Think’s Consumer Strategy Lowers Cost of Patient Care

Remedy identified Think Whole Person Healthcare (Think) as a building on the forefront of the future of medicine, and acquired the campus in 2018.

The property offers healthcare consumers the convenience, on-demand access, affordability, and quality they’re accustomed to in other retail environments, and it stands as one of the models of excellence in Remedy’s core fund.

Think is one of the largest independent primary care centers in the United States, employing 300 people across a wide range of disciplines and serving more than 45,000 patients. As an Accountable Care Organization, Think is specifically geared toward serving the needs of patients with chronic conditions who require ongoing coordinated care to keep them on goal and out of the hospital. Its state-of-the-art six-story, 148,000 square foot medical office building in the Aksarben Village neighborhood of Omaha, Nebraska, was designed to facilitate the organization’s team approach as well as take advantage of several retail healthcare consumer strategies.

Think was conceived by Blue Cross Blue Shield of Nebraska (BCBSNE) as a new concept for patient care, focused on customer service and lowering the cost of healthcare for both patients and insurance by looking at the whole person. Opened in July 2015, Think takes an integrative approach to managing patients’ health, with physicians, care coordinators, clinical pharmacists, and RNs all working as a team to manage chronic conditions. Just five years later, due to the success of Think’s approach to patient management, BCBSNE has already seen annual savings on insurance claims of over $8 million. In July 2019, Clarkson Regional Health Services joined with BCBSNE as a partner in the clinic.

“Think was built with the patient-physician relationship in mind—to maintain that continuous relationship with the patient, minimize risk, keep people out of hospitals and  emergency room—keeping them healthy with their families.”

Jim Canedy, MD
Think CEO

Challenge: Reduce Healthcare Costs for Chronic Patients

At the heart of Think is the primary care clinic, with 34 clinicians. The center also features a dispensing pharmacy and an array of aligned specialties, including massage and physical therapy, behavioral health, podiatry, and optometry. Blood work, X-ray, CT scans, mammograms, ultrasound, and DEXA are all done in-house for patient convenience and cost savings.

In addition, OrthoNebraska, Clarkson Heart Center, and Nebraska Cancer Specialists operate orthopedic, cardiology, and cancer outpatient clinics within the facility, and there is an urgent care center available for walk-in patients.

While specialist visits are on the rise in the US, primary care visits have declined by as much as 25% in the past decade,¹ despite evidence that regular visits to primary care physicians lower the likelihood a patient will visit an emergency room or be hospitalized.² Think aims to flip this trend by emphasizing the patient-physician relationship and making the experience of going to the doctor as convenient and comfortable as possible—encouraging frequent visits, before health issues spiral out of control.

“Think has been on the forefront of changing how healthcare is practiced in Nebraska, and the independent primary care model has been instrumental in our success. By working as a coordinated team to treat the whole person, Think has been able to raise the quality of care and reduce costs.”

Josette Gordon-Simet, MD
Think Chief Medical Officer

Built Like an Apple Store^®

Think’s sleek and modern building facilitates the organization’s collaborative approach to care by borrowing several design cues from retail innovators such as Apple and Target.

• Open spaces and grand elements. A glowing blue and white edifice cheerfully welcomes visitors from the parking lot, while a six-story curved atrium opens up as they reach the rear of the building, featuring a grand staircase and a honeycomb-like lattice that allows natural light to fill the space.
• Convenient amenities. A café, convenience/gift shop and optical shop share the first floor with Think’s full-service pharmacy, and offer visitors opportunities to shop or have a snack before or after their appointments. A massage studio and seating areas on the second floor provide chances for some relaxation.
• Shopping mall flow. Primary care services are located on the second through fifth floors, with access points near the rear atrium. The configuration encourages patients to pass ancillary services and increases referrals.
• Encourage community. Prior to the pandemic, Think offered classes and cooking demos for patients, and hosted events such as a knitting club. Spaces throughout the first and second floors are set aside for conversations and informal patient consults.

Integrated Care

This retail mindset extends to Think’s focus on customer service and communication. Its primary care physicians lead a patient care team that includes a triage nurse, clinical pharmacist, and clinical staff, augmented where appropriate by specialists such as physical therapists, nutritionists, optometrists, behavioral and mental health therapists, and more. For patients with two or more chronic conditions, a team of care coordinator nurses provide concierge-like service, coordinating with physicians, organizing and planning treatment programs, and scheduling appointments. Secure electronic health records mean everyone on the team has access to coordinate patients’ effective care, and the in-house lab and radiology departments mean 95% of test results are available same-day, often within 20 minutes.

“They’re very thorough, kind, compassionate, knowledgeable, and patient. I’m so happy my doctor is with this awesome system. I have a proactive doctor, not just reactive, which means the world of difference to me and my family.”

Deana Moore-Menard
Patient

At Think’s pharmacy, the largest in the region, clinical pharmacists work closely with the other healthcare providers to advise on potential drug interactions or side effects and suggest lower-cost alternatives. The pharmacy packages multiple medications in daily pouches, eliminating the need for pill counters and bottles. Patients can obtain their medications onsite, by delivery, or by mail, and a mobile app allows them to refill prescriptions with ease.

Seeing Success

As a result of its innovative, preemptive approach to patient care, Think is able to provide a high standard of treatment while delivering Nebraska’s lowest cost of care. In 2017, it achieved the following milestones for Medicare ACOs:

• Patient care cost an average of $8,798 at Think, a savings of $1,244 over the state average and more than $2,000 below the national average
• Saved $4.8 million in Medicare costs, delivering a reduction of $592 per patient – 1.5 times the savings of the next highest ACO in the state
• Scored a 98.94% overall quality ranking, the highest in Nebraska and 8th highest nationally
• Saw 23% fewer hospitalizations per 1,000 patients than the national average (250 vs. 325)

In addition, BCBSNE reported average savings of $1,102 in 2017 for each of the 7,020 BCBS-attributed patients, for a total savings of $7.7 million. Combined with Medicare savings, Think Whole Person saved a total of $12.5 million in healthcare costs for the year.

The Remedy Advantage

“Our building is beautiful and well maintained, and we have an open channel of communication with Remedy,” said Ashley Hatheway, CFO of Think. “From my experience, we couldn’t ask for a better or more flexible landlord.”

Percival Health Advisors, Remedy’s in-house strategic innovation and advisory firm, can help other health systems replicate Think’s formula to deliver high-quality healthcare at lower cost. Get in touch to learn more.

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1. Rao A, Shi Z, Ray KN, Mehrotra A, Ganguli I. National Trends in Primary Care Visit Use and Practice Capabilities, 2008-2015. Ann Fam Med. 2019;17(6):538-544. doi:10.1370/afm.2474
2. Pourat N, Davis AC, Chen X, Vrungos S, Kominski GF. In California, Primary Care Continuity Was Associated With Reduced Emergency Department Use And Fewer Hospitalizations. Health Aff (Millwood). 2015;34(7):1113-1120. doi:10.1377/hlthaff.2014.1165