Austin, Texas-based Harbor Well being, a startup major and specialty clinic group, is now providing Central Texas employers a direct major care choice, which offers staff a full spectrum of major care providers free of charge. Harbor co-founder Clay Johnston, Ph.D., M.D., M.P.H., who beforehand served because the inaugural dean of the College of Texas at Austin Dell Medical Faculty, lately spoke with Healthcare Innovation about Harbor Well being’s bold plans for redesigning the well being system from the bottom up.
In January 2024, Harbor introduced it had obtained $95.5 million in a funding spherical led by Common Catalyst, bringing the full funding at the moment to greater than $128 million. The apply mentioned its final mission is to revamp the well being system in order that docs and the crew working with them really get to know the individuals of their care.
The direct major care answer, known as Core by Harbor Well being, bypasses insurance coverage corporations and makes it straightforward for members to construct an ongoing relationship with their well being crew and attain their well being targets with out worrying a couple of fee-for-service cost construction, the corporate mentioned.
Healthcare Innovation: Earlier than we speak in regards to the direct major care providing, may you describe the origins of Harbor Well being briefly for our readers who aren’t acquainted with it? The place did the thought come from and the way did you set it collectively initially?
Johnston: Partially, it got here from what we had been making an attempt to realize on the medical faculty — to re-envision what the healthcare system ought to appear to be and construct it that approach. However we did it situation by situation in specialty areas. My realization was that we weren’t going to succeed that approach, that the incumbents within the healthcare system had been so highly effective and so strongly motivated to maintain all the things in that the established order that with one supplier group, it simply wasn’t going to work. We could not get the steering. We could not get the contracts from carriers. We acquired a whole lot of curiosity from self-insured employers, they usually purchased some stuff straight from us. That helped us, nevertheless it wasn’t sufficient to create a scalable system, and that is actually what I used to be there to do.
The belief was that as a way to make this work, now we have to tear the entire thing down and rebuild it, not perform a little transforming. That’s actually what we’re doing at Harbor, however we’re doing it in a staged approach. The very first thing that you just want if you are going to rebuild that system is a brand new system of first-touch care to exchange major care. What does that appear to be? How do you create it in order that it actually cares for people and their well being and is motivated to maintain them more healthy and likewise to scale back waste?
The primary stage is to construct that scientific system, and then you definitely layer on the specialty care. First off, you get a ton of information about the place good specialty care is going on. We have completed that. We have now a giant knowledge system, and we use machine studying to assist us to determine who’s doing issues finest. After which over time, we have introduced in increasingly specialists, and we’ll proceed to do this when now we have hassle gaining access to the standard that our individuals want. You then layer on completely different cost plans. So initially, you’ve acquired to take no matter contracts you are given. You don’t have any market affect. We take price for service, nevertheless it’s not why we exist. And, the truth is, we lose cash on price for service, nevertheless it’s a bridge. After which increasingly you attempt to get these contracts to appear to be capitated contracts or such as you’re taking full danger on individuals, and over time, you then can layer by yourself insurance coverage merchandise. So Core is our first profit product, and we plan so as to add extra merchandise in that area over time.
HCI: Is that this direct major care mannequin turning into extra frequent elsewhere? Are you seeing examples of supplier teams working straight with employers and bypassing the insurance coverage corporations?
Johnston: Sure, there are extra of us doing this now, and coming from all completely different areas. Some corporations create on-site clinics, teams like Clover. After which others are coming from strong major care teams who acknowledge that this offers them extra freedom to look after individuals the best way they need to be cared for. After which it is coming from particular person docs as effectively, though the person docs actually aren’t essentially promoting to employers. They do not have sufficient bandwidth to do this.
HCI: What number of clinic settings does Harbor Well being have now?
Johnston: We have now 11 bodily clinics and two cell clinics. We transfer round.
HCI: Are you already working with some employers in Central Texas? Or do you now must line up the employers to work with?
Johnston: Now now we have to line up the employers to work with. We have already got plenty of nibbles, so it will occur rapidly.
Some employers are providing high-deductible plans. The issue with that’s that any resistance to getting major care is only a unhealthy concept. It simply means you are going to let issues fester and worsen till they turn into costly. So we match properly into these high-deductible plans as a result of we make it free to get the correct care.
