Bright Health works new provider model

As the furor still rages over the future of the Affordable Care Act, or Obamacare, Bright Health appears comfortable with its future in providing insurance to individuals that the ACA mandates be taken in without regard to pre-existing conditions.

“What we’ve learned from an overall health care perspective is there’s probably two ways (of providing access to health care). One is a traditional insurance model and often people with pre-existing conditions could not get health insurance,” said Bob Sheehy, Bright Health’s CEO and co-founder. The other is a system that works more collaboratively with physicians. “That model is much closer to the delivery system. That’s one of the basic concepts of HMOs (Health Maintenance Organizations), and now I think that’s an important position.”

That’s also the position that Sheehy put his company in with an initial start in the Colorado ACA market and selecting Centura Health as the sole provider of services to people insured through Bright Health. Sheehy – a former executive with the nation’s largest insurer, United Health — noted it’s a much different position than health insurance companies have taken, mostly because they were serving companies that provided health insurance to their employees.

Sheehy said that Centura has a national reputation for effectively reaching goals from a population health perspective and working with data coming from many doctors. In that regard, Centura’s Colorado Health Neighborhoods, now the largest clinical integration of physicians and data in Colorado, was extremely important in the decision to select Centura and also located Bright’s initial ACA offering here.

“We had a kind of a shared vision of how that collaborative relationship could work, and we broke down the barriers between hospitals and insurance companies — that’s the model,” Sheehy said. “I think the relationship with Centura has been excellent.”

Clinical integration is more than just a catch phrase for Bright and Centura. Sheehy noted as a nation we have spent hundreds of billions of dollars just striving to properly account for care and allowing patient data to be shared between different specialists or other providers. The Health Neighborhoods network has proven to be a technological blessing to the independent physicians who have joined, but has also aided patients by allowing for a more team-driven approach to health care, which is what Sheehy’s model is also striving to achieve, he said.

“We’re committed to finding better ways to serve our communities,” said Gary Campbell, chief executive officer (CEO) of Centura Health in a prepared statement.  “By partnering with Bright Health in their strategy to enter the individual insurance market in Colorado, we are working to deliver optimal health value with resources and services delivered through CHN that educate, engage and empower consumers to make smarter decisions about their health.”

Bright is only nine months into providing ACA insurance in Colorado, so Sheehy said he doesn’t have a clear picture on how the financial side of the equation is turning out. Depending on what the Congress and the president do with the ACA, the company could be looking at a rate hike, but it is not thinking about leaving the market.

“We’re still in the midst of it, but originally we were looking to enroll somewhere between 10 and 15,000, and we’re at 11,500,” said. “But we’ve been getting a lot of feedback from consumers and that’s been really good. Overall we feel great about our first year.”

Bright Health actually expanded into new markets this year, though both were through extended Medicare programs in Birmingham, Ala., and Phoenix, Ariz. Connecting the insurance to clinically integrated physician organizations was a primary concern in those market selections as well, Sheehy said.

“This is particularly important for people with chronic conditions, so they are not bouncing between doctors,” he said. “Having a medical home with primary care physicians and the specialty care they need is really important.”

Though the starts and stops of dealing with the ongoing saga of the ACA has been trying, Sheehy said he remains convinced his model is the one that best serves the consumers who have to go to the ACA marketplaces for coverage.

“Our model supports the role of consumers in health care,” he said. “When consumers make their own choices, convenience, access and affordability are going to be the more important elements. This can really transition health care for the better, and I’m really optimistic about that.”

Sheehy is also optimistic about the role his company will be playing in that future.

“That’s one of the things about being an early-stage company; we’re not constrained by a lot of the bureaucracy and prior commitments that the larger companies are.”

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