Since its inception in 2012, Chicago-based Oak Street Health — a network of primary care centers for Medicare patients in medically-underserved communities — has effectively cared for some of the sickest and costliest patients, while also slashing hospitalizations by 40 percent for its patient population.
Oak Street Health, driven by its focus on prevention and chronic disease management, now cares for patients at 24 clinics across the Midwest.
The company was co-founded by Mike Pykosz, Geoff Price and Griffin Myers, MD, who now serve as Oak Street's CEO, COO and CMO, respectively. As CEO, Mr. Pykosz oversees the organization's mission to rebuild healthcare that is personable, equitable and accountable for Medicare patients, while simultaneously driving down costs.
Here, Mr. Pykosz explains his inspiration for establishing Oak Street Health, discusses the components that allowed Oak Street to reduce hospitalizations by 40 percent, shares the biggest challenge the healthcare industry faces and offers his advice for young leaders seeking to move mountains.
Editor's note: This interview has been edited for length and clarity.
Question: What was your inspiration for starting the company?
Mike Pykosz: Five years ago when we were thinking about starting Oak Street Health, what really drove the vision was thinking about finding and coordinating the right components to have engaged primary care. We built the company from the ground up with that vision. The way our system is currently set up, and the way that services are offered for older adults and Medicare patients does not meet the needs of patients. We want to change that. We thought about spending more time with patients, having fewer patients per physician … providing transportation to reduce the barriers to care … constructing community centers, offering services such as behavioral huddles, bringing care to patients in their homes and focusing on care management. We thought about offering coordinated care and helping patients with socioeconomic interventions and [helping them navigate] the insurance environment. When you bring all of those things together, you can drastically improve the outcome of the patient and enhance patient experience while also lowering costs. That was our goal. All of those components together are something we need as a society, and we thought 'we can do it but we need all of those factors together.'
Q: Oak Street Health has driven down costs and reduced hospitalizations by 40 percent for its patient population. How was that possible?
MP: Everyone wants a simple answer, and I wish I could give you a simple answer. If there was a silver bullet, if it was easy, Oak Street wouldn't exist because everyone would be doing it. But the answer is actually really difficult. It's doing a thousand little things every single day and having the proper support systems to make that happen. It's transportation to and from appointments, it's more time with patients so our doctors can form a relationship with a patient … it's same day appointments if someone is sick, it's 24/7 call centers, it's teams of providers that will go see someone in their home. All those components together make the difference. It's running a consistent set of processes so you can find out when people drop through the cracks or don't follow the model … it's having the data and technology infrastructure so you know what your patients are doing [and] have the information to help them navigate the system, acknowledge cracks and prevent acute episodes. It's harder than rocket science. If it were [rocket science], some PhD, national physicist would've solved the problem. It's actually doing a lot of little things right … every time.
Q: What is the biggest challenge the healthcare industry faces?
MP: Changing the way care is delivered from a system built up in 1960-70 that focused on acute care and acute episodes. At the time, the hospital was the focal point of care and it made sense because the challenge of healthcare used to be acute episodes. So the infrastructure was built upon that model, it was built upon fee-for-service. However, our society has changed; our life expectancies are longer, we have great medications to prevent heart attacks and the problem has shifted from acute episodes to chronic illnesses. It is no longer mainly episodic based. It's not something you can take care of in one hospital stay, it is something you have to manage. The challenge our system faces is changing the infrastructure because it's not set up to take on the chronic illness challenge, care management challenge. That is why we have so many issues with the cost and quality of care. We need to focus on how to turn that battleship, how to change this massive system that is a huge part of our economy.
Q: If you could change one thing about healthcare overnight, what would it be?
MP: I would change the lack of understanding around how the system works and what keeps people healthy. There's still too much of payers and providers fighting over rates, there's still too much lack of information sharing. So if I could wave my magic wand, I would find a way to refocus us [and the healthcare industry] on driving better quality care so we can stop arguing about information and rates and get to a place where everyone is truly working together. I also wish I could change the lack of understanding about what keeps people healthy by educating people on primary care to help people realize why they need a physician. We could rebuild the system much faster if everyone realized that.
Q: What is one nugget of advice you would offer to other new, aspiring leaders?
MP: Be persistent and be motivated by your mission. One thing we found really early was everything is a lot harder and takes a lot longer than you think it will. Things that make a lot of sense to you and are super logical will always take a little longer.
For example, at Oak Street we have great value proposition. We guarantee [insurers] a profit by delivering high quality care. We offer patients a better experience for free. In [a] fully rational world you'd expect every insurance company would want to work with you and every patient would want to be your patient, but that's not the reality. It requires breaking down a lot of little barriers, including a lot of inefficiencies, a lot of complexities and mindshare. But whatever it is … be persistent … and have faith that if you're trying to do the right thing, and if you stay at it, you'll be able to break down those barriers and accomplish these things.
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