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Customer-hungry insurers offering free visits to physicians


For Kaiser Health News


Health insurers in several big cities will take some pain out of  physician visits in 2016. The plans will offer free visits to primary-care physicians in their networks.

You read that right. Doctor visits without co-pays. Or co-insurance. And no expensive deductible to pay off first either.

In Atlanta, Chicago, Dallas, Miami and more than a dozen other markets, people seeking coverage through the insurance exchanges can choose health plans providing free doctor visits, a benefit once considered unthinkable.

The change is rolling out in a limited number of plans following reports that high co-pays and deductibles have discouraged many Americans who signed up for private coverage the past two years from using their new insurance under the Affordable Care Act.

Insurers say they hope encouraging visits to doctors will benefit members and their bottom lines by catching illnesses early before they become harder and more expensive to treat. For example, prescribing antibiotics promptly to a patient with pneumonia could avoid a lengthy hospitalization costing tens of thousands of dollars.

In addition, the policy could also cut down on the use of more expensive urgent-care centers and emergency rooms for cases that aren’t critical.

In most states, Dec. 15 was the deadline for coverage starting Jan. 1, though people have until Jan. 31 to enroll for 2016.

Two new health insurers, Harken Health, an independently operated affiliate of UnitedHealthcare, and Zoom+ are offering unlimited free primary-care visits at company-owned clinics. Harken operates in Chicago and Atlanta. Zoom+ is based in Portland, Ore.

Down South, Florida Blue, the state’s largest insurer, has health plans in Miami-Dade and nine other counties where low-income members buying plans can also get two free primary-care visits per year.

California-based Molina Healthcare, is offering not only free primary-care visits in some plans, but also free visits to specialists in Florida, Texas and five other states.

The no-fee visits go beyond the preventive services, such as immunizations and screenings, that all insurers must provide under Obamacare without charging a co-pay, even when a deductible hasn’t been met.

Health policy experts say the new approach sets the insurers apart in crowded insurance markets and may attract younger, healthier people who don’t have relationships with physicians.

“This is a great development … and shows how the market is trying to innovate,” said Katherine Hempstead, director of coverage for the Robert Wood Johnson Foundation.

“Consumers should find this very appealing. … It might be like ‘a spoonful of sugar helps the medicine go down,’ ” she said, quoting a line from the Mary Poppins song. “People are not going to grouse as much about cost-sharing later if they are getting something free first.”

Consumer advocates applaud the trend, which they say underscores why people need to look beyond the monthly premium when shopping for a plan. “It’s a smart move to reduce financial barriers to basic outpatient care to help patients manage their health,” said Lydia Mitts, a senior policy analyst at Families USA. “I hope other health plans will realize removing financial barriers to primary care doctors is a smart direction for patients and for the plans.”

The health plans offering free doctor visits are typically among the lowest-priced plans in many markets, according to a Kaiser Health News review of plans sold on the exchanges.

Some insurers can offer free visits because they operate health clinics staffed by salaried physicians. That’s the case at Harken Health, which has four primary-care clinics in Chicago and six in Atlanta for its members to use for unlimited visits. Harken also offers members access to a doctor by telephone and Internet. “We are creating unfettered access between the care team and the patients,” said Tom Vanderheyden, CEO of Harken Health. “We think it’s a significant differentiation.” Harken also offers free yoga and cooking classes.

Patients with easy access to Harken’s clinics should be able to avoid trips to urgent care centers, retail clinics and emergency rooms, and develop a deeper relationship with their primary care doctor, Vanderheyden said. “Better access … should mean better outcomes and happier people.”

Dave Sanders, M.D., CEO of Zoom+ and a physician, said offering free doctor visits at its modern clinics, should help attract young enrollees. “We are unabashedly focused on the millennial generation,” he said.

To that end, Zoom+ lets members make appointments using a smartphone app. The company’s  physician emphasize changing diets before prescribing drugs.

Dr. Craig McDougall of ZOOM+ talks about food as medicine with a patient visiting one of the insurer’s clinics in Portland, Ore.

Zoom+ has run clinics in the Portland area for the past year, but it has never offered an insurance plan before. Members can get free care at the clinics or Zoom’s freestanding emergency room.

Under the health law, marketplace plans must cover a certain percentage of a member’s health costs with the amount varying based on gold, silver or bronze tiers. “What we have done is to spend the resources on primary care,” Sanders said.

Zoom+ also offers free mental health visits and one free dental visit for a cleaning.

Florida Blue, the state’s Blue Cross and Blue Shield plan, developed a new product for 2016 called myBlue which offers two free primary-care doctor visits and then charges $1 a visit thereafter, $3 visits for specialists, free routine lab tests and free diabetic supplies. The myBlue plan was created to help people whose incomes qualify for the highest cost-sharing subsidies under the Affordable Care Act.

To offer such benefits, Florida Blue developed a smaller network of doctors, hospitals and pharmacies so it could better control costs. But to encourage enrollment in Miami-Dade County it recently partnered with three CliniSanitas medical clinics, which primarily serve the Hispanic audience in the area. The plan is also available across South Florida, and counties around Tampa and Orlando.

Jon Urbanek, a senior vice president for Florida Blue, said the new plan is intended to increase the insurer’s market share. He said participating providers in the myBlue products are not necessarily paid less than other doctors but their pay is more closely tied to reaching certain quality targets such as cancer and cholesterol screenings. In 6 of 10 counties where it’s available, the myBlue product offers the lowest premium. “We think our pricing positions us to do very well,” Urbanek said.

Molina Healthcare is offering zero co-pays for unlimited primary-care doctor visits for one of its silver-tier plans for 2016. Unlike Florida Blue, it says it offers free doctor visits in its plans without using a narrow network of doctors and hospitals. “We really want folks to get value from their premium dollar and not have any barriers for care,” said Lisa Rubino, senior vice president at Molina.

Molina offers the zero co-pay physician plans in Florida, Michigan, New Mexico, Ohio, Texas, Utah and Wisconsin.

This story was produced through collaboration between NPR and Kaiser Health News, an editorially independent program of the Henry J. Kaiser Family Foundation, a nonpartisan health care policy research organization. Neither the foundation nor the news service is affiliated with Kaiser Permanente.

How Molina lives with lower rates


While the Affordable Care Act has helped decrease the  national uninsured rate, it hasn’t  really addressed  healthcare costs, J. Mario Molina, chief executive of Molina Healthcare, one of the nation’s largest managed-care companies, told  Albuquerque Business First.

“I think the next evolution of healthcare reform is figuring out how we do a better job of controlling costs,” he said.

However, Mr. Molina has reasons to be happy about the ACA — it has helped  his company expand, in large part because Medicaid is one of Molina’s primary businesses. So it got many more patients as many states enrolled many more individuals as many states chose to expand their Medicaid programs under the ACA.

Mr. Molina said that his company’s premium-pricing strategy helped let it live with lower rates than other insurers, which have reached very high levels.

He cited the fact that  the insurer didn’t expect to receive any federal funds under the ACA’s risk programs.  That meant Molina could go in conservative because it didn’t have any prior experience, so the company either lowered rates or kept them relatively flat.

He also spoke about about the reinsurance, risk-adjustment and risk corridors: “a lot of companies are looking at the three Rs to help them and we weren’t looking at that at all. We assumed that this was going to be a product that would stand on its own and that’s how we priced it. It’s really worked out for us.”



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