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 gives staff a full spectrum of main care companies totally free. 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, 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 acquired $95.5 million in a funding spherical led by Normal Catalyst, bringing the overall 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 medical doctors and the workforce working with them really get to know the folks of their care.
The direct main care resolution, referred to as Core by Harbor Well being, bypasses insurance coverage firms and makes it simple for members to construct an ongoing relationship with their well being workforce and attain their well being objectives with out worrying a few fee-for-service fee construction, the corporate mentioned.
Healthcare Innovation: Earlier than we speak in regards to the direct main care providing, might you describe the origins of Harbor Well being briefly for our readers who aren’t aware of it? The place did the thought come from and the way did you place it collectively initially?
Johnston: Partly, it got here from what we have been making an attempt to attain on the medical faculty — to re-envision what the healthcare system ought to appear to be and construct it that method. However we did it situation by situation in specialty areas. My realization was that we weren’t going to succeed that method, that the incumbents within the healthcare system have been so highly effective and so strongly motivated to maintain every thing in that the established order that with one supplier group, it simply wasn’t going to work. We could not get the guidance. We could not get the contracts from carriers. We acquired lots of curiosity from self-insured employers, they usually purchased some stuff immediately 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 conclusion was that to be able to make this work, we have now to tear the entire thing down and rebuild it, not perform a little reworking. That’s actually what we’re doing at Harbor, however we’re doing it in a staged method. 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 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 cut back waste?
The primary stage is to construct that medical system, and you then layer on the specialty care. First off, you get a ton of information about the place good specialty care is occurring. We have achieved that. Now we have a giant information 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 do this when we have now bother having access to the standard that our folks want. Then you definately layer on completely different fee 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, in actual fact, we lose cash on price for service, nevertheless it’s a bridge. After which increasingly more you attempt to get these contracts to appear to be capitated contracts or such as you’re taking full threat on folks, 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 house over time.
HCI: Is that this direct main care mannequin changing into extra frequent elsewhere? Are you seeing examples of supplier teams working immediately with employers and bypassing the insurance coverage firms?
Johnston: Sure, there are extra of us doing this now, and coming from all completely different areas. Some firms create on-site clinics, teams like Clover. After which others are coming from strong main care teams who acknowledge that this offers them extra freedom to take care of folks the way in which they need to be cared for. After which it is coming from particular person medical doctors as properly, though the person medical doctors 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: Now we have 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 should line up the employers to work with?
Johnston: Now we have now to line up the employers to work with. We have already got numerous nibbles, so this may occur rapidly.
Some employers are providing high-deductible plans. The issue with that’s that any resistance to getting main care is only a dangerous 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 fitting care.
HCI: In excited about the forms of employers this could enchantment to, I used to be picturing high-tech firms who would supply this as a perk, however possibly not. Is it additionally for employers with lower-wage staff?
Johnston: It truly 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 college districts. That is actually engaging 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 all people’s greatest pursuits to make it free. It is a dumb factor that we’ve made it costly.
HCI: That is most likely very engaging 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 in line with the way in which they assume drugs ought to be practiced. They did not go to med faculty to be on a hamster wheel. They went to med faculty to actually take care of folks, 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 someone 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 try this, in order that the clinicians are actually working on the high of their recreation 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 fearful 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 price for service, the place the EHR is a core part of what they contact,. However, , what I used to be describing about fixing the healthcare system — you possibly can’t do it with the present EHR, proper? We’re already getting them to interface with the EHR in another way, however finally we’ll be the place the EHR just isn’t 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 making an attempt to do is tremendous laborious. I imply, it most likely sounds ridiculously bold, and it will be if we have been making an attempt to do it nationally on the similar time.
We’d like this native penetration for a wide range of issues. It makes lots of issues simpler. One is advertising. Folks know us now. Phrase of mouth is our main supply of selling. One other is {our relationships} with companions comparable to specialty care organizations. We’re sufficiently big on this city that individuals care about us. They need our referrals. They will companion with us in a extremely collaborative option to attempt to enhance their outcomes. Then we get higher contracts with current insurers as a result of we’re sufficiently big, 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 necessary.
We’ll develop in Texas. However then, sure, we are going to develop past that. What we’re making an attempt to do is create the entire working system. Presently, every thing works on price for service, and there is the RVU system that type of drives clinician habits, 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 constructions and working system in order that it then can turn into extra simply exportable. So we would not essentially must personal the practices for them to apply on this completely different method. That is finally what we’re pondering will permit extra speedy scaling. Our ambitions do undoubtedly transcend Texas, however we’re not going to do something in that respect till we’re fairly assured that we have now the mannequin proper, that it is extremely profitable right here, and that it is able to to scale.
HCI: What about various fee fashions centered on main care that massive insurers and CMS are experimenting with? Does that match into what Harbor Well being is doing?
Johnston: It does completely. We truly 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 engaging to us. They maintain on to lots of the advantages that we produce when it comes to bettering outcomes. They dangle on to that monetary profit, so it is it is tougher 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 permit us to share among the financial savings.
