By Rob Bell, Rochester Beacon

Michael Mendoza M.D. says the Rochester region’s health has not fully recovered from the COVID-19 pandemic.

Cardiovascular measures, maternal and child health, immunizations and blood pressure control are “still a challenge,” he said.

“The biggest challenge that hasn’t gotten better—and in some cases has gotten worse—is the disparity in blood pressure control between Black and brown populations and white populations. And that’s not OK.”

Mendoza, former Monroe County commissioner of public health and the face of the county’s response to the pandemic, is now senior medical director at Town Square Health, a Chicago-based company planning to open its debut health center in Rochester around September.

The site is expected to be near Westfall and Clinton in Brighton, close to a complex already used by many residents for medical care. It will focus on Medicare patients, including adults 65 and older and some younger patients who qualify for Medicare because of disability.

For Mendoza, the aim is not simply to open another primary care office. It is to test whether a different model of care can help prevent declines in health before patients reach a crisis point.

“I’m going to want to know that people are healthier,” Mendoza says. “Are they living longer and healthier lives?”

Town Square Health uses a value-based multispecialty care model for Medicare patients it calls Primary Care 3.0—a concierge-style experience.

Under the traditional fee-for-service model, doctors and health systems are generally paid based on the number of visits, services, and procedures they provide. A value-based model ties payment more closely to patient outcomes.

“Part of the reason we can spend more time with patients and be more thorough is because we get paid when the patients do well and not just when we see a lot of them,” says David Buchanan, CEO and co-founder of Town Square Health.

Buchanan, a Western Pennsylvania native, says Rochester appealed to him both because of the market and because the city felt familiar.

“When I first came to Rochester, it felt like coming home,” he says. “I feel like Pittsburgh and Rochester really have a lot of similar histories, and you can see it in even the infrastructure and the houses and the community.”

David Buchanan

Buchanan says Town Square Health may open more locations throughout Western New York. But “right now we’re laser focused on the Rochester area.”

He co-founded the company in 2025 after leadership roles at Oak Street Health and CVS Health. 

CVS Health acquired Oak Street Health in 2023, adding a primary care network focused on value-based care for older adults and Medicare patients. 

According to Buchanan’s LinkedIn profile, he served as Oak Street’s chief clinical officer, chief clinical and technology officer, and executive medical director before later working as chief innovation officer for health care delivery at CVS Health.

“David and I have known each other for a while,” says Mendoza, who grew up in Chicago and later moved to Rochester, where he has worked as a family physician, public health commissioner and health care executive. 

The two doctors reconnected as Buchanan was looking to build local relationships.

“His commitment to prevention and community health is a perfect reflection of our Primary Care 3.0 vision,” Buchanan said after announcing Mendoza’s new role.

The doctors say Town Square Health’s model reflects what many clinicians want from their work: the ability to put quality first.

“There’s this element of being a physician that’s like a craftsperson,” Buchanan says. “You’re really trying to take the best care of individual patients.”

Still, value-based care is not without concerns.

While the model is designed to reward better outcomes rather than more visits, critics have raised questions about whether it can create new pressures on providers and patients. 

Practices often need to invest heavily in technology, data systems, and reporting tools to track quality measures. 

Town Square Health says it plans to use Heidi, an AI note-taking tool, during visits to reduce administrative work. Buchanan said the tool is meant to keep doctors from “staring at their laptops and typing” instead of looking at patients and listening. Patients who are uncomfortable with AI will be able to opt out.

The idea is that ambient documentation tools could transcribe clinical visits and generate draft notes; automated scheduling and patient reminders would reduce no-shows and minimize staff time on phone calls. Additional applications could include prior authorization tools to expedite insurance approvals and AI-supported triage and chat functions to address routine questions.

AI could also reduce physician burnout.

About 42 percent of U.S. physicians report burnout symptoms, according to a survey administered by the American Medical Association. The figure is down from 62.8 percent post-pandemic; however, even with that decline, physicians remain significantly more likely to experience burnout than workers in other fields, adding to concerns about whether the health care system can retain enough clinicians to meet rising demand.

There is also the question of how “value” is measured, and whether this model could create unintended consequences. For example, providers may have a financial incentive to limit referrals or order fewer tests to control costs and increase margins. That raises concerns about whether some patients could end up receiving less care than they need.

