Austin, Texas-based Harbor Well being, a startup main and specialty clinic group, is now providing Central Texas employers a direct main care possibility, which offers staff a full spectrum of main care companies 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 College, not too long ago 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 acquired $95.5 million in a funding spherical led by Basic Catalyst, bringing the full funding at the moment to greater than $128 million. The observe mentioned its final mission is to revamp the well being system in order that medical doctors and the staff working with them really get to know the individuals of their care.
The direct main 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 staff and attain their well being targets with out worrying a couple of fee-for-service fee construction, the corporate mentioned.
Healthcare Innovation: Earlier than we speak concerning the direct main care providing, might you describe the origins of Harbor Well being briefly for our readers who aren’t accustomed to it? The place did the concept come from and the way did you set it collectively initially?
Johnston: Partly, it got here from what we have been attempting to realize on the medical faculty — to re-envision what the healthcare system ought to appear like 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 have been so highly effective and so strongly motivated to maintain every part 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 obtained quite a lot of curiosity from self-insured employers, and so they purchased some stuff instantly 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 with a purpose to make this work, we’ve got 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 simply want if you are going to rebuild that system is a brand new system of first-touch care to interchange main care. What does that appear like? 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 you then layer on the specialty care. First off, you get a ton of information about the place good specialty care is going on. We have finished that. We’ve got a giant knowledge system, and we use machine studying to assist us to establish who’s doing issues greatest. After which over time, we have introduced in increasingly more specialists, and we’ll proceed to try this when we’ve got hassle gaining access to the standard that our individuals want. Then you definately layer on completely different fee plans. So initially, you’ve obtained to take no matter contracts you are given. You don’t have any market affect. We take payment for service, nevertheless it’s not why we exist. And, in actual fact, we lose cash on payment for service, nevertheless it’s a bridge. After which increasingly more you attempt to get these contracts to appear like 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 main care mannequin changing into extra widespread elsewhere? Are you seeing examples of supplier teams working instantly with employers and bypassing the insurance coverage corporations?
Johnston: Sure, there are extra people 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 stable main care teams who acknowledge that this offers them extra freedom to look after individuals the way in which they need to be cared for. After which it is coming from particular person medical doctors as effectively, though the person medical doctors actually aren’t essentially promoting to employers. They do not have sufficient bandwidth to try this.
HCI: What number of clinic settings does Harbor Well being have now?
Johnston: We’ve got 11 bodily clinics and two cellular clinics. We transfer round.
HCI: Are you already working with some employers in Central Texas? Or do you now need to line up the employers to work with?
Johnston: Now we’ve got to line up the employers to work with. We have already got a number of nibbles, so this can occur shortly.
Some employers are providing high-deductible plans. The issue with that’s that any resistance to getting main care is only a dangerous thought. It simply means you are going to let issues fester and worsen till they change into costly. So we match properly into these high-deductible plans as a result of we make it free to get the fitting care.
HCI: In desirous about the sorts of employers this is able to attraction to, I used to be picturing high-tech corporations who would supply this as a perk, however perhaps 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 main care due to deductible points. In the end, main care should be free, proper? It’s in everyone’s greatest 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 technique to observe. 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 people, as a result of it is extra according to the way in which they suppose medication ought to 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 among 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 in the present day onto different personnel, and we have been fairly considerate about how we do this, in order that the clinicians are actually working on the high of their recreation and doing the issues that they know are beneficial, and we all know are beneficial, and that clearly makes them happier, too. We’re not nervous about billing for insurance coverage on a regular basis.
HCI: Does that change how they use the EHR?
Johnston: Nice query. So in the present day it doesn’t. Most of our sufferers are nonetheless payment for service, the place the EHR is a core element of what they contact,. However, you recognize, what I used to be describing about fixing the healthcare system — you may’t do it with the present EHR, proper? We’re already getting them to interface with the EHR in another way, however finally 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 an even bigger elevate, 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 might be in Texas?
Johnston: Sure. What we’re attempting to do is tremendous arduous. I imply, it in all probability sounds ridiculously bold, and it could be if we have been attempting to do it nationally on the similar time.
We want this native penetration for quite a lot of issues. It makes quite a lot of issues simpler. One is advertising and marketing. Individuals know us now. Phrase of mouth is our main supply of promoting. One other is {our relationships} with companions comparable to specialty care organizations. We’re large enough on this city that individuals care about us. They need our referrals. They’re going to companion with us in a extremely collaborative technique to attempt to enhance their outcomes. Then we get higher contracts with present insurers as a result of we’re large enough, and we will 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 are going to develop past that. What we’re attempting to do is create the entire working system. At present, every part works on payment for service, and there is the RVU system that type of drives clinician conduct, and there are copays, coinsurance, deductibles. What we’re attempting to do is rebuild all of that stuff to vary the underlying incentive buildings and working system in order that it then can change into extra simply exportable. So we would not essentially have to personal the practices for them to observe on this completely different approach. That is finally what we’re pondering will enable 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 we’ve got the mannequin proper, that it is extremely profitable right here, and that it is able to to scale.
HCI: What about various fee fashions targeted on main care that large 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 wonderful 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 aren’t as enticing to us. They maintain on to quite a 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 more durable for us to do all of the issues that we might in that system, nevertheless it’s nonetheless useful on this transition. We even have offers in industrial insurance coverage that enable us to share among the financial savings.
