With 11 health insurance companies planning to sell coverage on the Affordable Care Act exchange next year, the level of competition in Florida is already higher than in most other states. But a new company with some old money behind it announced plans on Wednesday to step up the competition in South Florida.
Harken Health Insurance Company, an independent subsidiary of UnitedHealth Group, the nation’s largest health insurer, said it will sell coverage for 2017 on the ACA exchange in Miami-Dade and Broward counties using a managed-care model that includes a network of primary-care clinics and personal counselors to guide members through the healthcare experience.
It’s unclear which companies Harken will be competing with in South Florida because the state’s Office of Insurance Regulation, which reviews rates and plans, has not said how many insurers will compete in each of Florida’s 67 counties.
But Miami-Dade and Broward are the powerhouses of the ACA exchange — both in Florida and nationwide among the 38 states that use the federally run exchange. According to the Department of Health and Human Services, nearly 645,000 people in the Miami and Fort Lauderdale markets had signed up for ACA coverage as of Feb. 1.
About 1 million people in Florida received financial help from the government to help pay their health insurance premiums for plans bought on the Affordable Care Act exchange in 2015, according to the Department of Health and Human Services. The average subsidy was $300 a month.
Tom Vanderheyden, chief executive of Harken, said the health insurance startup plans to stand out from its South Florida competitors by opening 12 primary-care clinics in Miami-Dade and Broward counties and assigning each new member a “health coach” who will closely follow the patient, including attending doctor appointments, ensuring medications and other needs.
Vanderheyden said the primary-care clinics will be staffed with physicians, nurses and others and that the centers will be accessible to Harken members “free of charge” during set operating hours. Centers will include doctors offices and community rooms where members can take yoga lessons or learn to cook healthy meals, he said.
For members who need specialized medical care, Vanderheyden said, “we have one of the largest networks of specialists and facilities available. Period.” But he declined to name any of those providers.
The health coaches, he said, will help members navigate the healthcare system — from arranging doctor appointments to ensuring patients are getting their prescription medications.
Harken’s model for ACA plans launched this year in Chicago and Atlanta, where Vanderheyden said the company plans to expand the number of primary-care clinics. He said Harken covers 35,000 lives in those two markets but declined to share projections or discuss rates for South Florida.
11 Insurers filed requests to sell coverage in Florida on the Affordable Care Act exchange for 2017.
The company will enter Florida’s ACA exchange market at a time when UnitedHealth, its chief investor, has reported significant losses on Obamacare coverage and plans to exit at least 22 of the 34 states where it now sells those plans.
But Harken’s model, with primary-care clinics in the community and patient navigators helping to guide members, could be successful, particularly if its model of managed care keeps members healthy and out of hospitals, experts say.
With free and unlimited doctor visits, members may be more willing to seek care early, said Chris Sloan, a senior manager for healthcare consultant Avalere Health.
“The whole idea of something like this is they’re trying to reduce illness or catch stuff early,” Sloan said, “so down the line they can save a lot.”
Harken’s job won’t be easy in Florida, though, where competition from national Medicaid insurers and other established companies is intense.
Larry Levitt, senior vice president for special initiatives at the nonprofit Kaiser Family Foundation, a health policy think tank, said insurance companies such as Molina and Ambetter from Sunshine Health, which offered the lowest-priced plans on the exchange in Miami-Dade this year, have done well in the Obamacare market.
It’s not just their low-priced plans that made Molina and Ambetter successful in Florida’s ACA exchange market, Levitt said.
Those insurers are familiar with low-income populations because they also provide managed care through Medicaid, the public health insurance program for poor and disabled people. And they benefit from the relationships they’ve established through Medicaid, including provider networks with lower-cost hospitals and doctors, which then enables Molina and Ambetter to offer ACA plans with lower premiums.
UnitedHealth, by contrast, “came in with plans looking much more like what they offer to employer groups,” Levitt said, with access to large hospital systems and other benefits.
The big ones have to develop limited network products to compete.
John Holahan, Urban Institute researcher
“I think Harken is an attempt to offer a product that could compete more effectively against the likes of Centene (parent company of Ambetter) and Molina,” Levitt said.
John Holahan, a researcher with the nonprofit Urban Institute, which has been tracking plans sold on the ACA marketplace, said that between Medicaid insurers such as Ambetter and Molina, and Florida Blue, which offers two popular HMO plans on the Obamacare exchange in Miami-Dade, “Florida has a lot of competitors,” which could help keep premiums in check for 2017.
A previous version of this article misstated the operating hours for Harken Health Centers. Operating hours will be set according to members’ needs at each center.