The models used by many newer health insuers rely on data and claims information to identify members most in need of health care interventions–and then brings the doctor to them. (Photo: Shutterstock)
Spending an hour waiting in a sterile doctor's office waiting room paging through a dog-eared copy of People magazine under fluorescent lighting may soon just be a tale we tell our grandkids, right up there with, "when I was your age, I had to walk to school, uphill both ways."
Though the pandemic hastened the death of the office waiting room and drove many consumers into the convenient embrace of virtual health care visits, a new model of capital-light health care delivery has been brewing for years–driven in large part by a new breed of health insurance companies who have swapped investment in physical capital for data and technology.
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Once upon a time, a consumer's health insurance plan gave them access to a range of health care providers who were reimbursed at rates negotiated with the insurers. Over the past several years, however, it's been more common for major insurers to simply buy up health care practices and provide care directly through their own network.
It's a model that worked well for established entities like UnitedHealth and Blue Cross Blue Shield with large sums of capital at their disposal. But what about newcomers to the field? They've taken the idea and run with it–with one significant change, according to Business Insider. Fledgling insurers such as Bright Health and Clover are building up a roster of health care providers–virtually.
"It gives us the reliability of making sure we can bend that cost curve everywhere we go without having to go into each market with a bunch of bricks and mortar," John Kao, CEO of California-based Alignment Health told Business Insider. Alignment counts among its employees 150 physicians who provide care via virtual or home visits, using technology and claims data to target the segment of its 83,000 members most in need of additional care.
Across the country in Massachusetts, startup Devoted Health's "in-house" medical team serves to "wrap around and complement" its established network of health care partners. Clover Health, which serves the Medicare Advantage market, has taken an approach a bit more appropriate for their demographic and has heavily invested in a home-care program, bringing back the old model of housecalls. And though they're not an insurer (yet), we would be remiss not to mention Amazon and its growing roster of employers who have signed on for its Amazon Care virtual health service.
One exception to the trend, notes Business Insider, is Bright Health, which has gone on a buying spree and amassed a network of 61 clinics.
One key to the new models being leveraged by these health insurers: data and technology. They're aiming to identify members most in need of their services and streamline the care coordination process for them.
"What we really want to promote is the health care system to move to a value-based model where you're really rewarding performance based on the quality of the care they provide, not just the quantity of care," CEO Mike Mikan said. "Every consumer is better served when they're part of an aligned model."
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Emily Payne
Emily Payne is director, content analytics for ALM's Business & Finance Markets and former managing editor for BenefitsPRO. A Wisconsin native, she has spent the past decade writing and editing for various athletic and fitness publications. She holds an English degree and Business certificate from the University of Wisconsin.
