Boutique plans aim to strengthen patient-provider bonds

April 14, 2016

Experts says UnitedHealthcare’s new boutique-style health plan is designed to drive innovation in primary care.

In what experts are calling a much-anticipated move, UnitedHealthcare’s formation of a boutique-style health plan will drive innovation in the world of primary care.

The nation’s largest insurer’s recent $65 million launch of an independent subsidiary, Harken Health, offers unlimited free doctor visits and 24/7 telephone care. Each member has access to a personal health coach, mental health counseling, yoga, cooking and acupuncture classes.

This boutique plan is available in Chicago and Atlanta, and covers 35,000 members who signed up on the exchanges. UnitedHealthcare also still sells traditional plans in those cities.

Back in November, UnitedHealth announced a loss in revenue due to its participation in the health insurance exchanges and threatened to exit in 2017.

Barbouche

“Health plans are looking to drive innovation in primary care-centric care delivery,” says Michael Barbouche, founder and CEO at Forward Health Group, a software and services company that provides value-based population management solutions. “There hasn't been a surge of primary care innovation in our health systems. Instead, the focus has remained on revenue acceleration before the fee-for-service music stops playing.”

If you run a hospital or health system, you may have never seen revenues this enormous, according to Barbouche. 

“For consumers, very little of this money is being leveraged to drive growth in primary care, add staff to primary care, buy scribes for primary care, or coordinate care between behavioral health and primary care,” he says. “We realized decades ago that a primary care model would likely be better and cheaper for the world and for patients. We have yet to see this fully materialize in our mega-health systems.”

The bottom line? “When health systems are asked to drive a primary care model on their own, organizations of all stripes are too consumed by their current challenges to re-calibrate in a value based, primary care-led model,” Barbouche says. 

Next: Tailor-made models

 

 

Ian Ellis, vice president of strategy, engagement solutions at Change Healthcare, a single financial and administrative healthcare network, shares a similar viewpoint.

“The traditional payer model has leaned toward a one-size-fits all model for B2B wholesale employer-sponsored insurance, so as the market shifts to B2C [business-to-consumer]-to exchanges and the government segments-payers will have to create models that will appeal to individuals’ unique preferences, as evidenced by UHC’s launch of Harken,” he says. 

“One of the most significant implications of this consumer transformation is on capability building, for everything from sales and marketing to care management to customer service-as payers look to enable smarter healthcare that is consumer-centric,” Ellis says.

The beauty of the B2C market is that when individuals can choose their plan and care, Ellis sees unique, targeted models emerging to meet the needs and preferences of specific segments of consumers. 

“These models aren’t for everyone, but they aren’t designed to be either,” he says. “We will continue to see innovation in targeted models for specific segments, whether focused on convenience, high-touch customer service, or managing care for populations with complex care needs.”

United not alone

Established companies are not the only ones exploring boutique-style health plan offerings, says Sally Poblete, CEO of Wellthie, a healthcare technology company offering e-commerce software and analytics solutions.

New insurance companies are emerging with a bigger focus on helping consumers stay well, live a balanced life, and also deliver better and more responsive service, she says.

“This is a great time for the industry when incumbents such as United are testing new models, while new players like ZoomCare, Bright Health and Canopy health insurance are launching, joining another new health plan, Oscar,” Poblete says. “These innovators are responding to consumer’s hunger for an engaging, welcoming, and convenient interaction with their health plan.” 

Ellis agrees that similar consumer-friendly integrated primary care health plans emerging from the delivery system, “such as Zoom+ of Portland, as well as primary care clinics that focus on specific populations and coordinating with payers to drive convenience and improved outcomes, such as Oak Street Health of Chicago,” he says.

Overall, the growing number of boutique style plans indicates payers are experimenting with provider models where the patient has no financial barriers to receiving primary care, says Managed Healthcare Executive Editorial Advisor Joel Brill, MD, chief medical officer, Predictive Health. “The question is whether this will improve outcomes for those with chronic conditions. UnitedHealth is using a white label model, while others employ physicians,” Brill says.

Tracey Walker is content manager for Managed Healthcare Executive.