About ImpactPHL Perspectives:

If you are curious about pursuing financial returns while influencing the positive growth of Greater Philadelphia and the world at large, then welcome to the conversation. ImpactPHL Perspectives is a multi-part series which explores the many facets of the impact economy in Greater Philadelphia from the perspectives of its doers, movers, shakers, and agents of change. Each volume is written directly by a leader in this space, to discuss best practices and share lessons learned, while challenging our assumptions about the returns - financial and societal - on engagement in the impact economy. For more of ImpactPHL Perspectives, check out the ImpactPHL Blog.

By: Bridget Wiedeman, Reinvestment Fund

In Philadelphia—as in communities throughout the United States—where you live may very well determine how long you live.

According to research by Virginia Commonwealth University’s Center on Society and Health, life expectancy in Philadelphia neighborhoods that are only a few miles apart can vary by as much as 20 years.

The factors that contribute to this inequity range from education and income to unsafe housing and the lack of opportunities to play or exercise. Another influencing factor is difficulty accessing primary medical care.

There is substantial evidence to suggest that greater access to primary care benefits both the patient and the health care system. Indeed, patients who receive better access to care typically have fewer serious illnesses and, therefore, use fewer acute care treatments and procedures.

“Life expectancy in Philadelphia neighborhoods that are only a few miles apart can vary by as much as 20 years.”

In Philadelphia, there are still communities that lack access to basic care. A 2018 report by the Philadelphia Department of Public Health and the Leonard David Institute of Health Economics at the University of Pennsylvania found that while the city as a whole has an adequate supply of primary care providers—approximately one for every 1,243 residents—some communities have shortages that are significant enough for them to qualify as underserved according to Health Services and Resources Administration designations. These areas also have higher concentrations of racial and ethnic minorities and lower median household incomes than do areas offering greater access to care.

The report also found that, although the percentage of uninsured people has decreased in Philadelphia, especially as more adults have enrolled in Medicaid as a result of the Affordable Care Act’s Medicaid expansion, fewer providers are accepting new patients on Medicaid.

These gaps in health care are a critical problem in Philadelphia and elsewhere. The cost of medical visits remains a significant barrier for many lower income and working class people. The lack of convenient access to care also deters many working families that struggle with limited flexibility in their work schedules from receiving the care they need.

The good news is that there is a full spectrum of solutions—ranging from traditional community health centers to innovative, new models that offer more affordable and more convenient access to care—and that impact investments can play an essential role in delivering these solutions to the communities where they are needed most.

One model that Reinvestment Fund has invested in as we work to close the gap in access to care is urgent care, a model that emerged about 15 years ago to provide treatment for illnesses and injuries that need immediate attention but do not require the services of an emergency department. Urgent care offers patients, including those who are uninsured or are on Medicaid or Medicare, access to high quality, low-cost care on a walk-in basis.

Convenience is a key benefit. The growth of the urgent care model parallels the growth of the on-demand economy in which providers enable customers to access services when their schedules allow. The model is primarily seen in suburban, higher income communities.

Health insurers are also keen to partner with urgent care providers to drive cost savings and maintain high-quality care. They are willing to negotiate competitive rates with urgent care centers due to their interest in transitioning unnecessary, costly emergency room visits to urgent care centers. About 75% of emergency room visitors are never admitted to the hospital and could be seen in a less intensive setting; urgent care centers are poised to capture many of these patients.

“Although the Philadelphia region is home to some of the world’s finest hospitals that deliver best-in-class health care, many of our communities still suffer from the lack of access to care. Equal access to health care can be—must be—more than an aspiration; it must become a fact of life.”

In Philadelphia, we have invested in Vybe, an urgent care company that is focused on combining the provision of quality health care with excellent service. Vybe provides a broad range of services for illnesses and injuries, physical exams, vaccinations, lab tests, and x-rays, and offers extended daily and weekend operating hours.

Vybe fills an essential niche in Philadelphia’s health care ecosystem, offering a more convenient and more affordable alternative to emergency care and increasing community access to medical services.

Vybe customer, Tye, recalls going to the urgent care center after waking up feeling extremely ill one morning. “I was in and out in under 30 minutes. An appointment with my primary care physician would have taken days. Had I gone to the emergency room, it would have been overkill, and I would have sat in the waiting room suffering for hours. Urgent care proved to be a great solution for me.”

In 2018, the organization had nearly 56,000 patient visits, of which 30 percent were Medicaid patients. At some of Vybe’s locations, almost half of all of the patients are on Medicaid.

Another non-traditional model that Reinvestment Fund has invested in is direct care, through which patients receive unlimited access to personalized care, including same- or next-day appointments, extended office hours and remote access to their doctors with online messaging and video visits.

It is a model that is reinventing health care delivery. Under most traditional fee-for-service primary care models, doctors make money based on the number of patients they see and, therefore, are incentivized to see as many patients as quickly as possible. Patients are incentivized to limit their visits to the doctor, because of co-pay and other costs that add up as well as scheduling that can be challenging.

Direct care takes both of these factors out of the equation. It incentivizes doctors to spend as much time as necessary with each patient, because their compensation does not rely on volume, and because their patient panels are small enough to allow them to do so. Moreover, it incentivizes patients to access care regularly because it is cheaper and convenient.

One direct care provider that Reinvestment Fund has supported is R-Health, which partners with employers and insurance companies to offer primary, preventive, urgent, and chronic care for a fixed monthly fee with no insurance billing or out-of-pocket costs for patients.

Reinvestment Fund has helped finance R-Health clinics in southern and central New Jersey that serve state workers and their families who opt into the R-Health program as part of their health benefits. Since R-Health started serving state workers in fall 2016, an estimated 4,000 teachers, police officers, firefighters, and other state and local government employees and retirees have signed up to receive primary care at R-Health locations.

Under the R-Health program, enrolled patients can see their primary care provider as often as they like, with no co-pay and no change to their existing insurance premium. Moreover, they can see their provider for longer at each visit, if necessary.

These are just two examples of the kinds of innovative primary care models that impact investments can and do support. More innovation and more investment will be needed if the gaps in care are to be filled.

Although the Philadelphia region is home to some of the world’s finest hospitals that deliver best-in-class health care, many of our communities still suffer from the lack of access to care. Equal access to health care can be—must be—more than an aspiration; it must become a fact of life. Impact investment has the potential to help make high-quality care available to all. Let us work together to transform our best intentions into real solutions that benefit all who live in our region and in our nation.

Bridget Wiedeman is Reinvestment Fund’s Senior Director for Health Services, leading the organization’s health care financing portfolio, which works to increase access to quality comprehensive medical care in underserved and low-income areas nationwide. She also heads the Healthy Communities team, which also encompasses Reinvestment Fund’s K-12 and early childhood education financing.