HCI: In eager about the sorts of employers this might attraction to, I used to be picturing high-tech corporations who would provide this as a perk, however possibly not. Is it additionally for employers with lower-wage staff?
Johnston: It really is each. One of many first ones that is already dedicated, is a enterprise capital agency. They need fairly easy accessibility for his or her staff. However we have additionally heard from employers just like the counties and faculty districts. That is actually enticing to them due to their staff not getting major care due to deductible points. Finally, major care must be free, proper? It’s in everyone’s finest pursuits to make it free. It is a dumb factor that we’ve made it costly.
HCI: That is in all probability very enticing to the clinicians as a option to apply. However does it require a sure retraining to get out of that fee-for-service hamster wheel mindset? Is it a shift in how they work together with sufferers?
Johnston: What we’re discovering is that this turns into fairly pure to of us, as a result of it is extra according to the best way they suppose drugs must be practiced. They did not go to med faculty to be on a hamster wheel. They went to med faculty to essentially look after individuals, and having the incentives align with that, it simply feels proper to them.
The opposite factor we have tried to do is to take a number of the arduous duties and have anyone else deal with them. That offers us some extra flexibility. We put the prior authorizations and issues that clinicians are doing right now onto different personnel, and we had been fairly considerate about how we do this, in order that the clinicians are actually working on the prime of their sport and doing the issues that they know are invaluable, and we all know are invaluable, and that clearly makes them happier, too. We’re not apprehensive about billing for insurance coverage on a regular basis.
HCI: Does that change how they use the EHR?
Johnston: Nice query. So right now it doesn’t. Most of our sufferers are nonetheless price for service, the place the EHR is a core part of what they contact,. However, you already know, what I used to be describing about fixing the healthcare system — you’ll be able to’t do it with the present EHR, proper? We’re already getting them to interface with the EHR otherwise, however in the end we will be the place the EHR shouldn’t be going to be related. It is actually going to be us designing a system to match the mannequin of care. That is a much bigger carry, however it’s one which we have already began to to provoke.
HCI: Is a part of your marketing strategy to scale this geographically past the place you’re in Texas?
Johnston: Sure. What we’re making an attempt to do is tremendous laborious. I imply, it in all probability sounds ridiculously bold, and it will be if we had been making an attempt to do it nationally on the similar time.
We want this native penetration for quite a lot of issues. It makes a whole lot of issues simpler. One is advertising and marketing. Folks know us now. Phrase of mouth is our major supply of selling. One other is {our relationships} with companions equivalent to specialty care organizations. We’re sufficiently big on this city that folks care about us. They need our referrals. They will accomplice with us in a very collaborative option to attempt to enhance their outcomes. Then we get higher contracts with present insurers as a result of we’re sufficiently big, and we are able to meet the wants of staff throughout the metro. So for all these causes, rising and actually being good in a market is vital.
We’ll develop in Texas. However then, sure, we’ll develop past that. What we’re making an attempt to do is create the entire working system. At the moment, all the things works on price for service, and there is the RVU system that type of drives clinician conduct, and there are copays, coinsurance, deductibles. What we’re making an attempt to do is rebuild all of that stuff to vary the underlying incentive buildings and working system in order that it then can turn into extra simply exportable. So we would not essentially have to personal the practices for them to apply on this completely different approach. That is in the end what we’re considering will permit extra fast scaling. Our ambitions do positively transcend Texas, however we’re not going to do something in that respect till we’re fairly assured that now we have the mannequin proper, that it is extremely profitable right here, and that it is able to to scale.
HCI: What about different cost fashions centered on major care that massive insurers and CMS are experimenting with? Does that match into what Harbor Well being is doing?
Johnston: It does completely. We really take part in ACO Attain, which is a superb program. It permits us to do all of the issues that I simply described. We additionally take part in Medicare Benefit agreements with different insurers, however they don’t seem to be as enticing to us. They maintain on to a whole lot of the advantages that we produce when it comes to enhancing outcomes. They grasp on to that monetary profit, so it is it is tougher for us to do all of the issues that we may in that system, nevertheless it’s nonetheless useful on this transition. We even have offers in business insurance coverage that permit us to share a number of the financial savings.
