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Zooming in on Millennial patients



Kaiser Health News


Lacee Badgley, the mother of a 7-year-old, works full time as an insurance adjuster. Like most working parents, she finds making time for doctor’s appointments a challenge.

“I don’t have the time or energy to drive around town and then wait,” she said.

That’s why Badgley, 36, switched from her previous doctors to Zoom+, a medical provider and health insurer that aims to give patients more control and transparency. She can make same-day appointments through a mobile app, and she’s usually in and out within 30 minutes.

“It’s one-stop shopping,” she said. “I am a big fan of getting everything quickly … I get my medication, my tests, everything in one visit.”

Zoom, which serves patients in Portland, Seattle and Vancouver, Wash.,  is trying to buck the traditional healthcare system by offering what it bills as convenient, affordable care in a hip and user-friendly environment. The retail clinics, painted a vibrant turquoise, are stylish and simple. The prices are posted on the walls.

Zoom was created by physicians Dave Sanders and Albert DiPiero to address problems that have plagued medical care for decades: rising costs, poor service and low quality, Sanders said. “We fundamentally wanted to change the system,” he said.

The company targets Millennials, who have been at the forefront of change in other industries. Zoom is designed for an imaginary patient named Sarah, who is in her early thirties and wants to get her health care the same way she gets other services in her life — quickly and efficiently.

The waiting rooms clearly illustrate that dynamic: There are no magazines because patients don’t typically wait long enough to read.

Zoom started as a single clinic in Portland 10 years ago and now has more than 30 locations. Last year, the company expanded in Portland and now offers dental care, mental-health services and chronic-disease management, as well as appointments with cardiologists, dermatologists and other specialists.

It also opened a “performance studio” to help people reach their fitness goals and a clinic that treats emergencies such as broken bones and concussions.

This year, Zoom began selling insurance through the Oregon health exchange. Sanders said that by having insurance members of its own, Zoom will be able to better assess its success at controlling expenses and improving care.

Only about 2,500 have signed up for Zoom’s insurance, Sanders said. He hopes to expand the insurance arm over time and believes the overall model could be replicated in other cities.

In some ways, Zoom is similar to Kaiser Permanente, which also provides medical care and insurance.

But Kaiser is a closed system: It only accepts Kaiser members. Zoom is more of a hybrid, treating not only Zoom insurance members but people with other health plans and self-paying patients as well. As a result, the company is both a partner and a competitor to some other insurers.

Of course, Kaiser is also a healthcare giant {not connected with Kaiser Health News} that operates in multiple states, while Zoom is much smaller and regionally contained.

People covered by Zoom insurance can get care at Zoom medical facilities or with Zoom partners, including Oregon Health & Science University hospitals.

In recent years, more health care providers have been offering insurance, but the vast majority of them are hospital systems, said Katherine Hempstead, director of coverage for the Robert Wood Johnson Foundation.

It’s unique for a network of retail clinics to add an insurance arm, and Zoom’s model is distinct because it is selling a branded experience to a specific population, Hempstead said. One Zoom poster says the complete health system is “designed to make you happier, healthier, smarter, faster, sexier, creativer.”

Hempstead said Zoom seems to be betting on the idea that young people are brand-loyal and view health much more broadly. As a result, they may be coming to Zoom not only to see a doctor but also to work with a fitness coach, get therapy or take cooking classes.

“It’s a totally new-school approach,” she said. “A company like this is saying, ‘We will be the destination of everything you think of when you want to stay healthy.’ The question is: Will the economics work out?”

That could be a challenge given how saturated the Portland insurance market is, said Sabrina Corlette, a research professor at Georgetown University’s Health Policy Institute. And some insurers on the exchange are much more established.

In addition, Millennials aren’t typically heavy users of the healthcare system, though many come for regular checkups, she said. Zoom’s success as an insurer depends in part on convincing young people that insurance “is a valuable thing for them to get and maintain,” Corlette said. Attracting young, healthy consumers also helps balance out any older, sicker members.

Other health care companies are marketing to millennials also, including New York-based insurer Oscar, which attracts younger consumers with its user-friendly technology. Oscar started selling coverage through Covered California this year. Harken Health, a subsidiary of UnitedHealthcare, assigns members in Chicago and Atlanta to a personal health coach, and — like Zoom — it also offers classes in cooking and yoga.

