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Health startup led by ex-UnitedHealth manager goes where rivals quit

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(Bloomberg) — UnitedHealth Group Inc. (NYSE:UNH) and Humana Inc. (NYSE:HUM), two of the largest U.S. health insurers, are leaving the Patient Protection and Affordable Care Act (PPACA) public exchange in Colorado next year.

Bright Health, a startup that hasn’t yet signed up its first customer, sees opportunity.

The new health insurer, led by former UnitedHealth executive Bob Sheehy, picked Colorado as its initial state market. The Minneapolis-based company is pursuing an increasingly popular model, teaming up with one health system — Centura Health in this case — to provide hospitals and doctors for its members.

See also: Private exchange makers show more numbers

“What we’ve seen, particularly in the individual market, is that the old insurance model doesn’t work,” Sheehy said in a phone interview. “A better model is one that really aligns the care provider, the physicians and the hospitals, financially, with the insurance company.”

Insurers are experimenting with new strategies in the markets created by PPACA, which is also known as Obamacare, and also as the ACA, where large firms like Humana and UnitedHealth have recorded big losses. Oscar Health Insurance Corp., the New York insurance startup valued at $2.7 billion, struck deals with tight hospital networks when it expanded into Texas and California this year. It also has narrowed its network in its home state.

Cost control

Sheehy, 58, said Bright Health’s partnership with Centura will let the firms focus on bringing down costs while improving health care for clients. He said the company will pursue a similar model as it expands into three to five additional markets over the next five years. Bright Health is also considering sales of Medicare Advantage plans, he said.

“The model of working in a collaborative way with a care partner like Centura will work well in each of those marketplaces,” he said.

Pam Nicholson, Centura’s senior vice president of strategy, said the health system, Colorado’s biggest, isn’t taking a financial risk in its agreement with Bright Health. Sheehy said the firms are “financially aligned,” without providing details.

Centura had previously served as an exclusive provider for plans sold by Colorado HealthOP, the so-called co-op insurer started with federal funds under PPACA.

The insurer said in October that it was closing, one in a string of failures of government-backed firms after a shortfall in federal funds designed to prop up the PPACA market.

See also: Colorado PPACA CO-OP strategy unclear

HealthOP’s closure helped create an opening for Bright Health. Members who sign up for Bright Health plans will pick a primary-care doctor from Centura to manage their care, according to Nicholson. The companies will work together on programs to manage chronic diseases and make sure members are getting appropriate care, she said.

Insurers are increasingly linking up with health care providers in the PPACA markets, according to McKinsey & Co. There were 71 co-branded relationships for this year, up from 36 in 2014. Financially, carriers with limited networks posted better results than insurers that included more doctors and hospitals, McKinsey found.

Bright Health said in April that it raised $80 million from backers including Bessemer Venture Partners and New Enterprise Associates. Along with Sheehy, its founders are Kyle Rolfing and Tom Valdivia, both former executives at Definity Health Corp., which was acquired by UnitedHealth.

Harken experiment

Even as UnitedHealth exits the individual PPACA markets in at least 27 states, the company — the largest U.S. health insurer — has launched an experiment of its own. Harken Health, an independent subsidiary of UnitedHealth, sold PPACA plans for this year in Chicago and Atlanta, signing up more than 35,000 people.

“Harken is a small and interesting innovation,” UnitedHealth Chief Executive Officer Stephen Hemsley told investors in April. “It’s in a very modest pilot position.”

The unit is expanding into Miami and Fort Lauderdale, Florida, in 2017, according to information provided by Harken on Wednesday. Members get care led by primary-care physicians and health coaches at Harken Health Centers, which can help lower costs by keeping customers from making expensive emergency-department visits.

“Harken is committed to shifting this ‘emergency room mindset’ by bringing unlimited access to primary care physicians who know you personally to each of the communities we serve,” Tom Vanderheyden, Harken Health’s CEO, said in the document.

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