Evergreen Project aims to change how insurance and care are delivered
BALTIMORE – While legislators and judges in Washington D.C. work to either eviscerate or preserve the Patient Protection and Affordable Care Act, two men in Maryland – one a serial entrepreneur and the other a physician and respected public health official – work diligently to create a new model for healthcare delivery and insurance, a self-described “audacious attempt to create systemic change.”
The Evergreen Project, launched by Peter Beilenson, MD, and Jim Kucher in late 2010 has been slowly laying the groundwork to create a healthcare co-op, a member-owned insurance plan that aims to use evidence-based healthcare as one of the cornerstones of providing low cost health insurance. Over time, the men envision a network of Evergreen clinics across Maryland, with doctors employed by the co-op and member-owners who will share in the savings brought on by improved efficiency.
“We’ve done some market research that indicates people are receptive to the idea of the co-op,” said Kucher. “In fact, by a long shot, the biggest market sensitivity we found in healthcare is price, price, price.”
While the main focus of the Evergreen Project is to provide less expensive health insurance to meet those price concerns, it is by no means designed as a stripped down version compared to other commercial products. Rather, it seeks to provide the care evidence shows is the most effective at treating the patient, with the ultimate understanding that healthier members use health services less over time, which in turn creates more efficient and cost-effective care.
“If a person is sick and there are three medications they can take and one costs ten cents a pill but doesn’t work and the other costs ten bucks and does work, we want them taking the medication that costs ten dollars,” noted Kucher.
Another core concept of the co-op is based on deriving savings from reducing the use of the emergency room and on preventing hospital admissions and readmissions. To accomplish this, Evergreen will borrow heavily from another project in the state that Beilenson helped manage called Healthy Howard, an inexpensive health plan created for low-income residents of Howard County.
At the core of the Healthy Howard program and one that will also play a significant role at Evergreen is the use of health coaches. At Healthy Howard, members are assigned a coach who will meet with them face-to-face to discuss and help them set health goals.
“The health plans are developed in concert with the patient, not prescribed by the doctor and not a telephonic health coach calling them on the phone, a system that has clearly shown it doesn’t work,” said Beilenson. “Our model has been shown by the Johns Hopkins School of Public Health to have made a significant difference in their health behaviors.”
The health coaching was so successful it received the 2011 Healthy Living Innovation Award from HHS Secretary Kathleen Sebelius. “The whole country is moving toward more prevention and coordinated care, and I think that's what health coaching is all about. That and accountability,” said Liddy Garcia-Bunuel, executive director of Healthy Howard of the award.
Another significant contribution by the health coaches has been to reduce emergency room visits by plan members. Coaches are available by phone 24/7 for health consultations to help them address health problems when they get sick and not based on typical primary care physician office hours.
“Healthy Howard has proven that the interventions they constructed have been able to reduce emergency room use in underserved populations by almost half, which is a huge cost savings,” said Kucher. “And it turns out it is not so much medicine as it is access.”
The 24/7 access to trained healthcare providers under the model helps fill the void during nights and weekends, which is when many people end up in the emergency room because their family doctor isn’t typically available.
Beilenson admits that the health coaching is very labor intensive and comes at a cost, but “it’s a method that is shown to be cost effective.”
With a tested working model for care delivery in place, Evergreen is now in the process of clearing state regulatory hurdles with the aim of becoming a certified health plan by the time the health insurance exchanges go live on Jan. 1, 2014. It has also applied for and expects to receive a portion of the $3.8 billion the federal government has made available in low-interest loans to non-profits to help them establish healthcare co-ops around the country.
Plan members are expected to be people who come from low- to moderate-income homes and who don’t have access to health insurance through their employer, though Beilenson said they also expect to draw a fair number of members from what he calls the “Whole Foods crowd” – higher income people who support the model and idea of a healthcare co-op.