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GREENSBORO, N.C. (WGHP) — Talk about a revolution in Greensboro!

No, I’m not talking about the 1781 Revolutionary War Battle in which Greensboro’s namesake fought in what is now a national park on the city’s northwest side.

Nor am I talking about the Revolution Mill complex Moses and Ceasar Cone opened in 1898. It was a type of revolution in that it was the first and largest flannel mill in the southern United States.

I’m actually talking about a relatively new business that’s established its headquarters in the same Revolution Mill. It’s quickly become one of this area’s fastest growing companies.

“We’re very proud to be in Greensboro. This is the epicenter of innovation for so many things,” UpStream CEO Dr. Sanjay Doddamani told me recently.

You could argue UpStream is “revolutionizing” healthcare— especially when it comes to senior adults on Medicare, the federal government program that provides health insurance for Americans 65 and older.

There are other companies that do many of the things UpStream does. But not many can claim UpStream’s quick success—especially locally.

Today, it works with almost 1,000 primary care physicians in three states. It also helps manage the care of more than 180,000 patients. More on this in a few paragraphs.

UpStream was founded in 2018 by a pharmacist, Fergus Hoban, who recognized many primary care physicians were becoming overwhelmed with the regulatory and administrative demands placed on them— especially when it came to treating their elderly patients.

Many seniors have chronic health conditions, multiple doctors, an overwhelming number of medications and transportation issues. It’s more than many primary doctors offices can handle effectively. It’s also why many are leaving the profession—citing “burnout.”

Dr. Doddamani is a licensed cardiologist who, a few years back, realized the same thing.

“I was able to see first-hand how older, sicker patients were struggling with their chronic conditions,” Doddamani said. “Many patients with heart failure also have coronary disease, high blood pressure and other medical conditions.”

So Doddamani joined UpStream as its CEO and started to help it grow.

Establishing its headquarters in Greensboro was the result, mainly, of UpStream establishing a partnership in early 2022 with the city’s main healthcare provider, Cone Health, and its efforts to coordinate the care of thousands of local patients with Medicare or other participating insurance plans through Cone’s Triad Healthcare Network.

“We have a great appreciation for what they (Cone Health) have done for so long,” Doddamani told me. “And our partnership has been a slow evolution really predicated on working with physicians, and that culminated in a greater opportunity to collaborate.”

UpStream’s name was inspired by a quote from Archbishop Desmond Tutu: “There comes a point where we need to stop just pulling people out of the river. We need to go upstream and find out why they’re falling in.”

“Rather than waiting for the downstream consequences and endless hospitalizations and suffering, (we need to) work our way to what their (the elderly patients) needs are and address them with the primary care physician,” Doddamani said.

Think of it as a team approach to the challenge with the primary care physician as the quarterback.

UpStream embeds clinical teams—nurses and pharmacists—in primary care offices. These teams—in collaboration with the primary care doctors—work one-on-one with patients to make sure nothing falls through the cracks in their care and keep them from ending up in hospitals.

UpStream also uses what it calls “concierges” who can help patients with non-clinical parts of care like—among many things— transportation and even supplies like walkers, canes, crutches.

“People, as they get older, sometimes can get forgetful or they’re just overwhelmed with the number of instructions,” Doddamani told me. “They need somebody to go over that more slowly to coordinate that type of care.” Hence the concierges.

For patients in Greensboro and surrounding areas, UpStream even has its own pharmacy within its headquarters complex. The company also offers medication delivery to patients.

And that’s not all.

Healthcare reform in the United States fostered the growth of value-based care programs which reward doctors with incentive payments for the quality of care they give to people on Medicare.

The more physicians meet certain benchmarks (lower blood pressure numbers within a certain patient population, for example) the bigger their reimbursements from Medicare.

For its participating physicians, UpStream essentially helps coordinate this financial component, assumes the risk, and guarantees a certain reimbursement.

“This takes time. It takes resources. It takes engagement. It takes time out of a physician’s’ day. And so we are able to call these ‘guaranteed advanced payments” because we take out the economic uncertainty and pay on a concurrent basis,” Doddamani said.

UpStream also offers physicians a technology platform that allows them to recognize what challenges and problems their patients are facing.

In short, the physicians are less stressed, and—most importantly— their patients get better, more individualized care at lower costs.


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“My hope is that long-term, we’ll be in 20 states with a million patients,” Doddamani told me. “But right now the most important priority is the physicians that are right in front of us, the patients right in front of us and that we’re demonstrating value, demonstrating an impact, and being incredibly good partners.”

Sounds like a revolution to me!

To read more about UpStream, click here.