Oak Street Health vs. Medicare Advantage: A Clear Distinction
Many people become confused about the role of Oak Street Health because its business model is so closely tied to Medicare. While their entire service offering is designed around Medicare beneficiaries, particularly those with complex health needs, it is crucial to understand that they are a provider of healthcare services, not a seller of insurance plans.
Medicare Advantage plans, also known as Medicare Part C, are health insurance plans offered by private companies that have a contract with Medicare. These plans bundle Original Medicare Parts A and B and often include extra benefits, such as vision, hearing, and dental coverage. When an individual enrolls in a Medicare Advantage plan, they are choosing a private insurance company to manage their Medicare benefits.
Oak Street Health, by contrast, is a physical network of primary care clinics. They specialize in treating adults on Medicare, and their goal is to provide comprehensive, preventative, and coordinated care to their patients. Their revenue model is based on managing the care of Medicare and Medicare Advantage patients, often through a "global capitation" arrangement. In this system, they receive a fixed amount of money per patient to manage all of their healthcare needs, creating a strong incentive to keep patients healthy and out of the hospital.
How Oak Street Health's Value-Based Model Works
Oak Street Health's business model is centered on a value-based approach, which contrasts with the traditional fee-for-service model. Instead of being paid for each service or procedure, they are financially rewarded for keeping their patients healthy and reducing overall healthcare costs. This approach has led to several key elements of their care delivery:
- Integrated Care Teams: Each patient is supported by a team that includes not just a doctor, but also nurses, social workers, and other specialists who help coordinate care.
- Longer Appointments: The capitation model allows Oak Street Health providers to spend more time with patients during appointments, which helps them better understand complex health issues.
- Proactive Prevention: Instead of reactive care, the focus is on preventive services, wellness programs, and screenings to catch potential problems before they become serious.
- Social Services: The care teams can also assist with non-medical needs, such as help navigating insurance benefits, finding social services, and arranging transportation to appointments.
- Proprietary Technology: They use advanced IT tools to track and manage the health of their high-risk patients, ensuring their needs are consistently addressed.
This holistic, team-based strategy is what sets Oak Street Health apart as a primary care provider, and it is made possible by their partnerships with Medicare and private Medicare Advantage insurance carriers.
How Oak Street Health and Medicare Advantage Work Together
Patients with Medicare Advantage plans can absolutely become patients at an Oak Street Health clinic, provided their specific plan is accepted. Oak Street Health has a strong network of partnerships with many of the leading private insurance companies that offer Medicare Advantage plans.
Here’s how the relationship typically works:
- Patient Chooses a Plan: An eligible senior chooses and enrolls in a Medicare Advantage plan from a private insurer, such as Aetna, Humana, or UnitedHealthcare.
- Patient Selects a Provider: The senior then selects an Oak Street Health clinic as their primary care provider (PCP), ensuring the clinic is in-network with their chosen Medicare Advantage plan.
- Oak Street Health Manages Care: Oak Street Health receives payment from the private insurer (through a value-based arrangement) to manage the patient's total healthcare needs, delivering their specialized primary care model.
- No Cost Change: Importantly, the patient’s out-of-pocket costs and benefits, as determined by their Medicare Advantage plan, do not change simply because they become an Oak Street Health patient.
Comparison: Oak Street Health vs. a Medicare Advantage Plan
| Feature | Oak Street Health | Medicare Advantage Plan |
|---|---|---|
| Primary Function | A network of primary care centers for seniors on Medicare. | A type of health insurance plan offered by a private company. |
| Service Type | Provides healthcare services, including primary care, chronic condition management, and social services. | Provides insurance coverage for healthcare services, often bundling different types of care (hospital, doctor visits, etc.). |
| Business Model | Value-based care; focuses on keeping patients healthy to reduce overall healthcare costs. | Often includes value-based arrangements with providers, but is fundamentally an insurance product. |
| Role for a Patient | Your primary care provider (PCP) who delivers care. | Your health insurance carrier who pays for care. |
| Who Can Be a Patient? | Any Medicare beneficiary, including those with Original Medicare or certain Medicare Advantage plans. | Any eligible senior can enroll, but the specific plans accepted by providers vary. |
| Revenue Source | Paid by Medicare and Medicare Advantage insurance companies to manage patient care. | Receives payments from the government to administer benefits for enrollees. |
Conclusion
To be clear, Is Oak Street Health a medicare advantage? No, it is not. Instead, Oak Street Health is a specialized network of primary care clinics that has built its entire operational model around serving older adults who are covered by Medicare, including those enrolled in Medicare Advantage plans. They work in tandem with insurance plans, offering their comprehensive, value-based care to patients. By focusing on preventive care, providing integrated care teams, and assisting with social needs, Oak Street Health aims to deliver better health outcomes for its patient population, all while accepting coverage from a variety of Medicare and Medicare Advantage carriers.
To determine if your specific Medicare Advantage plan is accepted at an Oak Street Health location near you, you should always verify your coverage details directly with Oak Street Health or your insurance carrier.
