Fortified by an preliminary public providing, Oak Avenue Well being is shifting into new markets and testing a much less acquainted enterprise mannequin because it navigates the COVID-19 pandemic.
The Chicago-based community of main care clinics for individuals 65 and older, a lot of whom have complicated medical and social wants, raised $352 million when it went public final month.
The preliminary public providing provides Oak Avenue the capital to execute its aggressive progress plan, which incorporates constructing new senior-focused facilities throughout the nation and piloting three Walmart-based clinics for sufferers of all ages. However the funds include extra intense, short-term scrutiny for the corporate, which has operated within the purple since launching in 2012.
Now Oak Avenue must handle such strain on prime of controlling rising medical prices and bettering well being outcomes for high-risk sufferers throughout a public well being disaster.
“At a time when main care is struggling, our mannequin is additional wanted,” says CEO Mike Pykosz. “We already felt that our mannequin might present a lot higher-quality care, however now COVID simply actually added one other layer to that.”
Many docs who receives a commission for every medical service supplied noticed revenues tank as individuals averted in-person care earlier within the pandemic. However main care practices like Oak Avenue that accumulate a set quantity to maintain sufferers wholesome fared higher.
Oak Avenue rapidly shifted to telehealth earlier this yr and repurposed its affected person transport vans to ship meals from meals pantries. Nonetheless, the pandemic stalled the corporate’s speedy enlargement.
However within the final six weeks, Oak Avenue has opened 12 new facilities—increasing its community to 66 places in 9 states—and introduced a take care of Walmart to open clinics at three shops within the Dallas-Fort Value space. Oak Avenue expects to have 75 clinics in 11 states by year-end.
“It is a threat anytime an organization is rising as quickly as they’re,” says William Blair analyst Ryan Daniels. “They’ve confirmed by way of nearly 70 facilities now a really predictable and constant affected person ramp and revenue ramp, so I believe it may be replicated. But when you are going to go from 54 facilities at the beginning of the yr to 150 facilities three or 4 years from now—and perhaps it will not be that many—that is a whole lot of progress. They’ve to ensure they proceed to maintain the tradition, maintain the administration expertise.”
In the long term, the pandemic might make older adults much less prepared to go to well being care services or lead insurers to favor home-based care, Piper Sandler analyst Sean Wieland warns in an Aug. 31 report. However with investments in main care yielding financial savings down the street ($1 in main care saves the well being care system a median of $13, Oregon researchers discovered), it is doubtless that “main care will get pleasure from anointed standing within the post-COVID healthcare supply paradigm,” Wieland writes.
The Walmart clinics for sufferers of all ages will take Oak Avenue outdoors its consolation zone and core Medicare enterprise. Whereas older sufferers will probably be handled underneath Oak Avenue’s customary value-based mannequin of care, wherein Medicare and Medicare Benefit insurers pay a set quantity per affected person, these with different insurance policy will probably be handled underneath the extra widespread fee-for-service, or volume-based, fee mannequin.
Pykosz says the aim of the partnership is to check whether or not clinics in Walmarts, which are typically in additional suburban and rural places than Oak Avenue, appeal to extra new sufferers. For Walmart, the deal is one other step towards its imaginative and prescient of changing into “America’s neighborhood well being vacation spot.”
Oak Avenue might face elevated competitors as extra suppliers transfer into its core enterprise. Along with senior-focused rivals like Chicago-based VillageMD and Miami-based ChenMed, a lot of impartial docs, hospitals and well being methods will probably be seeking to seize a bit of the rising Medicare-eligible inhabitants.
Oak Avenue’s sufferers have a median earnings of $20,700, and about half wrestle with at the least one social issue that impacts well being, similar to meals insecurity, whereas 40 % have a behavioral well being analysis, in response to the corporate’s prospectus.
In the course of the firm’s second-quarter earnings name, Pykosz mentioned the estimated dimension of Oak Avenue’s goal market is 27 million moderate- to low-income Medicare-eligible sufferers residing in suburban and concrete areas, which interprets to a $325 billion annual market alternative.
“On the finish of the second quarter, we cared for as much as 85,000 of those lives, which represents lower than 5 % of the addressable Medicare inhabitants within the markets we presently function in, and a fair tinier fraction of the general market alternative,” Pykosz mentioned on the decision.
Past the engaging market, Daniels says Oak Avenue’s Medicare-focused mannequin is not in jeopardy regardless of the upcoming presidential election, which has critical implications for the way in which well being care is delivered.
“No matter who sits within the presidency, it’s extremely favorable for Medicare Benefit,” Daniels says. “If it is Trump, it is established order. If it is Biden, you might even see enlargement of Medicare Benefit or taking down the age restrict or shopping for into Medicare.”
And Oak Avenue’s deliberate participation in a brand new program from the Facilities for Medicare & Medicaid Companies that bypasses insurers may very well be a boon if it brings the corporate extra sufferers and better revenue margins, as anticipated.
However ultimately, Wall Avenue goes to need to see a revenue. Income elevated 75 % in 2019 to $556.6 million, whereas the corporate’s web loss expanded 37 % to $109.four million. On Sept. 16, it reported second-quarter income of $214.four million and a web lack of $26.eight million—consistent with preliminary estimates. Since debuting at $21 apiece on Aug. 6, Oak Avenue shares surged as excessive as $53.58 on Sept. 2 earlier than retreating to $45.12 on Sept. 24.
This story first appeared in our sister publication, Crain’s Chicago Enterprise.