Maryland Insurance Cooperative Taking Root

Evergreen Health is the only health insurance cooperative that employs physicians itself rather than link to provider networks. Evergreen embraces telemedicine and offers a wide range of services through primary care medical homes.

Innovation is the central issue in economic prosperity.—Michael E. Porter

For many years, Peter Beilenson, MD, MPH, has advocated for single-payer financing of US healthcare.

Now, he runs an insurance company.

Beilenson is president and CEO of Evergreen Health, one of two dozen insurance cooperatives formed with support of the Patient Protection and Affordable Care Act. Evergreen is the only PPACA-spawned cooperative with a health services delivery network.

The health plan business model at Evergreen is closely tied to the PPACA individual and group exchanges. Doctors are salaried in Evergreen's healthcare delivery system, which has been formed with the primary care medical home model. Evergreen medical homes embrace telemedicine and offer a wide range of services including primary care, wellness programs, home monitoring of chronic diseases such as diabetes, and preventative services.

The average size of an Evergreen primary care physician's patient panel is about 1,400. Nationally, the average is 2,200, according the Center for Excellence in Primary Care at the University of California, San Francisco.

Evergreen has its roots in the Healthy Howard Plan, which Beilenson helped launch in 2008 as the top health officer in Howard County, MD. Healthy Howard targeted 2,000 uninsured individuals. The plan offers primary care with a monthly premium of about $65. In addition to affordable rates, the plan features face-to-face health coaching.

Beilenson, who earned his medical degree at Emory University and master's degree at Johns Hopkins, schooled me on Evergreen and its sister co-ops in an interview earlier this month.

HLM: How does a health insurance cooperative work?

PB: It's a nonprofit health insurance company with the majority of the board made of members. … We are unique among the 23 co-ops in that we have a health system. We raised several million dollars on our own to create our primary care system. … The other 22 basically have networks of providers.

HLM: Where do co-ops fit in the patchwork quilt of reform efforts under the PPACA and other federally driven healthcare reforms?

PB: I think of it more as a Rube Goldberg cartoon, but the quilt analogy works. … Where there is a co-op in a state with an exchange, co-ops are driving down costs 10 to 15% because of competition. The market presence of another competitor has reduced costs.

HLM: Before Evergreen, you formed the Healthy Howard Health Plan. What did you learn that you have applied at Evergreen?

PB: We didn't know that healthcare reform was even going to happen in 2007. … Using the patient-centered model is clearly the way to go. … Access to doctors up to midnight made a huge difference in triaging people away from the emergency room. At Evergreen, we've had a tiny number of emergency room visits.

HLM: Are co-ops such as Evergreen good fits with particular markets or can they thrive in the broader, national health insurance market?

PB: We definitely feel our model is replicable regionally and nationally. … The states should be the incubator of change, and the federal role is to support and kick-start what's happening at the state level.

HLM: Can a patchwork quilt approach to transforming US healthcare succeed? What happens if it fails?

PB: I would guess this will eventually lead to a single-payer system. They really didn't bend the cost curve. … The federal government and states will either bend the cost curve or the system will move to a single-payer model because the costs will just be too difficult to sustain. … A single-payer system is the most equitable.

HLM: What are the benefits of establishing medical homes?

PB: Basically, you want someone to coordinate your care. Primary and preventive care are not provided by specialists. … Specialists are very important but they focus on one part of the body. Our primary care medical homes are actually more robust than a primary care center.

HLM: Are you confident or cautious about the 2014 beneficiary pool at Evergreen?

PB: Cautiously optimistic.