New health plan announced with no copays for primary care

2016-06-18 | Sun Sentinel

June 18--Purchasers of individual health insurance coverage will see a new option when the 2017 enrollment period opens later this year, if state insurance regulators approve.

Harken Health Insurance Co. has chosen Broward and Miami-Dade counties as the third test market for its approach to health care "that unites relationship-based primary care with flexible, competitively priced health insurance," the company said in a statement.

In 2016, Harken Health began operations in just two metro areas, with six centers in Atlanta and four in Chicago. The company plans two more centers in Atlanta and six more in Chicago.

The company has been licensed by the state Office of Insurance Regulation to provide health insurance in Florida, but its detailed plans are still under review by the state, according to the company.

The concept is based on research indicating that increased access to primary care leads to healthier outcomes at a lower cost, Harken CEO Tom Vanderheyden said in an interview. "The most important thing missing in the health care system is a trusted relationship between the patient and a personalized care team," he said.

Members will get no-cost access to 12 primary care centers in the two counties, including four in Broward: Hollywood, Davie, Oakland Park and Coral Springs.

The health care centers are deliberately designed to be small and cater to a limited number of members, Vanderheyden said. "It harkens back to Starbucks," he said. "You never see a mega-Starbucks because they want you to have the same experience no matter where you go."

Except for prescription drugs, Harken's plans will have no coinsurance, which are the copays patients are charged after reaching their deductibles. Members will be allowed unfettered access to care at the centers with no out-of-pocket costs.

Primary care physicians will be a part of a member's overall "Care Team," which will also include behavioral health specialists and a "Health Coach" assigned to help develop overall health and well-being plans.

Health coaches will also accompany members to visits with their primary care physicians, the company says. Members will find other health-oriented services at the centers, such as yoga, fitness and nutrition classes.

Eliminating payment for primary care services is central to the plan's appeal because it creates value in the minds of many members, said Larry Levitt, a senior vice president at Kaiser Family Foundation.

"Many plans have high deductibles," he said. "People end up paying premiums for something they never use."

Health plans will also include prescription drug coverage and access to UnitedHealth's Compass Plus wraparound provider network.

That could be important to success in big Miami-Dade County, said Mark Cherry, principal analyst with health care industry analyst Decision Resources Group, because the Compass Plus network includes Baptist Health South Florida.

"Harken could make an impact for 2017 if the insurer offers an exchange product with a competitive premium as well as access to Baptist Health South Florida," he said.

Centers will be located so plan members in both counties can access one in a 20-minute drive, Vanderheyden said.

Harken Health's sole investor is United Healthcare, the nation's largest health insurance provider. Vanderheyden says the company is an "independently operated affiliate" of UnitedHealthcare. And although UnitedHealthcare is Harken's sole investor, there's no synergy, he said, between the fact Harken is entering South Florida at the same time UnitedHealthcare is pulling out of federal exchanges in Florida and all but a handful of other states.

Vanderheyden helped develop the concept in 2014 when he was UnitedHealthcare's vice president of business development and innovation.

Harken Health offers a fresh take on a concept popularized by Medicare Advantage plans -- the privately managed Medicare upgrade insurance popular among seniors, said Allan Baumgarten, an independent analyst who produces annual health market reviews for several states, including Florida.

One such Medicare Advantage plan is California-based CareMore, which offers complete medical assessments, evaluation of medication, on-site lab results and a personalized care plan "in a comfortable and accessible environment," according to its website.

In South Florida, CAC clinics, which are now run by Humana, focus on seniors and provide transportation and health coaching, he said. "And there is an aspect of déj... vu, in the sense that it resembles some of the classic clinic-based HMOs like Kaiser, Group Health in Minnesota and HIP in New York."

Vanderheyden said Harken Health plans were priced "in the middle of the pack" in the plan's first year and membership, at more than 35,000 in Chicago and Atlanta, "exceeded our expectations."

As pricing for most plans has increased every year since the Affordable Care Act has been in effect, insurance companies have been looking for ways to remain affordable.

Cherry says "exchange insurers seem to be gravitating toward two strategies: gatekeeper or narrow network."

Harken is a gatekeeper network, he said, with a primary care physician coordinating care, while "Florida Blue's BlueSelect and Humana's South Florida HUMx have narrow networks that exclude certain health systems."

South Florida is a logical market for expansion by Harken, even if there's no way to know yet whether the model will be profitable, says Larry Levitt, senior vice president at Kaiser Family Foundation.

"Enrollment is stronger there than anywhere else in the country," Levitt said. "There's already a ready base of customers and the marketplace is very price competitive. If they can make it work at a lower premium there's potential for it to gain market share very quickly."

Cherry said that while "older seniors have really liked the 'white glove' treatment, there's a question of how younger people who have been raised by preferred provider organizations will respond to having to see a primary care physician before going to a specialist.

"Will they view health coaches as helpful, or just an obstacle to getting the care and meds they think they need?"

Still, he said exchange customers will likely sign up for Harken Health as long as it offers a competitive premium. "If successful, it'll spread to Tampa and Orlando if successful here," he said. "Focusing on preventive care should help keep costs down, especially if it prevents hospitalization. Just as important may be reducing unnecessary visits to expensive specialists."

rhurtibise@sun-sentinel.com, 954-356-4071