Main Street Health

Main Street Health is a Nashville, Tennessee-based value-based healthcare company that works exclusively with providers in rural communities in the United States. Its core model places a Health Navigator inside each partner clinic; the navigator supports the clinic's providers with care coordination tasks such as ensuring patients receive preventive screenings, calling patients with medication pickup reminders, scheduling primary care visits after hospital discharge, and assisting with social determinant of health needs. Navigators — who may be social workers, licensed practical nurses or pharmacy technicians — are reachable by patients by phone and in person, and connect local clinic teams to a centralized Main Street care team that includes a physician, pharmacist, nurse practitioners and social workers.

At launch the company operated an "Extra Access Program" pairing Medicare and Medicare Advantage beneficiaries at participating primary care clinics, urgent care centers and independent pharmacies with a local health navigator, beginning with 34 clinics across eight counties in West Tennessee. The company states it works with all types of rural providers, including small independent private practices, large group private practices, rural health clinics, critical access hospitals, community health centers and health systems, and it hires local teams in each market it serves.

Founding story

Main Street Health was founded by Brad Smith, former Director of the Center for Medicare and Medicaid Innovation and co-founder and CEO of palliative care company Aspire Health, which was sold to Anthem in 2018. After leaving federal government, Smith studied value-based primary care companies and concluded that rural areas were underserved; he cited family ties to rural East Tennessee and rural Alabama. The company was launched through Smith's healthcare firm Russell Street Ventures. Bennett Graham, previously a general manager in Anthem's Diversified Business Group and SVP of operations at Aspire Health, is co-founder and President.

Business model

Main Street Health partners with local primary care physicians and other rural providers to move their practices into value-based care contracts with private insurers and Medicare, supplying the embedded Health Navigator staffing, data and opportunities the clinics need to succeed under those arrangements.

At launch the company said it would earn money by taking a portion of the savings it generates for insurers, or a portion of the per-member, per-month rates that some health insurers would pay the providers.

Traction

As of October 2023 Main Street partnered with more than 900 clinics across 18 states, with plans to add eight more states in 2024 for a 26-state footprint. Reported early outcomes include a 42% improvement in quality Star scores, a 23% reduction in hospitalizations and a 9% reduction in medical costs.

Latest developments

In October 2023, coinciding with the HLTH conference, Main Street announced it had raised more than $315 million led by Oak HC/FT, with participation from the five largest national Medicare Advantage plans (UnitedHealthcare, Humana, Elevance, CVS Health and Centene), Echo Health Ventures, LRVHealth and provider partners, at a reported pre-money valuation of $1.2 billion, and said it would expand into eight additional states.