In an Instagram post, Town Square Health says its model, in addition to improving the health of aging adults, will “deliver returns for our investors.”

Asked who those investors are, a spokesperson replied in a written statement that Buchanan is “bootstrapping the company during our initial phase of operation. We are officially announcing our Seed Round of fundraising in Fall 2026. Our model creates a natural alignment between investor returns and patient outcomes by reducing operating costs and the total cost of care, and by improving patient engagement. This structure allows Town Square Health to generate sustainable financial performance beyond what has been previously achieved in legacy value-based care models.”

Company leaders say this model is designed to avoid some of these reported concerns. 

Mendoza says he would evaluate the model by whether patients show improved health outcomes, such as better diabetes care, improved blood pressure control, and fewer unnecessary hospital visits. He says those outcomes are reported to payers as evidence that the model is helping keep patients healthy.

Sahar Elezabi, M.D., president of the Monroe County Medical Society, says Town Square Health’s model would be new to the Rochester market, although similar models exist in other regions.

MCMS is a physician-led organization that supports doctors through education, advocacy, networking and community collaboration.

Elezabi notes that most local primary care practices are affiliated with the University of Rochester, Rochester Regional Health, or federally qualified health centers such as Jordan Health and Trillium Health, and added that private adult primary care practices have continued to decline.

“This would be new, innovative in our area, and actually needed,” Elezabi says.

Michael Mendoza

Consolidation among major health systems and the decline of private practices have created a need for new options, Elezabi says, citing dwindling physician reimbursement, rising health care costs, and the challenges of operating a private practice as reasons for the decline.

“Private practices are small businesses, like any other small businesses,” she says. “So they’re really having a hard time competing, just surviving.”

While the region’s major health systems already use value-based contracts through accountable care organizations, Elezabi says the key issue is how effectively the model is applied.

“It’s not necessarily just about value-based contracting,” she says. “It’s how do you apply it and how do you run it? I think it’s a wise, smart move that would benefit the community. If the model is run correctly, with the needed resources and sticks with the laws and the regulations, I think it would be a really nice addition to our community.”

Town Square Health says it chose Rochester as its first market after looking for communities where it believed its Medicare-focused model could meet a need.

The company points to Monroe County’s Medicare Advantage enrollment, saying the county “has the highest Medicare Advantage enrollment rate of any major urban county in the United States.”

It also cited “fragmented care delivery, physician burnout, and an underinvestment in proactive senior-focused primary care” as factors that have left many Rochester Medicare patients without the “coordinated, relationship-driven care” the company wants to provide.

According to Common Ground Health, a local nonprofit health research and planning organization, one in five people in the Rochester-Finger Lakes region is 65 or older. 

An AARP-commissioned data report found that the number of Rochester residents 65 and older living in poverty rose 70 percent from 2011 to 2021, from 3,633 to 6,175, or 22 percent of city residents in that age group.

This means that, for older adults, access to health care is determined by more than the availability of doctors. Transportation and mobility limitations, caregiver strain, high out-of-pocket costs, and the complexity of Medicare and Medicaid coverage can all affect whether people receive the care they need.

Mendoza says coordination is a frequent issue for older patients. “They say, ‘Well, it’s so hard to get from here to there and make all these appointments. Can we bring it all into one place?”

Town Square Health sees itself as filling a gap rather than competing with existing systems, as demand for primary care remains high.

“There’s not enough great primary care,” Buchanan says. “People are waiting three to six months for primary care. We want to do what we can to help address that.”

The initial Rochester team is expected to include providers, nurses, a practice manager and patient navigators.

Over the next five to 10 years, Buchanan says, the goal is to expand beyond the first Brighton-area center. He says success could mean serving about 20,000 patients across three or four centers in the Rochester area.

For Mendoza, the measure will be whether the model improves health outcomes in a region where older adults face growing needs and where post-pandemic inequities persist.

“There is a demand for a different way of doing care for a lot of people,” he says.

Rob Bell is a Rochester Beacon contributing writer and former Democrat and Chronicle reporter, photographer and editor. He also produces and hosts “Plants & Beats,” a podcast exploring mindfulness, music and culture.