In the wake of Health Republic demise, new provider-owned health plan looks to expand network, lure customers

The dissolution of Health Republic, a nonprofit health insurance cooperative established in New York in 2013, leaves 44,000 Suffolk County residents scrambling to find new health insurance coverage in a hurry.

The cooperative’s demise opens a window of opportunity in Suffolk for another recent entry into the health insurance marketplace, a company owned by the North Shore-LIJ Health System — which is expanding its presence in Suffolk County with its takeover of Peconic Bay Medical Center in January 2016.

North Shore-LIJ entered the growing field of provider-owned health insurance companies in 2013 with the launch of CareConnect. The insurer touts itself as a patient-centered carrier that works hand-in-hand with its in-network health care providers to efficiently deliver high quality care — an arrangement it says benefits the health care consumer’s pocketbook by enabling it to offer affordable, comprehensive coverage.

The Affordable Care Act presented the Manhasset-based health system with an opportunity to start thinking about care delivery and community care differently, Care Connect president and CEO Alan J. Murray said in a recent interview.

“As an insurance company that was wholly owned by the largst heath care provider in the region, which is also the largest private employer in the region, the concept was to build a customer service company that can simplify health care by bridging both worlds and to do that through selling insurance,” Murray said.

“And that’s exaclty what we’ve done,” he said.

In its first two years, CareConnect grew its network of providers into one that covers the entire downstate market, Murray said. It now includes 20,000 physicians and 44 hospitals and medical facilities from Westchester and NYC to eastern Long Island, now that PBMC is part of the North Shore-LIJ health system.

“It’s designed to be different,” the CEO said. The network is a “narrow network” of high-quality doctors and facilities. “It’s integrated care, not just access to care. It’s coordinated care so the patient is getting the right care at the right time, in the right place,” Murray said.

“It’s built on a no-denial philosophy,” he said. “Yes, we require prior authorizations and yes, we do medical management. But rather than a ‘Mother, may I?’ if a phsycian requests a service that’s outside the clinical practice guidelines that the community has devleoped thru North Shore-LIJ, then we get a practising physician on the phone with him and we have a conversation. We can even get the chair of the department on the phone with him.

“And the result of that conversation is consensus on what is the best course of action for the patient. In the old world it would have been, ‘The insurance company denied your care.’ In the CareConnect world, it’s ‘I had a conversation with one of my peers and we think there’s a better course of treatment.’ And
that’s kind of the backbone of what CareConnect has built over the last two years,” Murray said.

“That’s a radical departure from what happens now,” PBMC president and CEO Andrew Mitchell said. A provider doesn’t have the chance to speak to another physician at an insurance company until the appeal level.

“It is a night-and-day change from what most physcians are used to,” Murray said.

“We’ve married that philosophy to the consumer as well,” he said. “We’ve built a company based on customer service, based on the belief that you should have the ability to talk to a human being 24/7, 363 days a year.” CareConnect has one toll-free number and an employee will pick up the phone in under 10 seconds “and 88 percent of the calls are resolved by the person who picks up the phone,” Murray said.

As of Jan. 1, CareConnect is adding telemedicine to its benefits, launching a service it calls “Tele-Doc.” A member can use it as often as he wants to access a physician by phone — at no cost. The doctor can access the member’s electronic medical records, review test results and write prescriptions.

There’s also a customer care center that members can visit to speak to a company representative in person.

“One of the major drivers in the decsion by [PBMC’s] board to go with North Shore-LIJ was that it came with an embedded insurance program that would be a unique way of connecting the patients, the providers and the insurance company together with an altogether different approach to healthcare,” Mitchell said.

CareConnect is now busy working to build its physician network on the East End.

All of PBMC Health’s physician practices and facilities have been in the network since June, Mitchell said.

CareConnect’s premium pricing is “the most affordable in the area, bar none — substantially,” Murray said.

CareConnect director of sales Sean Tahaney deals with a lot of small business customers. “We’re very up front with them,” he says. “It’s an unabshedly narrow network. And it’s half the cost of some of these other programs. It’s 35 percent less expensive than Empire.

“Our drug plan has free generic drugs, with a zero copay, and a $50 copay for brand name drugs. It’s an affordable plan,” he said. CareConnect’s pharmacy network is the Caremark network, which includes CVS, Walgreen, Barth’s, Martin, Wal-Mart, Kmart, Target and King Kullen.

“It’s very, very viable solution for people looking for great care — a network that is preselcted and a price point that almost can’t be beat in the market,” Murray said.

Randy Morreale, a partner at Neefus Stype Insurance in Aqubogue, said he thinks CareConnect is “a fantastic option” for his clients.

“We have a lot of customers who were with Health Republic,” Morreale said. “We have to move all of them.”

Karl Washwick of the Washwick Agency in Riverhead is also busy moving clients from Health Republic into other programs.

He likes the CareConnect option and said he is switching to it himself.

“I like the way they do business,” Washwick said. “They don’t deny procedures and that’s what’s particularly important. We get calls all the time from clients who tell us their insurance company denied coverage. That doesn’t happen with them. If it comes to their pre-approval department, their doctor will reach out to your doctor and discuss the treatment.

“They cut the BS out of the middle. It eliminates a lot of the expense and the redundancy,” he said. “It seems like just a different paradigm.”

Washwick said he knew Health Republic was doomed. “It was built on the smoke and mirrors of government subsidies. You can’t sell a dollar for 75 cents and hope to make it up in volume,” he said. “I told my customers it’s not sustainable but take it right now,” he said. “It was the most affordable thing out there.”

In contrast, Washwick said, “CareConnect is built on a sustainable platform. It’s extremely well-funded and they built it very slowly, in terms of client base. Everything is tested. They did everything right.”