There is an interesting insurance pilot project that is going on in Atlanta and Chicago:
UnitedHealth Group’s new Harken Health subsidiary is trying to grab that niche, in a modified way, with a clinic-based plan that offers unlimited primary care and behavioral visits at no charge.
The health plan, which offers services with no coinsurance charge and copays only for prescription drugs, will be available at four neighborhood office locations in Chicago and its suburbs and will open six centers in the Atlanta area….
members have access to UnitedHealth’s wide national network of hospitals and specialists, including Northwestern Memorial HealthCare, University of Chicago Medicine and Advocate Health Care in Chicago. That runs counter to the strong trend for plans to offer narrower hospital networks….
The clinics, which opened this month, are staffed by Harken-employed primary-care physicians, nurse practitioners, behavioral-care specialists and health coaches….
There is same-day scheduling for appointments and 24/7 telehealth access to staff providers. Exam rooms feature patient data screens allowing the member, doctor and health coach to go over all medical information with full transparency.
This is very interesting benefit design for what is otherwise a fairly straightforward Exchange plan. I am looking at the Silver Harken Health for Atlanta zip code 30301 on Healthsherpa.com right now and the rest of the schedule of benefits looks typical. There is a $3,000 deductible and a $6,000 out of pocket maximum where the out of pocket above deductible looks to be prescription drug co-pays. For a Silver, this is pretty typical. Pricing wise this is middle of the pack as the Atlanta price leader is a narrow network based on a Medicaid managed care organization that spammed the exchanges with insubstantially dissimilar designs.
The bet in Atlanta and Chicago is a bet on avoidance. Primary care and behavioral health care are dirt cheap compared to acute crisis care. The bet is that removing any cost barrier to care will see people use a lot more primary care and behavioral health care to catch problems earlier. Furthermore, if the hours of these clinics are pretty good (evening and weekends), these clinics should serve as emergency room and urgent care diversion locations. A PCP visit at an office is, from an insurer point of view, significantly cheaper than the same services at an urgent care center, and way cheaper than an ER visit.
The first level of the short term bet is a utilization management bet. The longer term bet of this plan design is that expensive chronic conditions can be managed approrpiately and effectively which transforms them into somewhat expensive chronic conditions and some proportion of future expensive conditions can be averted or at least delayed by better and/or more frequent primary care.
I am very curious about the results of this experiment as it is an insurer going into the care management business at the PCP end and not the hospital side. It is a narrow slice of being an integrated payer-provider system and a fairly unique (to my knowledge) twist on the model.