Primary Care – Health Care

Primary Care


When it opened its first center in Chicago in 2013, Oak Street Health wanted to show that its model of providing value-based primary care to seniors could work.

It’s doing just that, as the network of primary care centers announced today that it will open clinics in two more states this year—Texas and Tennessee.

“Our mission is to rebuild healthcare as it should be,” Oak Street’s CEO Mike Pykosz told FierceHealthcare. It’s a job the company has done by bringing primary care to seniors in underserved areas, improving patients’ health and their healthcare experience.

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“We can generate phenomenal results. The challenge for us and our team is to do that in a lot of places, for a lot more patients and really transform healthcare,” said Pykosz, one of Oak Street’s founders.

Mike Pykosz
(Oak Street Health)

The health organization will now operate in nine states with more than 50 centers that serve about 70,000 Medicare patients.

It’s entry into two southern markets—it will open two locations in Memphis within the Frayser and Audubon Park neighborhoods this winter followed by a center in the Dallas-Fort Worth area this summer—caps a year of growth for the healthcare startup.

It also plans to expand in states where it already has clinics. It plans a fourth center in Cleveland, three new centers in Detroit and a second location in the Greensboro-High Point metro area of North Carolina—all expected to open in late spring.

In Rhode Island, a second center in South Providence celebrated its grand opening in a partnership with Blue Cross Blue Shield earlier this month.

It also has clinics in Illinois, Indiana and Pennsylvania, with plans to continue its geographic expansion in 2020.

That growth will significantly increase access to Oak Street Health’s innovative approach to primary care for older adults across the country, the company said.

Getting going

The first several years of operation at Oak Street were about proving its primary care model and approach would work, Pykosz said. “We had some pretty big ideas,” he said. That included opening up primary care centers in underserved areas, investing to keep patients healthy, creating a much more consumer-centric model and paying for those investments by taking full risk. By driving improved health outcomes, Oak Street believed it could become a national model for healthcare.

The next phase is to expand and bring that model to a lot more people. “We’re not moving the needle yet on healthcare,” he said about the problems of low quality and high cost that plague the healthcare system. “This is just the beginning.”

Oak Street Health measures its success in two key ways: by showing improved health outcomes of its patients and by improving the patient experience. “Are patients healthier?” Pykosz said.

Oak Street has seen patient hospitalizations reduced by 41%, compared to standard Medicare benchmark, and measured a 49% percent reduction in emergency room visits. Oak Street has an 89% Net Promoter Score used to guage the loyalty of its patients and their satisfaction with care.

Oak Street has funded its expansion by raising capital from a variety of different individual and institutional investors, he said. Securities and Exchange Commission filings show they’ve raised at least $200 million over six funding rounds. It’s investors include General Atlantic and Harbour Point Capital.

As the country tries to shift to value-based care, Oak Street has made national headlines as it offers a change from traditional fee-for-service healthcare.

“Our centers don’t look like doctor’s offices,” he said. They are not located in medical office buildings, but are in retail areas, all with a 1,000-square-foot community center in the front.

Patients who visit an Oak Street Health center will have a healthcare experience they may not have encountered before, the company says. Patients can expect extended time with their clinicians and individualized treatment plans. There’s community-centered support for social wellness, a 24/7 patient support line and access to transportation to and from the center for eligible patients. To create a one-stop shop for healthcare, Oak Health also offers supplementary services, such as behavioral health support and Medicare education classes.

Two-thirds of every dollar the government spends on Medicare goes toward paying for acute care episodes, Pykosz said. Only 3% of those dollars go to primary, preventive care or preventing bad things from happening to patients. “We feel like that is backward,” he said. “That is what we are trying to change.”

“We are at a place at Oak Street, where the model works. The quality of care and the patient experience are significantly better than what patients can find in other places. Not only does it work in our home market of Chicago, it’s worked in all the other major cities like Philadelphia, Detroit, Indianapolis,” he said.

A new simple blood test for brain tumors that could be used by GPs in primary care is being developed thanks to funding of nearly £500,000 by Cancer Research UK. Around 60,000 patients in the UK are living with a brain tumor but only 20 per cent of patients are still alive five years after diagnosis, partly because they present late with large inoperable tumors.

