Eight clinics serving seniors open in past two months in St. Louis area [St. Louis Post-Dispatch]

Nov. 26—OVERLAND — As the number of baby boomers reaching retirement age continues to climb, the St. Louis area is seeing a surge in new seniors-only health clinics. In the past two months, eight such clinics have opened, providing much-needed care in East St. Louis, the city of St. Louis and north St. Louis County neighborhoods.

The new clinics are focused on those enrolled in Medicare Advantage — managed care plans that operate based on value rather than volume.

They are not your typical doctor offices.

The clinical staff provides transportation, same-day appointments and on-site prescriptions. They offer meetings with dieticians and social workers. They coordinate care with specialists.

Community rooms host activities such as bingo, yoga or a nutrition class. Doctor visits take much longer. Patients receive an array of health screenings to catch problems early.

"The focus is much more on prevention and wellness and trying to be proactive about their health, rather than just responding to when diseases get out of control or when new or concerning symptoms develop," said Dr. Justin Huynh, senior medical director at Oak Street Health. "It is very different than most of the primary care that patients are used to."

Oak Street Health opened the area's first clinic in East St. Louis on Sept. 28, two more in north and south St. Louis a month later, and a Jennings location on Nov. 3.

ArchWell Health opened four clinics in October in Ferguson, Overland, and north and south St. Louis.

At ArchWell, staff refers to patients as members because they want the facilities to feel more like a community hub, said Dr. Janell Wilson, the medical director for ArchWell's St. Louis market.

"We're not just doctors taking care of their medical issues," Wilson said. "That's why they're 'members.' We want them to come in, interact with us, come into the activity center, use us for whatever they need. Sometimes, they may not be sick. They just need to come in and talk, and we can do that."

The model is based on the idea that seniors can avoid higher medical costs down the road if they receive coordinated care and a thorough assessment of their chronic conditions and social needs.

"We are trying to take a more holistic approach," Huynh said. "There are many other factors that contribute to health, and if we don't address those, we are not going to give the best care or get the best outcomes for our patients."

Communities where residents face barriers to care and stressful living conditions are where the model is needed most, the directors say. Residents often find themselves having to travel to large hospital campuses for appointments.

The new clinics are located next to grocery stores, salons and sandwich shops.

"We want to put these offices in the community," Wilson said. "When you look at the number of people and the age of who we think needs care, St. Louis has a large population that would benefit from this care and that's what we've seen ... When they come in and see the center, they're just amazed that it's there."

The trade-off

Medicare is a federal government program which people pay into while they are working that provides health insurance for those age 65 and older.

Enrollees typically pay a monthly premium that covers outpatient care and doctor visits ($148.50 on average) and share a cost each time they use those benefits. Prescription coverage also usually involves extra cost.

Medicare Advantage plans, however, are offered by private insurance companies and are similar to employer health care coverage. The insurers receive a set amount of money for a person's care every month, whether or not the person uses services.

The health plans are responsible for everything from processing claims to determining the necessity of treatments. Enrollees typically must choose from a list of certain physicians or pay extra.

Most Medicare Advantage plans do not charge anything additional beyond the premium that Medicare already charges. A majority also include prescription drug, vision, telehealth, hearing aid and dental benefits.

Sheldon Weisgrau, a health policy expert at the Missouri Foundation for Health, said traditional Medicare is generally more costly for enrollees.

"And in exchange for that, you get to go to just about any hospital or doctor out there," Weisgrau said. "Medicare Advantage says to folks, 'You are going to have to go to doctors and hospitals that are in our network, but in exchange for that, we are going to save you on out-of-pocket costs, and we are going to provide these other benefits. So, that is the trade-off."

Enrollment in Medicare Advantage plans has more than doubled over the past decade. More than 26 million people are enrolled, accounting for 42% of the population, according to a report by the Kaiser Family Foundation. In Missouri, it's 43%.

Enrollment has increased by 10% the past two years and is projected to keep rising, accounting for more than 50% of beneficiaries by 2030.

"Part of that is because folks that are aging into Medicare now are much more used to being in these plans," Weisgrau said. "Everybody who is coming off of employer-sponsored coverage is familiar with managed care, so they are more comfortable with these type of plans than people previously were."

Nashville, Tennessee-based ArchWell formed in February and has opened 15 clinics across the U.S. In addition to the sites in St. Louis, three are in the Kansas City area, and the rest are in Alabama, Oklahoma and North Carolina.

Oak Street Health, headquartered in Chicago, has operated since 2012 and recently expanded to include over 140 locations in 18 states.

Each of the St. Louis-area clinics will have the capacity to serve about 3,000 seniors.

Data is mixed

With over 70 million Medicare beneficiaries and about 10,000 baby boomers being added to the rolls every day, there is a growing need for cost-effective care.

Weisgrau said the data is mixed, however, on whether Medicare Advantage plans actually improve health care outcomes and save the federal government money.

Because the health plans get paid more for complex patients with more illness, the industry has been accused of "upcoding" — adding diagnoses to make enrollees appear less healthy than they are.

Many insurers are wanting to get in on the business. A new KFF analysis found a record 3,832 Medicare Advantage plans will be available in 2022, an increase of 8% over 2021 and the largest number of plans available in more than a decade.

Medicare Advantage plans may not be the best option for everybody, Weisgrau said, and navigating the choices can be difficult. People can receive free and unbiased Medicare counseling in Missouri by calling the state's CLAIM program at 1-800-390-3330.

Medicare's open enrollment period began Oct. 15 and ends Dec. 7.

'Good old-fashioned doctor'

Dr. Otha Myles is the director of ArchWell's Overland clinic. He is currently the clinic's only doctor, but he hopes to be eventually be joined by more. The doctors will each care for a maximum of 500 patients, instead of the typical 3,000 for a primary care doctor.

Myles decided to close his private medical practice in a wealthier part of southwest St. Louis and come to ArchWell. The pandemic had hit his practice hard as people put off their routine and preventative care.

"This is just a great model that allowed me the opportunity to be a good old-fashioned doctor that loves to take care of patients and not have to deal with the administrative work," Myles said.

On a recent day at the Overland clinic, Myles saw 70-year-old Nancy Scheffler who lives nearby and is enrolled in Medicare Advantage. This was her second visit.

She learned about the clinic from a flyer delivered to her home about an open house where attendees got free box lunches, listened to live music, met the mayor and were greeted by St. Louis Cardinals' Fredbird.

Scheffler said she liked how the clinic was closer than SSM Health DePaul Hospital in Bridgeton, where she had been going for her care.

She was getting screened for the first time for dementia and depression, she said. Her first visit included a slew of screenings for things like heart and nerve issues. Myles was also addressing her concerns about balance and numbness in her feet.

"You feel like you are at home here," Scheffler said. "It seems like these people take their time with you."

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