CLEVELAND, Ohio — Older patients are usually sicker and more expensive to treat. But that’s exactly the kind of patients that ArchWell Health — a national network of health clinics that’s expanded into Greater Cleveland — likes best.
Keeping seniors healthy and out of hospitals is ArchWell’s main goal — and also its business plan. The more patients the company keeps out of hospitals, the more ArchWell makes from Medicare Advantage reimbursements.
The primary care health company only signs up patients who are 60 and over who are on Medicare Advantage. It uses a model that promotes preventive care and better coordination among health care professionals, experts said.
“If we keep people out of the hospital and out of the ER, keep them healthy and doing well, then in this business model we actually do well financially,” said Dr. Don Goddard, president and national director of primary care at ArchWell Health.
This could be the future of health care, and it’s new to Ohio.
The primary care network opened its first Cleveland-area locations in September and October in Parma, Brook Park, Eastlake and Maple Heights.
A Westlake location opens Thursday. Four more are slated to open soon in Cleveland Heights, Euclid and in Cleveland on Lorain Avenue and Kinsman Road.
Six of the local facilities will repurpose former Rite Aid, CVS and Save-A-Lot stores, the healthcare company said.
The healthcare company targets areas that don’t have enough primary care physicians but do have a growing elderly population. In Cuyahoga County, the share of the population that is 65 and older increased from 15.5% in 2010 to 19.6% in 2022, according to U.S. Census Bureau data.
Nationally, ArchWell has more than 70 primary care centers across 11 states, and plans to expand to 100 centers by early 2026.
At ArchWell clinics that seem more like an activity center than a doctor’s office, patients can drop by, hang out and join in bingo, karaoke, adult coloring and movies. The camaraderie alleviates loneliness. It also helps caregivers bond with patients — who are called “members” — so that health problems can be identified and addressed quickly.
In the few weeks since it opened, ArchWell’s Maple Heights location has already untangled a longstanding paperwork problem for one new patient. Unable to get a nebulizer to ease her breathing from her former physician, the patient was making frequent trips to the emergency department for help.
An ArchWell caregiver completed the paperwork and had the device delivered to the patient’s home. Now, the patient and her caregivers can focus on controlling her diabetes, said ArchWell Maple Heights manager Misha Fuller.
“Something so small can make a huge difference,” Fuller said.
The Maple Heights clinic has signed up nearly 50 patients, and caregivers are focused on getting them vaccinated against COVID-19 and influenza as the winter respiratory virus season starts.
Fuller, who lives in Maple Heights, thinks the new primary care clinic benefits her community.
“I feel good at the end of the day,” Fuller said. “This is the most rewarding work — keeping people healthy and out of the hospital, and helping extend their life spans.”
The ArchWell philosophy emphasizes a holistic approach to health that includes social determinants of health, such as accessing healthy food or transportation to doctor’s appointments, and reducing the effects of chronic disease. Care teams include case managers and social workers.
The patient-to-doctor ratio is low, allowing office visits that can last from 20 to 60 minutes. By way of comparison, the average visit in the U.S. lasts 18 minutes, according to a 2023 study.
If a member is ill, an ArchWell physician will personally call to check on them.
“We’re trying to take care of seniors with a lot of needs,” Goddard said. “To keep them healthy and out of the hospital, we have to address everything that’s affecting their health.”
If ArchWell members do need to see a specialist or visit the hospital, a case manager coordinates follow-up care.
“We expect that patient to be in our office within three days after discharge from a hospital,” Goddard said. “We do a phone call to make sure anything they need from the hospital is there.”
Goddard is already well acquainted with Cleveland’s healthcare landscape. He grew up in Mentor, had a private practice in Chardon and was an University Hospitals administrator before moving to Tampa, Florida, where he now lives.
“it’s funny, when you move away from Cleveland, you realize how good you had it. I definitely miss Cleveland a lot,” he said.
Goddard — no relation to the late, legendary Cleveland weatherman Dick Goddard — joined ArchWell Health soon after the startup company launched in 2021.
Oak Street Health and ChenMed are among the national networks of health clinics that, similar to ArchWell, are focused on keeping older Americans healthy by emphasizing wellness.
Oak Street Health, part of CVS Health, offers personalized wellness plans and social activities for older adults. Oak Street has at least four locations in the Cleveland area.
ChenMed operates more than 100 dedicated medical centers for seniors in 15 states; it has clinics in Maple Heights and Columbus.
ArchWell emphasizes quality care over volume
ArchWell’s business model, called value-based care, is when the government pays healthcare companies based on outcomes rather than on the number of services provided. This differs from most healthcare models, known as “fee-for-service,” in which caregivers are paid for services provided.
Under its model, ArchWell receives a pool of reimbursement money from the Centers for Medicare and Medicaid, based on how many hospitalizations the federal government expects ArchWell’s patients to have in one year. If Archwell prevents more hospitalizations than the government expects, it still keeps the reimbursements.
As an example, if an ArchWell center had 1,000 patients and only 100 were hospitalized in a given year, the company would keep its reimbursement for the 900 who weren’t hospitalized, Goddard said.
“You don’t do well in this business, unless your patients are doing well,” Goddard said.
Dr. Victoria Maize, a professor of medicine, family medicine, and public health at the University of Arizona, sees value-based care as a positive development.
There’s a benefit when healthcare providers look at the whole person — body, mind and spirit — and all of the things that may be influencing their health, such as lifestyle, genetics, behaviors and beliefs, said Maize, author of a forthcoming AARP book on integrative medicine, “Heal Faster: Unlock Your Body’s Rapid Recovery Reflex.”
“(Value-based care) aligns the incentives in a way that we as a society should want the incentives to be,” Maize said. “How do we keep people as healthy as possible and out of the hospital, as opposed to for-profit hospitals that want their beds full or want to be doing more surgical procedures, because then they make more money, right?”
Some ArchWell patients get annoyed by all of the attention they receive from clinic caregivers, but most have the opposite reaction, Goddard said.
“They’ll say, ‘I don’t need to be called all the time,’ because we’re always checking in on them, making sure they’re okay,” he said. “But the majority of patients love all the attention they get and the follow-up that we do on their medical needs.”
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