A primary care doctor is the first stop for a patient’s medical care, including chronic disease management. The reality, however, says healthcare provider ConcertoHealth Inc., is that patients with chronic illnesses and long-term conditions don’t have access to regular, quality preventive and primary care to meet their complex needs.
The Association of American Medical Colleges estimates there will be a shortage of 12,500 to 31,100 physicians in the U.S. by 2025.
Concerto is taking on the healthcare system’s costliest members—patients with chronic diseases represent more than 85% of the country’s $2.7 trillion in annual healthcare spending, according to the Centers for Disease Control and Prevention. It’s using an integrated care model to provide round-the-clock individualized primary and preventative services.
The strategy has served the company well, increasing more than fivefold from 4,300 patients in January 2016 to 22,300 currently.
Concerto announced a five-year growth strategy last month, starting with relocating its headquarters from Irvine to Aliso Viejo. The company’s new 28,700-square-foot office at 85 Enterprise is home to 110 employees. It plans to hire 120, including about 60 in Orange County, bringing companywide employment to 550.
Concerto operates care centers in Washington and Michigan, and also serves members in Ohio and Illinois. It opened a new administrative office last month in Southfield, Mich., to serve the Detroit metro region.
Integrative Care
Concerto estimates approximately 74% of its patients have chronic medical conditions, primarily behavioral health disorders, congestive heart failure, diabetes, chronic obstructive pulmonary disease and asthma. Many are eligible for both Medicare and Medicaid.
Challenges in managing “the vulnerable, frail and elderly patient population”—Concerto’s demographic target—include coordinating transition between care settings, post-discharge support, patient compliance to care plans, and chronic disease management.
“Think of us in simple terms of operating what feels like a medical group kind of model,” said Chief Executive Alec Cunningham.
Its care team is comprised of doctors, nurses, field-based clinicians, care coordinators, social workers, pharmacists, dieticians and nutritionists. Field-based caregivers provide regular or after-hours primary care support to patients in their homes and in care centers, such as nursing homes, hospitals and assisted-living facilities.
The healthcare provider also offers proprietary software program Patient3D, which enables care providers to access real-time monitoring of patients via a single source. It provides patient data, engagement insights, care decisions, and various analytics.
Health Plan Partner
Concerto partners with health plans to serve as one accountable provider for the total care cost. Cunningham said it doesn’t intend to replace or compete with health plans’ networks of primary care physicians but to provide support.
The company spent over a decade as an insurer before exiting that market.
“We realized with the aging of America, there’s opportunity to better service that population,” Cunningham said.
“Rather than being an insurance company ourselves, we can provide this support platform that bridges those gaps to create more integrated, more proactive care.”
Concerto, formerly Fidelis SeniorCare, moved from Schaumburg, Ill., to California in 2015. It sold Fidelis SecureCare of Michigan Inc. to Centene Corp. (NYSE: CNC), and Fidelis SecureCare of North Carolina Inc. and Fidelis SecureCare of Texas Inc. to FHP Insurance Holding Co. Inc. in order to focus on expanding its medical home and care coordination model.
Cunningham joined Concerto in 2014. He previously served as chief executive of WellCare Health Plans Inc. (NYSE: WCG) in Tampa, Fla.
He said Concerto’s experience in caring for Medicare, Medicaid and other complex medical-needs patients allows it to create a model addressing social and financial realities by combining social work with care management.
Concerto received a $30 million round of financing from existing investors in November 2016 co-led by Ann Arbor, Mich.-based Arboretum Ventures and Deerfield Management Co. in New York. Arboretum Managing Director Tim Petersen remains board chairman; Deerfield partner Leslie Henshaw was added to the board.