Darcy Hoyt, a veterinarian, said she signed up for Zoom insurance after regularly using the clinics for the past few years. The monthly premiums to cover her and her two children are lower than what her previous insurer charged, and she appreciates knowing in advance how much everything will cost.

“So far, so good,” Hoyt said. “For the relatively young, healthy families with kids falling off bikes and getting common colds, it’s very streamlined.”

The model appeals to people who want a different approach to medicine that doesn’t have the “vestigial appendices of a health care system that has been around for 50 years,” said John McConnell, director of Oregon Health & Science University’s Center for Health Systems Effectiveness.

“It’s like the iPhone,” McConnell said. “Zoom changed the paradigm … The whole way of delivering care is very different.”

Zoom is selective about its patient population. While it sees privately insured patients and uninsured ones with the ability to pay, it doesn’t accept people who are on Medicaid or Medicare.

By limiting whom they serve, McConnell said, the company’s providers may be cherry-picking the least costly patients and leaving other medical groups and hospitals to deal with medically needier people.

Sanders countered that one company can’t be all things to all people and Zoom has decided to invest its resources in serving a population that was ignored by the health system before the Affordable Care Act came along.

Zoom keeps costs low by providing care in neighborhood clinics and avoiding unnecessary tests and procedures. It relies heavily on nurse practitioners and physician assistants, and maintains small staffs. It also has its own electronic health record system.

“The whole process has been stripped,” Sanders said. “We took out a lot of the people, we took out all the paper, we took out the whole Taj Mahal.”

To advance its mission, Zoom has taken on regulators and state policymakers. It successfully lobbied for laws in Oregon allowing nurse practitioners to dispense medication and insurers to reimburse for more telemedicine.

The emergency clinic is one place where doctors said they are able to avoid overhead and pass savings along to patients. For patients paying out of pocket, a visit costs under $300.

Badgley, who has private insurance, came in to the clinic recently because she had been in bed for days with what she thought was the flu but still felt horrible after returning to work. She only had to explain once why she was there.

In the exam room, Dr. Aviva Zigman pulled out a pen and wrote Badgley’s symptoms on an oversized white board, along with the tests she might need and how long the appointment would take. Soon afterward, Zigman quickly determined that Badgley had an ear infection and gave her some antibiotics.

Zigman said that as a provider, the Zoom model is much more efficient than a typical emergency room for routine ailments and her patients can get what they need quickly.

Another Zoom patient, Amy Cannon, 45, goes to the company’s new primary care clinic for management of her high cholesterol, prediabetes and high blood pressure. The clinic, which has a kitchen in the lobby, offers cooking and yoga classes on site. Cannon said it feels more like a private club than a doctor’s office, and the assistant greets her with a hug.

“It’s ‘Cheers’ for health care,” Cannon said. “Everybody knows your name.”


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.

‘Twice the health’ at ‘half the cost’


Healthcare Payer News reports that a new kind of health system, with insurance built in, “is trying to validate its primary-care model and disrupt a seemingly competitive regional healthcare market.”

It’s Zoom+, a  clinic network now selling insurance for the first time with a unique — indeed, anti-establishment — low-price model.

Founder Dave Sanders, M.D., likes to describe his firm as aiming “to deliver twice the health, at half the cost and 10 times the delight.”

“At 28 neighborhood clinics and ‘advanced care studios’ in Portland, Vancouver, Wash., and Seattle, Zoom patients get team-based care from MDs, NDs, NPs, and PAs, with same day appointments, telemedicine, health coaching, food and exercise counseling, parenting help, mental health treatment and basic dental services, which will all come as part of the health plans.”

“Over the past nine years, Zoom has evolved into a kind of 3.0 version of Group Health Cooperative, HealthPartners or Kaiser Permanente. It might also be compared to direct primary care networks like Qliance or Iora Health, as well the new health insurer Oscar.”

Sanders said: “As physicians, what we all know to be true are that food and movement are the soul of human health, along with relationships, stress and sleep. For some reason, our medical schools and system perpetuate the myth that health relies in laboratories, and imaging and medicine.”

“Zoom offers those condition management services, but the goal is to spread a ‘culture and ethos’  of ‘food and movement as medicine’—clinics that offer personalized activity training, diet counseling and smoothies.”

Healthcare Payer News says: “If Zoom can serve those populations and win converts from the third segment, while nurturing a strong brand and experience, Sanders said they could expand to other regions and patient populations.” But Zoom does not yet accept  Medicaid or Medicare.



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