The University of Bristol-led research project to develop an affordable, point of care blood test to diagnose brain tumors earlier using fluorescent carbon dots and nanophotonics will be headed by Dr. Kathreena Kurian, Associate Professor in Brain Tumour Research and Dr. Sabine Hauert, Senior Lecturer in Robotics in collaboration with co-investigators: Professors Carmen Galan and Richard Martin at the University of Bristol; Dr. Neciah Dorh at FluoretiQ Limited and Dr. Helen Bulbeck at Brainstrust.

The cross-disciplinary research project brings together medical practitioners, along with experts in population health, nanoparticle engineering and detection, as well as computational modeling.

Dr. Kathreena Kurian, Head of the Brain Tumour Research Centre at the University of Bristol, said:

A simple blood test carried out by GPs would help decision-making and early diagnosis. This would revolutionize care by speeding up diagnosis, reducing costs to the NHS, anxiety of unnecessary scans and reducing the number of patients presenting with inoperable large brain tumors.

Additionally, this test could be used as an early monitor of brain tumor recurrence. Our work will be followed by a multicentre cohort biomarker study to determine the effectiveness of the test in a real-world setting."

Dr. Sabine Hauert from the Department of Engineering Mathematics and Bristol Robotics Laboratory (BRL), added: "Nanoparticles have shown promise in early detection of cancer by fluorescent labeling of very low levels of biomarkers in blood samples and other fluids."

Dr. Alexis Webb, Cancer Research UK's senior early detection funding manager, said:

At the moment the number of people who survive after a brain tumor diagnosis remains low and little has changed in over a generation. We're proud to support this innovative project and funding brain tumor research remains a priority for the charity. We need better techniques to diagnose brain tumors earlier, when more treatment options are available, to secure a future for more people affected by the disease."

Professor Carmen Galan, Professor of Organic and Biological Chemistry in the School of Chemistry, who has developed the fluorescent carbon-based nanomaterials that form the basis for the project, explained: "The fluorescent nanoprobes are produced by low-cost renewable routes and we have shown that we can decorate them with different biomolecules to target specific biomarkers in physiological conditions, which is really exciting."

Dr. Neciah Dorh, CEO of FluoretiQ Limited, stated:

As a diagnostics company, we are passionate about creating technology that can improve people's lives and we see this project as natural extension of the work that we are currently doing in infectious disease."

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In the UK in 2013, 38 percent of brain tumor patients visited their GP five times or more before being referred for diagnosis by imaging MRI/CT scan and neurosurgical biopsy, because the symptoms such as headache are non-specific, so there is an urgent need to develop new tests for brain tumors to help GPs diagnose brain tumors earlier.

There is a pressing need for the discovery of new blood biomarkers for brain cancer and state-of-the-art technology that allows for its sensitive detection. The aims of the research project are:

  • discover novel biomarkers, in addition to known markers such as Glial fibrillary acidic protein (GFAP), which will be used as a baseline;
  • implement a computational model to predict biomarker levels in blood;
  • develop a fluorescent nanoparticle that can label this marker in blood;
  • work with Bristol-based start-up FluoretiQ towards an affordable near patient testing solution.

Glioblastoma is the most common type of malignant brain tumor among adults and it is usually very aggressive, which means it can grow fast and spread quickly. It is characterized by abnormal blood vessels following a leaky blood-brain barrier (BBB). GFAP is unique to the brain and not present in blood that circulates throughout the body. Antibodies in GFAP are used to diagnose gliomas in tissue samples. There is evidence that GFAP crosses the leaky BBB and is an early non-specific peripheral blood biomarker which predates the clinical diagnosis of glioblastoma.

However, GFAP levels are too low for routine detection by routine protein detection tests such as ELISA. The research team has already identified other novel potential protein biomarkers of brain tumours using the epidemiological method, Mendelian Randomization, which may be present in low levels in the blood.

Fluorescent carbon dots (FCDs), also known as nanoparticles, are cheap and easy to create using a three-minute synthesis. FCDs can be readily attached to ligands such as antibodies targeting specific protein markers. FCDs labeling biomarkers can then be detected using nanophotonic technology, which has been developed by FluoretiQ, for rapid, sensitive, and low-cost diagnosis. Computational modeling will then be used to predict tumor size given biomarker availability in blood and establish the theoretical limits of the detection.


University of Bristol