems before they begin.

  • - [David] What happens is many Americans

  • don't see a primary care physician.

  • They can't find one, or they can't get an appointment

  • for a month.

  • Many times people don't know they have something,

  • and they end up in a hospital

  • where they have to get a much more expensive procedure.

  • - [Narrator] To help reduce higher health costs downstream,

  • a host of companies are now spending billions

  • on primary care practices.

  • UnitedHealth, a massive conglomerate that includes

  • 60,000 physicians and an insurance business,

  • is one of the furthest along in PCP investments.

  • Through its medical provider arm Optum Care,

  • it has been buying up multi-specialty physician practices

  • to provide care at home, virtually and on site.

  • The idea is to keep people out of the hospital,

  • because that's where the costs are highest.

  • Meanwhile, Amazon is planning to buy primary care company

  • One Medical, a practice that operates more than 180

  • medical offices in 25 US markets.

  • The $3.9 billion deal could give Amazon

  • a larger foothold in offering

  • healthcare services to employers.

  • The company CVS Health is also stepping into the mix

  • with a deal to pay $8 billion for Signify Health,

  • a company focused on in-home evaluations.

  • - Ultimately, CVS wants to be not only your pharmacist

  • and your insurer, through its AETNA arm,

  • but it also wants to be your village clinic.

  • - [Narrator] Then there's Walgreens.

  • After buying a controlling stake in startup clinic chain

  • VillageMD, it struck a roughly $9 billion deal

  • to combine with Summit Health,

  • a large owner of urgent care centers.

  • So how exactly do these companies plan to make money

  • off of these investments?

  • In practice, a Value-Based reimbursement model

  • means providing financial rewards

  • for better patient outcomes.

  • It can also be tied to a capitation system,

  • which pays healthcare providers a fixed amount

  • for each patient they deliver care to per unit of time.

  • This prioritizes the patient and cost saving over services,

  • which can significantly reduce health spending.

  • Still, some healthcare economists worry

  • whether this Value-Based approach

  • will benefit patients or just reduce costs

  • and improve the bottom line for providers and insurers.

  • - For example, a primary care physician

  • might be more reluctant to allow a patient

  • to go see a specialist

  • or to perform a more expensive procedure.

  • - [Narrator] Ultimately, some healthcare economists

  • say moving away from a Fee-For-Service model

  • could help temper ballooning healthcare costs in the US.

  • - [David] As more and more of these bigger companies

  • get into Value-Based care,

  • it's just going to accelerate the move

  • towards Value-Based care and away

  • from this Fee-For-Service model.

  • (bright cheerful music)

- [Narrator] Corporate giants like Amazon, United Health

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