The Commercial Market: Alternative Payment Models for Primary Care

Leading edge employers and health plans are investing in innovative, whole-person primary care models for employees and their families. The pandemic forced changes as work and care went virtual, demand for behavioral health services increased, and routine preventive care and chronic care were sidelined. Watch PCC's May 2023 webinar to hear innovative practices, employers, and health plans discuss what it takes to build and sustain advanced primary care. We are joined by Aetna, Crossover Health, Morgan Health, and Blue Shield of California.

Background Resources

  • Who is Morgan Health?
  • Overcoming obstacles to accountable care, by Dan Mendelson.
  • Crossover Health, Aetna pilot primary care service for Seattle employers with a fixed-fee payment model.
  • The California Advanced Primary Care Initiative is spearheaded by PBGH's California Quality Collaborative. A coalition of commercial payers is working together to enable primary care practices to transform to a high-performing, value-based model that reduces costs and improves quality and equity. 
  • Engaging Primary Care in Value-Based Payment: New Findings from the 2022 Commonwealth Fund Survey of Primary Care Physicians

Molly Chidester

Executive Director and Deputy Director for Healthcare Innovation, Morgan Health
As Deputy Director for Healthcare Innovation at Morgan Health, Molly supports efforts to advance affordability, quality, experience and health equity for the 160M Americans who receive their health insurance through their employer. In her role, she leads a team responsible for supporting Morgan Health’s portfolio companies and piloting healthcare innovations in the employer-sponsored insurance market.   read more

Nate Murray

Chief Business Development Officer, Crossover Health
Nate Murray is an entrepreneur with a strong passion for healthcare and more than 10 years of experience in the industry. He is an active member in the Health 2.0 movement, has worked for several large healthcare payers in operations and product development, and has experience in partner and consumer marketing, call center operations, and strategic planning. He has also worked in healthcare technology, helping payers and consumers understand and make important decisions based on costs. Most recently, Nate led the development of a direct-to-consumer Medicare marketing program, and he is credited with building the largest online Medicare partner network. read more

Nina Birnbaum, MD

Medical Director for Innovation Acceleration, Blue Shield of California
Nina Birnbaum is a family physician and the medical director for Innovation Acceleration at Blue Shield  of California. Prior to joining Blue Shield in April 2021, she served as the medical director for primary  care for a multi‐specialty medical group in the Bay Area. Nina’s work is focused around supporting high‐ functioning, multi‐disciplinary teams and amplifying the joy of work in clinical practice.   Nina received her medical degree from Columbia University College of Physicians and Surgeons and  completed residency training at UCSF/San Francisco General Hospital. She continues to serve her  community as a primary care doctor. read more

Rebecca Waber

Executive Director, Innovation Strategy, Commercial Product, Aetna
Rebecca Waber heads the Disruptive Innovation product team for Aetna’s self and fully-insured commercial business.  In this role, she focuses on addressing foundational affordability, access, and quality challenges by approaching them from new angles such as alternative plan design and pricing models.  She is particularly interested in out of pocket costs, behavioral health, and primary care.     read more
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